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Abstract Despite the well-known benefits of spinal anesthesia (SA), this technique remains underutilized among pediatric anesthesiologists. According to the data from the Pediatric Regional Anesthesia Network, SA accounted for less than 5% of all neuraxial techniques. Some of the factors for underutilization of SA include: Limited duration, unfamiliarity with the technique in younger children, and surgeon preference for general anesthesia. The safe and successful use of SA in children involves recognition of anatomical and physiological differences between adults and children owing to differences in bony structures, spinal cord growth and cerebrospinal fluid physiology. Reports on successful use of SA in children for various surgeries have increased. This educational review summarizes what is known about SA in children, reviews the literature from the last decade and provides suggestions for development of SA in children. Technical considerations, role of ultrasound, guidance on dosing, physiological effects, unexplained aspects of the mechanism of action and combined caudal/SA are discussed.

Resumen A pesar de los beneficios bien conocidos de la anestesia raquídea (AR), esta técnica sigue siendo subutilizada entre los anestesiólogos pediátricos. De acuerdo con los datos de la Red Regional de Anestesia Pediátrica, la AR representó menos del 5% de todas las técnicas neuroaxiales. Algunos de los factores a los que se atribuye dicha subutilización son: su duración limitada, la falta de familiaridad con la técnica en niños de menor edad, y la preferencia del anestesiólogo por la anestesia general. El uso seguro y exitoso de la AR en niños implica el claro conocimiento de las diferencias anatómicas y fisiológicas entre adultos y niños, en virtud de las diferencias en las estructuras óseas, el crecimiento de la médula espinal y la fisiología del líquido cefalorraquídeo. Los reportes sobre el uso exitoso de la AR en niños para diferentes cirugías ha aumentado. La presente revisión educativa resumen la información conocida sobre AR en niños, revisiones de la literatura de la última década y ofrece sugerencias para el desarrollo de la AR en población pediátrica. Se discuten consideraciones técnicas, el papel de la ecografía, orientación sobre la dosificación, los efectos fisiológicos, aspectos no explicados del mecanismo de acción y la combinación de anestesia raquídea/caudal.

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Abstract Background: The administration of colostrum through its absorption at the oropharyngeal level stimulates the mucosa-associated lymphoid tissue, providing a local immunological protection barrier. The study aimed to investigate the association of oropharyngeal colostrum administration with the reduction of inflammatory indices. Materials and methods: This was an observational, ambispective, analytical study of newborns < 32 weeks of gestation at risk of sepsis. Oropharyngeal colostrum was administered at 0.2 mL every 4 h for 5 days. Inflammatory indices were analyzed. Statistical analysis included frequencies, percentages, mean and Standard deviation, contingency coefficient, and Kolmogorov–Smirnov test for the distribution curve of the numerical data. Results: There were 50 patients, 33 (66%) female and 17 (34%) male, with a median gestational age of 30-31 weeks (95% confidence interval [CI]). Nineteen patients had sepsis. A lower positivity rate in C-reactive protein was found, with a median of 0.5-0.6 (95% CI) at 5 days of colostrum administration versus 0.5-1.1 (95% CI) as the initial C-reactive protein. Analysis with χ2 yielded a p = 0.13, and the contingency coefficient showed a p = 0.196, indicating an association. Conclusion: Oropharyngeal colostrum administration was associated with a lower C-reactive protein positivity rate and clinical improvement in premature newborns at risk of sepsis.

Resumen Introducción: La administración del calostro a través de su absorción a nivel orofaríngeo estimula el tejido linfoide asociado a mucosas, proporcionando una barrera de protección local e inmunológica. Conocer la asociación de la administración de calostro orofaríngeo con la disminución de los índices inflamatorios. Material y métodos: Observacional, ambispectivo, analítico, recién nacidos < 32 semanas de gestación con riesgo de sepsis, se administró calostro orofaríngeo 0.2 ml cada 4 horas durante 5 días. se analizó índices inflamatorios, evolución clínica. Análisis estadístico: frecuencias, porcentajes, media y DS, coeficiente de contingencia y prueba de Kolmogorov Smirnov para la curva de distribución de los datos numéricos. Resultados: Fueron 50 pacientes, 33 (66%) femenino, 17 (34%) masculino, edad gestacional mediana 30-31 semanas (IC 95%), 19 pacientes cursaron con sepsis encontrando menor índice de positividad en la PCR, mediana de 0.5-0.6 (IC 95%) a los 5 días de administración de calostro vs 0.5-1.1 (IC 95%) como PCR inicial, analizando con Chi cuadrada con valor p = 0.13, mediante coeficiente de contingencia con p = 0.196, traduciendo asociación. Conclusión: La calostroterapia se asoció con menor índice de positividad en la PCR; clínicamente hacia la mejoría, en recién nacidos prematuros con riesgo de sepsis.

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INTRODUÇÃO: A estimulação sensório-motora (ESM) é uma intervenção precoce utilizada em recém-nascidos (RN) para a organização de seus sistemas. O fisioterapeuta que faz uso da ESM deve ter um olhar cuidadoso para os sinais apresentados pelos RN após os procedimentos. OBJETIVO: Analisar a percepção de fisioterapeutas sobre alterações do sistema autônomo e do estado comportamental de RN após procedimentos de ESM. MÉTODOS: Estudo transversal realizado com fisioterapeutas atuantes em unidades neonatais. Os dados foram coletados por questionário eletrônico, processados no programa SPSS (versão 21.0) e apresentados em frequência absoluta (n) e relativa (%). RESULTADOS: Participaram deste estudo 72 fisioterapeutas; 48,6% possuíam título de especialista, 63,9% atuavam em Unidade de Terapia Intensiva Neonatal, 38,8% residiam na região sul e 38,8% na região sudeste do Brasil. A percepção da maioria dos fisioterapeutas após procedimentos de ordem tátil foi estabilidade ou diminuição da frequência cardíaca (FC) e respiratória (FR), e estabilidade da saturação de oxigênio (SpO2 ), e após procedimentos de ordem vestibular foi estabilidade da FC, FR e SpO2 . Houve percepção de sono ativo, sonolência e alerta ativo após todos os procedimentos de ordem tátil e vestibular. O alerta ativo foi percebido após todos os procedimentos e o choro intenso não foi percebido. CONCLUSÃO: Do sistema autônomo, a maioria dos fisioterapeutas perceberam a FC e FR estáveis ou diminuídas e SpO2 estável ou aumentada após os procedimentos de ESM. Do estado comportamental, o alerta ativo foi percebido com maior frequência entre os fisioterapeutas.

INTRODUCTION: Sensory motor stimulation (SMS) is an early intervention used in newborns (NB) to organize their systems. The physiotherapist who uses SMS must pay careful attention to the signs presented by NB after the procedures. OBJECTIVE: To analyze the perception of physiotherapists about changes in the autonomic system and behavioral state of NB after SMS procedures. METHODS: Cross-sectional study carried out with physiotherapists working in neonatal units. Data were collected by electronic questionnaire, processed in the SPSS program (version 21.0) and presented in absolute (n) and relative (%) frequency. RESULTS: 72 physiotherapists participated in this study, 48.6% had a specialist degree, 63.9% worked in Neonatal Intensive Care Unit, 38.8% lived in the southern region and 38.8% in the southeastern region of Brazil. The perception of most physiotherapists after tactile procedures was stability or decrease in heart rate (HR), respiratory rate (RR) and stability of oxygen saturation (SpO2), and after vestibular procedures it was stability of HR, RR and SpO2. There was a perception of active sleep, drowsiness, and active alertness after all tactile and vestibular procedures. Active alertness was noticed after all procedures and intense crying was not noticed. CONCLUSION: Regarding the autonomic system, most physiotherapists noticed stable or decreased HR and RR, and stable or increased SpO2 after SMS procedures. Regarding the behavioral state, active alert was noticed more frequently among physiotherapists.

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Background: Congenital heart disease is a type of birth defect that affects about 1% of babies born each year and is the leading cause of death in infancy that is diagnosed at birth or later in life. Due to the high importance of this issue and high mortality and morbidity, the aim of this study was epidemiological investigation of congenital heart diseases in children during 2016 to 2021. Methods: In this cross-sectional analytical study, all children admitted to Bo Ali Hospital in Ardabil with primary diagnosis of congenital heart disease or secondary diagnosis during hospitalization along with all children referred to the clinic of this hospital with diagnosis of congenital heart disease were included in the study. Results: A total of 449 children with congenital heart disease were included in the study. 235 cases (52.33%) were boys, 35 cases (7.79%) had diabetic mothers and 12 cases (2.6%) had obese mothers. 20 cases (4.4%) were the result of multiple pregnancy and 31 cases (6.9%) were preterm. Significantly, preterm birth was more in children with cyanotic disease (p=0.036) and multiple births and maternal diabetes and aneuploidy were more in children with cyanotic disease compared to Asianotic children (p value equal to 0.008 respectively and 0.001 and 0.001). Conclusions: The frequency of congenital heart diseases, gender composition and related risk factors such as preterm birth and maternal diabetes were aligned and similar to domestic and foreign studies. Maternal diabetes and preterm birth can be considered as risk factors for congenital heart diseases.

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Objective To summarize the occurrence of postoperative adverse events in neonatal surgery under the integrated manage-ment of internal and external departments in the ward of West China Second University Hospital,Sichuan University,and analyze the risk factors affecting postoperative adverse events.Methods A total of 272 newborns who underwent surgical procedures in West China Second University Hospital,Sichuan University from January 2019 to December 2021 were included.The occurrence of postoperative comprehen-sive adverse events was recorded,and the newborns were divided into the symptomatic group and the asymptomatic group according to the occurrence of complications.The high-risk factors that affecting postoperative adverse events in neonatally surgical procedures were analyzed by univariate analysis and multivariate analysis.Results There were 108 newborns experienced comprehensive adverse events after surgery.The results of univariate analysis showed that there were statistically significant differences in the proportion of male newborns,gestational age,birth weight,Apgar score 1 minute postpartum,the proportion of newborns with preoperative diagnosis of necrotizing small enteritis or/and gastrointestinal perforation,premature infants and low birth weight infants,the proportion of newborns with respiratory control when admitted to the operating room and mean arterial pressure(MAP),the proportion of newborns underdoing emergency surgery,and intraoperative infusion of red blood cell suspension between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that the small gestational age(OR=0.972,95%CI=0.950～0.994,P=0.014)and low MAP when admitted to the operating room(OR=0.955,95%CI:0.919～0.993,P=0.019)were the independent risk factors affecting the occurrence of postoperative adverse events in newborns.Conclusion Under the integrated management of internal and external departments in the ward,the small gestational age and low MAP when admitted to the operating room are the independent risk factors for the occurrence of postoperative adverse events in newborns.Improving the prenatal diagnostic measures and optimizing the time of fetal growth in and out of utero to reduce the associated effects of gestational age,and increasing the neonatal blood pressure when admitted to the operating room may reduce the incidence of postoperative adverse events in newborns and improve long-term prognosis.

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AIM: To explore the results of fundus screening in 5 307 newborns and the related factors of fundus diseases.METHODS: A total of 5 307 newborns who underwent fundus screening in our ophthalmology department from January to December 2022 were selected. RetCam III system was used for fundus examination, and abnormal fundus conditions were recorded. The influencing factors of retinal hemorrhage in full-term infants and retinopathy of prematurity(ROP)in preterm infants were analyzed.RESULTS: The incidence of ocular abnormalities in newborns was 27.17%, with the highest incidence of retinal hemorrhage(61.23%), followed by retinal exudation(22.95%), ROP and ROP like retinopathy(10.68%). The incidence of morning glory syndrome(0.21%), albino fundus(0.21%), and permanent fetal vasculature(PFV; 0.28%)was lower. The incidence of eye abnormalities in full-term infants was lower than that in preterm infants(26.30% vs 30.08%, P&#x003C;0.05), and the incidence of retinal hemorrhage and exudation in full-term infants was higher than that in preterm infants(P&#x003C;0.05). The incidence of ROP and ROP like retinopathy in preterm infants was higher than that in full-term infants(P&#x003C;0.05). Natural delivery is a risk factor for retinal hemorrhage in full-term infants(P&#x003C;0.05). Fetal age(32-34, 30-31 wk), birth weight(1 500-2 499, &#x003C;1 500 g), milk powder feeding, and oxygen inhalation are risk factors for ROP in premature infants(all P&#x003C;0.05).CONCLUSION: The incidence of eye abnormalities in newborns at our hospital is relatively high, and early detection of eye abnormalities in newborns can be achieved through fundus screening.

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RESUMO. Este estudo retrata, através de relatos e observações clínicas, o caminho percorrido por uma mãe para tornar-se suporte, porto ou casa, para seus bebês gêmeos, durante a internação em UTI neonatal e logo após a alta hospitalar. A investigação, que teve como base a abordagem psicanalítica de Donald Winnicott, emergiu de um recorte da pesquisa de mestrado da autora principal. A pesquisa ocorreu em dois momentos: I) acompanhamento da mãe e bebês durante a internação do recém-nascido na UTI-neonatal de um hospital geral de Porto Alegre durante um mês e nove dias com frequência semanal e II) acompanhamento após a alta através de visitas domiciliares. A segunda etapa teve início após uma semana da alta hospitalar e ocorreu durante um mês e 19 dias com frequência quinzenal. Para a coleta dos dados foram utilizados diários clínicos como um dispositivo na escuta das singularidades observadas em cada atendimento. Observou-se que a experiência de internação representou vivências de (des) continuidade para os bebês e mãe. O processo da travessia para casa representou uma inflexão importante em relação à sustentação corporal (e psíquica) dos bebês pela mãe. Destacamos ainda que o acompanhamento psicológico demonstrou ter sido importante para sustentar essa mãe ao longo da travessia e ajudá-la a se tornar 'casa' para seus recém-nascidos.

RESUMEN. Este estudio retrata, a través de informes y observaciones clínicas, el camino recorrido por una madre para convertirse en apoyo, puerto u hogar para sus bebés gemelos durante el ingreso a la UCI Neonatal y poco después del alta hospitalaria. La investigación se basó en el enfoque psicoanalítico de Donald Winnicott y se desarrolló en dos momentos: I) Seguimiento de la madre y los bebés durante la hospitalización en la UCI Neonatal de un hospital general de Porto Alegre durante un mes y nueve días con frecuencia semanal y II) Seguimiento tras el alta a domicilio. La segunda etapa se inició luego de una semana del alta hospitalaria y se desarrolló durante un mes y diecinueve días con una frecuencia quincenal. Para la recogida de datos se utilizaron diarios clínicos como dispositivo para escuchar las singularidades observadas en cada servicio. Se observó que la experiencia de hospitalización representó experiencias de (dis) continuidad para los bebés y la madre. El proceso de ir a casa representó una inflexión importante en relación al apoyo corporal (y psíquico) de los bebés por parte de la madre. También destacamos que la asistencia psicológica resultó ser importante para apoyar a esta madre durante todo el camino y ayudarla a convertirse en un 'hogar' para sus recién nacidos.

ABSTRACT. This study portrayed, through reports and clinical observations, the path taken by a mother to become support, harbor, or home, for her twin babies during admission to the Neonatal ICU and shortly after hospital discharge. Such investigation, based on Donald Winnicott's psychoanalytical approach, arose as a part of the first author's master's research. The research took place in two moments: I) Weekly follow-up of the mother and babies during the newborn's admission to the Neonatal ICU of a general hospital in Porto Alegre, state of Rio Grande do Sul, for one month and nine days, and II) Follow-up after discharge through home visits. The second stage started one week after hospital discharge and occurred for one month and nineteen days, with a fortnightly frequency. For data collection, clinical diaries were used as a device to listen to the singularities observed in each service. The hospitalization represented experiences of (dis) continuity for the babies and the mother. The journey process to home was an important inflection about the bodily (and psychic) support of babies by the mother. Psychological care proved essential to support this mother throughout the journey and help her become a 'home' for her newborns.

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Introdução: Diante das particularidades e desafios no manejo e tratamento de feridas em recém-nascidos torna-se importante para o enfermeiro conhecer, indicar e avaliar a eficácia e segurança das coberturas e produtos, inclusive na análise dos produtos para o público neonatal. Objetivo: Identificar na literatura as principais coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. Metodologia: Trata-se de uma revisão integrativa de literatura, com artigos publicados entre os anos de 2018 a 2022, que abordaram os temas de coberturas e produtos utilizados no tratamento de feridas em recém-nascidos. A coleta de dados foi realizada por meio de consulta na Biblioteca Virtual de Saúde e Scientific Eletronic Library Online. Foram utilizados os descritores "newborn", "wounds" e "bandage". A análise foi realizada conforme a estratégia PICO e estruturados pelo PRISMA. Resultados: Diante dos achados foi possível identificar 13 artigos que abordavam produtos e coberturas destinados ao tratamento de feridas em neonatos. Foram encontrados 14 tipos de coberturas/produtos e dispositivos que utilizam a terapia por pressão negativa. Considerações finais: A literatura indica o uso de produtos e cobertura com princípios passivos, ativos e biológicos para o tratamento de feridas em neonatos, inclusive no prematuro, valendo destacar a importância em considerar o uso seguro de coberturas adequadas a esse público.

Introducción: Dadas las particularidades y desafíos en el manejo y tratamiento de heridas en recién nacidos, es importante que los enfermeros conozcan, indiquen y evalúen la efectividad y seguridad de apósitos y productos, incluido el análisis de productos para el público neonatal. Objetivo: Identificar en la literatura los principales apósitos y productos utilizados para el tratamiento de heridas en recién nacidos. Metodología: Se trata de una revisión integrativa de la literatura, con artículos publicados entre 2018 y 2022, que abordaron los temas de apósitos y productos utilizados en el tratamiento de heridas en recién nacidos. La recolección de datos se realizó mediante consulta en la Biblioteca Virtual en Salud y Biblioteca Científica Electrónica en Línea. Se utilizaron los descriptores "newborn", "wounds" y "bandage". El análisis se realizó según la estrategia PICO y estructurado por PRISMA. Resultados: Teniendo en cuenta los hallazgos, fue posible identificar 13 artículos que abordaron productos y apósitos destinados al tratamiento de heridas en recién nacidos. Se encontraron 14 tipos de revestimientos/productos y dispositivos que utilizan terapia de presión negativa. Consideraciones finales: La literatura indica el uso de productos y coberturas con principios pasivos, activos y biológicos para el tratamiento de heridas en recién nacidos, incluidos los prematuros, y cabe resaltar la importancia de considerar el uso seguro de coberturas adecuadas para esta población.

Introduction: Given the particularities and challenges in the management and treatment of wounds in newborns, it becomes important for nurses to know, indicate and evaluate the efficacy and safety of dressings and products, even in the analysis of products for the neonatal population. Objective: To identify in the literature the main dressings and products used to treat wounds in newborns. Methodology: This is an integrative literature review, with articles published between 2018 and 2022, which addressed the topics of dressings and products used in the treatment of wounds in newborns. Data collection was carried out through consultation in Biblioteca Virtual de Saúde and in the Scientific Electronic Library Online. The "newborn", "wounds" and "bandage" descriptors were used. The analysis was carried out according to the PICO strategy and structured following PRISMA. Results: Given the findings, it was possible to identify 13 articles that addressed products and dressings intended for treating wounds in newborns. Fourteen types of dressings/products and devices that use negative pressure therapy were found. Final considerations: The literature indicates the use of products and dressings with passive, active and biological principles for the treatment of wounds in newborns, including premature neonates, and it is worth highlighting the importance of considering the safe use of dressings that are suitable for this population.

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Introdução: O Aleitamento Materno, especialmente nos primeiros seis meses de vida, é um fator primordial para o crescimento e desenvolvimento do Recém-Nascido, contribuindo para o vínculo afetivo entre mãe e filho, favorecendo o processo imunológico e psicológico. A prevalência mundial de bebês amamentados exclusivamente é de apenas 38%. No Brasil, 75% começam a ser amamentados desde o nascimento, diminuindo aos três meses de vida pela introdução de fórmulas infantis, apontando a importância de ações que orientem, apoiem e protejam o Aleitamento Materno Exclusivo e a sua duração para a melhores índices. Objetivo: Verificar quais as políticas de incentivo ao aleitamento materno adotadas nos hospitais e maternidades. Método: Trata-se de uma revisão sistemática, seguindo as recomendações do método PRISMA. A pergunta norteadora formulada a partir da estratégia PICO foi: "Quais as políticas de incentivo ao aleitamento materno adotadas nos hospitais e maternidades?". Foram consultadas as bases de dados PUBMED, MEDLINE, LILACS e SCiELO, entre janeiro a março de 2023. Para as buscas, foram combinados os descritores controlados com os operadores booleanos AND e OR, sendo incluídos somente artigos em língua portuguesa, devido a proposta do estudo em pesquisar as políticas nacionais de incentivo ao AM. Resultados: Foram selecionados 16 artigos, onde destes apenas 6 adotaram políticas de incentivo associados ao aumento das taxas de AME intra-hospitalar e na alta. A Iniciativa Hospital Amigo da Criança foi a estratégia mais presente nos estudos selecionados quanto ao incentivo do aleitamento materno. Conclusão: A IHAC e Método Canguru/Mãe Canguru foram as políticas adotadas por os hospitais e maternidades para o incentivo ao AM identificados nesta revisão sistemática.

Introduction: Breastfeeding, especially in the first six months of life, is a key factor for the growth and development of the newborn, contributing to the emotional bond between mother and child, favoring the immunological and psychological process. The worldwide prevalence of exclusively breastfed infants is just 38%. In Brazil, 75% beig to be breastfed from birth, decreasing at three months of life by the introducion of infant formulas, pointing to the importance of actions that guide, support and protect Exclusive Breastfeeding and its duration for the best indexes. Objective: To verify which policies to encourage breastfeeding are adopted in hospitals and maternity wards. Method: This is a systematic review, following the recommendations of the PRISMA method. The guiding question formulated from the PICO strategy was: "What policies to encourage breastfeeding are adopted in hospitals and maternity wards?". The PUBMED, MEDLINE, LILACS and SCiELO databases were consulted, between January and March 2023. For the search, controller descriptors were combined with the Boolean operators AND and OR, only articles in Portuguese were included, due to the purpose of the study to research national policies to encourage BF. Results: 16 articles were selected, of which only 6 adopted incentive policies associated with increased rates of inhospital and discharge EBF. The Baby-Friendly Hospital Initiative was the strategy most present in the selected studies regarding the encouragement of breastfeeding. Conclusion: The BFHI, Human Milk Bank and Kangaroo Method/Kangaroo Mother were the policies adopted by hospitals and maternity hospitals to encourage breastfeeding identified in this systematic review.

Introduccíon: La lactancia materna, especialmente en los primeros seis meses de vida, es un factor primordial para el crecimiento y desarrollo del recién nacido, contribuyendo al vínculo afectivo entre madre e hijo, favoreciendo el proceso inmunológico y psicológico. La prevalencia mundial de bebés amamantados exclusivamente es de solo el 38%. Em Brasil, el 75% comienza a ser amamantado desde el nacimiento, disminuyendo a los tres meses de vida por la introducción de fórmulas infantiles, señalando la importancia de las acciones que orienten, apoyen y protejan la lactancia materna exclusiva y su duración para los mejores índices. Objetivo: Verificar cuáles son las políticas de fomento de la lactancia materna adoptadas em hospitales y maternidades. Método: Se trata de una revisión sistemática, seguiendo las recomendaciones del método PRISMA. La pregunta rectora formulada a partir de la estrategia PICO fue: "¿Cuáles son las políticas de fomento de la lactancia materna adoptadas em hospitales y maternidades?". Se consultaron las bases de datos PUBMED, MEDLINE, LILACS y SCIELO, entre enero a marzo de 2023. Para las búsquedas, se combinaron los descriptores controlados com los operadores booleanos AND y OR, siendo incluidos solo artículos en idioma portugués, debido a la propuesta del estudio de investigar las políticas nacionales de incentivos a la lactancia materna. Resultados: Se seleccionaron 16 artículos, de los cuales solo 6 adoptaron políticas de incentivos asociadas al aumento de las tasas de lactancia materna exclusiva intrahospitalarias y en el alta. La Iniciativa Hospital Amigo del Niño fue la estrategia más presente em los estudios selecionados em cuanto al fomento de la lactancia materna. Conclusión: La Iniciativa Hospital Amigo del Niño y el Método Canguro/Madre Caguro fueron las políticas adoptadas por los hospitales y maternidades para el incentivo a la lactancia materna identificado en esta revisión sistemática.

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ABSTRACT Objectives: to analyze clinical outcomes in newborns of pregnant women with COVID-19. Methods: integrative review conducted in PubMed, Web of Knowledge, SCOPUS, CINHAL; 2,111 studies were obtained, and 8 articles comprised the final sample. Results: clinical outcomes in neonates of pregnant women positive for COVID-19 were classified according to the following categories: a) contamination by COVID-19, reported in 62.5% of the studies; b) hospital discharge due to improvement, mentioned in 37.5% of the articles; c) death, representing rare cases in 25% of the sample. The most prevalent gestational complication was prematurity, mentioned in 75% of the studies. This complication has been observed due to cases of premature rupture of membranes and placental abruption. Conclusions: despite the knowledge of asymptomatic and mildly symptomatic behavior in neonates, it is important to continue the search for new clinical data, as this public has uncertain reactions to SARS-CoV-2 infection.

RESUMO Objetivos: analisar desfechos clínicos em recém-nascidos de mulheres grávidas com COVID-19. Métodos: revisão integrativa realizada no PubMed, Web of Knowledge, SCOPUS, CINHAL; foram obtidos 2.111 estudos, e 8 artigos compuseram a amostra final. Resultados: os desfechos clínicos em neonatos de mulheres grávidas positivas para COVID-19 foram classificados de acordo com as seguintes categorias: a) contaminação por COVID-19, relatada em 62,5% dos estudos; b) alta hospitalar devido à melhora, mencionada em 37,5% dos artigos; c) óbito, representando casos raros em 25% da amostra. A complicação gestacional mais prevalente foi prematuridade, mencionada em 75% dos estudos. Essa complicação foi observada devido a casos de ruptura prematura de membranas e descolamento de placenta. Conclusões: apesar do conhecimento do comportamento assintomático e levemente sintomático em neonatos, é importante continuar a busca por novos dados clínicos, pois esse público apresenta reações incertas à infecção por SARS-CoV-2.

RESUMEN Objetivos: analizar los desenlaces clínicos en recién nacidos de mujeres embarazadas con COVID-19. Métodos: revisión integradora realizada en PubMed, Web of Knowledge, SCOPUS, CINHAL; se obtuvieron 2.111 estudios y 8 artículos conformaron la muestra final. Resultados: los desenlaces clínicos en neonatos de mujeres embarazadas positivas para COVID-19 se clasificaron según las siguientes categorías: a) contaminación por COVID-19, reportada en el 62,5% de los estudios; b) alta hospitalaria debido a mejoría, mencionada en el 37,5% de los artículos; c) fallecimiento, representando casos raros en el 25% de la muestra. La complicación gestacional más prevalente fue la prematuridad, mencionada en el 75% de los estudios. Esta complicación se observó debido a casos de rotura prematura de membranas y desprendimiento de placenta. Conclusiones: a pesar del conocimiento del comportamiento asintomático y levemente sintomático en los recién nacidos, es importante continuar la búsqueda de nuevos datos clínicos, ya que este público presenta reacciones inciertas a la infección por el SARS-CoV-2.

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El hipertiroidismo neonatal se produce generalmente por el paso transplacentario de anticuerpos estimulantes del receptor de la TSH (TSI) en hijos de madres con enfermedad de Graves-Basedow. Se presenta el caso clínico de un recién nacido con diagnóstico de hipertiroidismo neonatal. Se trata de un recién nacido de término que comenzó a los 6 días de vida con polipnea, taquicardia e hipertensión, que presentaba en la paraclínica de screening del cordón una TSH de 0,01 uUI/ml, con un control posterior en sangre periférica del mismo valor y con T4: 7,75 ng/dl, T3: 12,99 pg/ml. Recibió tratamiento con metimazol y propanolol con buena evolución. Es de importancia el control posnatal y valoración con endocrinología de todos los recién nacidos hijos de madres con hipertiroidismo, debido a que estos recién nacidos están expuestos a una morbimortalidad significativa, lo que hace necesario el diagnóstico y tratamiento oportunos.

Neonatal hyperthyroidism is generally caused by the transplacental passage of TSH receptor-stimulating antibodies (TSI) in children of mothers with Graves Basedow disease. We present a clinical case of a newborn diagnosed with neonatal hyperthyroidism. This is a term newborn patient that showed symptoms of polypnea, tachycardia and hypertension at 6 days of age; he presented a TSH of 0.01 uIU/ml in the paraclinical cord screening, and a subsequent control in peripheral blood of the same value with T4: 7.75 ng/dl, T3: 12.99 pg/m values. He was treated with methimazole and propranolol with good outcomes. Postnatal control and endocrinological assessment of all newborns born to mothers with hyperthyroidism is important, because these newborns are exposed to significant morbidity and mortality, which suggests the need for early diagnosis and treatment.

O hipertireoidismo neonatal é geralmente causado pela passagem transplacentária de anticorpos estimuladores do receptor de TSH (TSI) em filhos de mães com doença de Graves Basedow. É apresentado um caso clínico de um recém-nascido com diagnóstico de hipertireoidismo neonatal. Trata-se de um recém-nascido a termo que iniciou aos 6 dias de vida com polipneia, taquicardia e hipertensão, que apresentou na paraclínica de rastreio do cordão um TSH de 0,01 uIU/ml, com posterior controle em sangue periférico do mesmo valor e com. T4: 7,75 ng/dl, T3: 12,99 pg/ml. Recebeu tratamento com metimazol e propranolol com boa evolução. O controle pós-natal e a avaliação endocrinológica de todos os recém-nascidos de mães com hipertireoidismo são importantes, pois esses recém-nascidos estão expostos a morbimortalidade significativa, o que torna necessário diagnóstico e tratamento oportunos.

ABSTRACT

Objetivo: Descrever os relatos de vivências no processo de amamentação de mães de recém-nascidos prematuros. Método: Estudo qualitativo realizado com mães de recém-nascidos prematuros, internados em uma Unidade de Terapia Intensiva Neonatal, de um hospitalpúblico de Guarapuava-PR, no período de junho a julho de 2018, mediante aplicação de um instrumento com questões fechadas e outro com questões relacionadas à amamentação de prematuros. Foram incluídas no estudo mães que já haviam amamentado seus filhos ao seio ou por meio da ordenha mamária, e excluídas mães com idade inferior a 18 anos ou que apresentavam condições clínicas que as impediam de amamentar, cujos filhos estavam internados em período menor que três dias. Resultados: Participaram do estudo 10 mães de recém-nascidos prematuros, das quais 70% tinham idade gestacional de 32 a 36 semanas, 10% de 28 semanas e 20% de 29 semanas gestacionais. As mães relataram dificuldades em manter a pega e a sucção do leite materno e sentimentos de nervosismo, receberam apoio dos profissionais e familiares no incentivo à amamentação e no cuidado humanizado pela equipe de saúde. Conclusões: Diante do conhecimento das dificuldades encontradas pelas mães na amamentação de prematuros, é possível estabelecer medidas para evitar o desmame precoce, respeitando a autonomia da mãe no cuidado ao bebê.

Objective: To describe the breastfeeding experiences of mothers of preterm newborns. Methods: Qualitative study carried out with mothers of preterm newborns admitted to a Neonatal Intensive Care Unit at a public hospital in Guarapuava-PR, from June to July 2018, using a questionnaire instrument with closed questions and another with questions related to breastfeeding premature babies. The study included mothers who had already breastfed their children, and excluded mothers under the age of 18 or who had medical conditions that prevented them from breastfeeding, and whose children had been hospitalized for less than three days. Results: Ten mothers of preterm newborns took part in the study, 70% of whom had a gestational age of 32 to 36 weeks, 10% 28 weeks and 20% 29 weeks. The mothers reported difficulties in maintaining the latch and sucking breast milk, as well as feelings of nervousness. They received support from professionals and family members in encouraging breastfeeding and humanized care from the health team. Conclusion: With knowledge of the difficulties encountered by mothers in breastfeeding preterm babies, it is possible to establish measures to prevent early weaning, while respecting the mother's autonomy in caring for the baby.

ABSTRACT

Background: There is an association between low birth weight (LBW) and neonatal morbidity and mortality. The aim of the study was to identify associated factors with low 4-week weight gain among low-birth-weight newborns benefiting from the "optimized mother-newborn care model" within Bohicon health district in Benin. Methods: This was a retrospective, analytical study of 124 low-weight newborns benefiting from the "optimized mother-newborn care model", monitored for four weeks, and their mothers. Data on newborns and mothers as well as on the healthcare system were gathered through documentary review and interviews. Logistic regression was used to investigate associated factors with weight gain. Results: Of the 124 newborns monitored, more than half (54.84%) were female, their average birth weight was 2110.24±217.05 grams, and 103 (83.06%) reached the weight threshold of 2500 grams after four weeks. The mean age of the 101 mothers surveyed was 23.47±5.23 years. High household size (OR=5.65; CI95%: [1.04-30.71]), absence of home visits by community health workers (OR=10.93; CI95%: [1.54-77.14]), breastfeeding by expressing milk directly from the breast into baby’s mouth (OR=13.90; CI95%: [2.57-74.97]) and non-consumption of hindmilk by the newborn (OR=10.93; CI95%: [1.72-47.08]), were associated with weight gain in these low-weight newborns. Conclusions: The "optimized mother-newborn care model" appears to improve weight gain in low-birth-weight newborns. Taking into account the factors associated with low weight gain in low-weight newborns could improve the effectiveness of the implemented model in this health district.

ABSTRACT

Background: Accurate temperature assessment is essential in neonatal care as minor temperature changes can have a significant impact on the health and well-being of newborns. The purpose of this study was to compare the performance of three different types of thermometers, including non-contact infrared, digital, and mercury thermometers, for temperature assessment in newborns.Methods: This was a prospective, comparative study conducted between April 2022 and August 2022 in Cheluvamba hospital, Mysuru. A total of 400 healthy newborns were included in the study. Temperature readings were taken from the mid-forehead non-contact infrared thermometer and axilla using digital and mercury thermometers, while maintaining aseptic precautions. Parental oral consent was obtained for participation.Results: The mean temperature recorded with the digital thermometer in the axilla was statistically higher than that recorded with the mercury thermometer. The non-contact infrared thermometer showed a strong positive correlation with the mercury thermometer for the axilla region.Conclusions: The digital thermometer is a useful device for easy and valid measurement of skin temperature in newborns, especially when applied to the axilla. The findings suggest that the use of digital thermometers for axillary temperature measurement in neonates is supported by previous studies, which have reported their accuracy and reliability in comparison to mercury thermometers. The non-contact infrared thermometer may have limitations and its accuracy may vary depending on the site of measurement. The use of digital thermometers for neonatal temperature measurement may be more convenient, less hazardous, and equally reliable compared to traditional mercury thermometers.

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Background: Neonatal hyperbilirubinemia (NH) is the most common abnormality seen during the neonatal period. It affects nearly 60% of term and 80% of preterm neonates during the first week of life. Early discharge of healthy term and late preterm newborns after normal vaginal delivery is a common practice however there are reports of bilirubin induced brain damage (kernicterus) occurring in these infants. Therefore, to ascertain whether cord albumin can be used as a reliable indicator for predicting neonatal hyperbilirubinemia.Methods: A tertiary care hospital-based cross-sectional study was conducted in 142 healthy late preterm and term newborns of either gender with icterus appearing only after 24 hour of life with no other illness using a non-probability sampling method. Data analysis was done using statistical package for the social sciences (SPSS) version 16. Chi-square was used to determine the association between cord albumin and hyperbilirubinemia.Results: There is a significant negative correlation between cord albumin and serum bilirubin at 72-96 hours of life (p=0.001). A total of 142 healthy late preterm and term neonates included. The study group based on Cord serum albumin (CSA) levels ?2.8 g/dl, 2.9-3.3 g/dl, and ?3.4 g/dl shows 77.27%, 22.7% and none respectively developed NH requiring phototherapy. According to receiver operating curve (ROC) analysis, the cutoff point of 2.75 g/dl provides the best sensitivity and specificity result.Conclusions: Cord serum albumin level ?3.4 g/dl are probably safe for early discharge whereas cord serum albumin level <3.4 g/dl will need a close follow-up to check for the development of jaundice.

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Resumen Con la implementación de estrategias de cuidado perinatal, la tasa de transmisión vertical del virus de inmunodeficiencia humana (VIH) ha disminuido considerablemente en el mundo. A pesar de no mostrar cargas virales, los infantes expuestos al VIH no infectados (ENI) cursan en sus primeros meses de vida con mayores tasas de morbimortalidad. Esto se relaciona con enfermedades infecciosas por microorganismos oportunistas y menor respuesta a las vacunas en comparación con infantes sin exposición al virus, lo que sugiere alteraciones en su sistema inmunitario. En esta revisión abordamos diferentes evidencias de alteraciones en las respuestas inmunitarias innatas y adaptativas de infantes ENI que pudieran explicar esta disfuncionalidad inmunitaria. Adicionalmente, este conocimiento ayuda a entender cómo se desarrolla el sistema inmunitario desde los primeros momentos de gestación que servirán para encontrar alternativas de manejo y terapias para el bienestar de los infantes con esta condición.

Abstract With the implementation of perinatal care strategies, the rate of vertical transmission of human immunodeficiency virus (HIV) has decreased considerably worldwide. Despite the absence of viral loads, infants exposed to HIV not infected during gestation have higher morbidity and mortality rates. This is found to be related to infectious diseases by opportunistic microorganisms and lower response to vaccines in their first months of life compared to non-HIV exposed infants, suggesting alterations in their immune system. In this review we address different evidence of alterations in the innate and adaptive immune responses of HIV exposed infants that could explain their immune dysfunctionality. Additionally, this knowledge helps to understand how the immune system develops from the early stages of gestation and will serve to find management alternatives and therapies for the welfare of the infants with this condition.

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Background: Exclusive breast feeding during first 6-months has been proven to ensure growth and development of children. The habit of Exclusive breast feeding is often overlooked by mothers due to various factors. Therefore, this study aims to identify the barriers to Exclusive Breast Feeding.Methods: This is a prospective study conducted from August 2018 to October 2020 in a tertiary care hospital in Hyderabad among 155 mothers with neonate to 6 months old infants. Data was collected through face-to-face interview using premade questionnaire and a predetermined sample size of 155 was considered.Results: The prevalence of exclusive breast feeding was 20%. The barriers to exclusive breastfeeding practice were identified as lower socio-economic status (59.4%), Lack of formal education (52.9%), lack of counselling about breast feeding (10.3%), early return to work (32.2%), poor family support (49.03%), 22-25years mean age group (36.7%) , use of bottle feeding (16.3%) and pacifiers (12.2%). It was also observed that mothers experienced difficulties such as cracks (2.58%) and suction problems (2.58%) currently, and breast pain (2.58%) previously.Conclusions: Promoting education of women especially in lower socio-economic sector and emphasizing need of avoiding complementary feeding rather counselling women regarding importance of exclusive breastfeeding during first 6-months and negative impact of early return to work, and providing health care for the difficulties faced during breastfeeding and encouraging family support are recommendations to improve exclusive breastfeeding practice.

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The lingual frenulum inhibits tongue mobility in ankyloglossia, sometimes referred to as tongue-tie. It affects 4–16% of babies, with boys being more likely to be affected. Anterior and posterior tongue ties are the two primary forms. When a newborn opens their mouth, anterior tongue ties are easy to spot because they look like a heart; posterior tongue ties are trickier to spot. Ankyloglossia can make it difficult to nurse, speak clearly, maintain good oral hygiene, or engage in other oral activities. Tongue-tie can influence a baby's oral development as well as the way he or she feeds, talks, and swallows. It is crucial to diagnose ankyloglossia through a thorough examination. Treatment options include lactation consultation, improving latch during breastfeeding, and a procedure called frenotomy, which involves releasing the frenulum. Research is ongoing to establish evidence-based recommendations and standardized diagnostic criteria for ankyloglossia. This review will focus on etiology, pathophysiology and treatment of ankyloglossia in babies and its effect on breastfeeding.

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Background: Fetal malnutrition and fetal growth restriction results in dysfunctions of neuroendocrine system, pancreas and adipose-tissue; finally increasing the food intake and decreasing energy use. This results in an increase in adipose deposition and insulin-resistance and ultimately increasing chances of adult metabolic-diseases. This study makes an effort to compare and contrast the lipid-profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA)newborns correlating and with their mother抯 lipid-profiles.Methods: This was a case-control study, conducted in the Departments of Pediatrics and OBG of Karwar Institute of Medical Sciences,Karwar, Karnataka,India over a period of twelve months(January-2021 to January-2022). With 500neonates, 357appropriate for gestational age (AGA) and 143 small for gestational age(SGA) babies were included for the study as controls and cases for their lipid profiles using their cord-blood.Results: here, we found that SGA-babies had lower gestational age (37.40�01 weeks) at birth compared to AGA-babies (39.22�05 weeks) which was statistically significant. The mean Total Cholesterol (TC) level (84.47�.39 mg/dl) was higher in SGA-babies compared to AGA-babies (56.87�.28 mg/dl) and this difference was statistically highly significant (p value<0.0001). The mean very low density lipoprotein (VLDL) level (14.10�.67 mg/dl) was higher in SGA-babies than AGA-babies (7.17�69 mg/dl) with p value<0.0001 (highly significant). The mean low density lipoprotein (LDL) level (38.74�.85 mg/dl) was higher in SGA-babies compared to AGA-babies (25.63�.15 mg/dl) and this difference was statistically significant (p value<0.0001). The mean high density lipoprotein (HDL) levels of AGA and SGA-babies were comparable with low statistical significance (26.70�.90 mg/dl of SGA; 24.45�567 mg/dl of AGA, p value 0.095).Conclusions: Levels of all lipids were observed to be higher in SGA babies than in AGA babies. Mothers who gave birth to SGA babies were found to have statistically significant high VLDL levels.

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This systematic review critically investigates the administration of the Bacillus Calmette-Guérin (BCG) vaccine in neonates with severe combined immunodeficiency (SCID). The BCG vaccine, derived from Mycobacterium bovis, is a live attenuated vaccine recognized for its significant role in mitigating the impacts of tuberculosis (TB) in endemic areas. Despite its beneficial effects in controlling TB, safety and efficacy concerns have been raised when the vaccine is administered to SCID patients, who have a severe dysfunction or absence of the immune system. The potential for the vaccine to lead to severe complications due to the immunocompromised state of SCID patients necessitates a comprehensive investigation. To better understand these issues, a thorough literature review was carried out, integrating data from clinical trials and observational studies available on the PubMed database. An extensive review and analysis of 32 relevant articles revealed substantial evidence of complications from BCG vaccination in SCID patients. These findings emphasize the urgency for a more effective pre-vaccination screening process to circumvent potential adverse effects. Given the crucial role of the BCG vaccine in controlling TB, its potential to induce severe complications in SCID patients warrants careful consideration. Therefore, this review proposes an in-depth screening algorithm for newborns before BCG vaccination administration. The goal is to prevent these adverse events, offering critical insights to health policymakers, researchers, and clinicians in the field.