Factors associated with early initiation of breastfeeding

Introduction: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). Methods: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. Results: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. Conclusion: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

The newborn screening tests in Brazil: regional and socioeconomic prevalence and inequalities in 2013 and 2019

Abstract Objective: To analyze the prevalence evolution of Guthrie, hearing, and eye screening testing among newborns in Brazil, between 2013 and 2019, according to demographic and socioeconomic characteristics. Methods: This is a cross-sectional study with data from 5231 infants from the Pesquisa Nacional de Saude (PNS), in 2013, and 6637 infants, in 2019, for the Guthrie test, hearing, and red reflex tests. The authors analyzed the outcomes according to the region of residence, self-reported color/race, having health insurance, and per capita household income. By using bivariate and multivariate Poisson regression models, the prevalence ratios and their respective 95 % Confidence Intervals (CI95%) were calculated for each year. Results: In 2013, Guthrie test, hearing, and red reflex tests were performed in 96.5 % (95%CI 95,8;97,0), 65.8 % (95%CI 63,9;67,7), and 60.4 % (95%CI 58,5;62,3) of infants, respectively. In 2019, the prevalence was 97.8 % (95%CI 97,3;98,2) in the Guthrie test, 81.6 % (95%CI 80,3;82,9) in the hearing test, and 78.6 % (95%CI 77,1;79,9) in the red reflex test. The testing frequency was higher among residents of the Southeast and South regions of Brazil, among infants whose mother or guardian was white, had health insurance, and was in the higher income strata; and the most evident differences were in the eye and hearing testing. Conclusions: The coverage inequalities according to the region of residence, income, and having health insurance highlight the need to use strategies that enable exams to be carried out, with more information about their importance, encompassing actions from primary care, prenatal care to the puerperium, aiming at universal access and equity.

Development and validation of a diagnostic prediction model for severe periventricular-intraventricular hemorrhage in newborns: insights from a retrospective analysis utilizing the MIMIC-III database

Abstract Objective: Periventricular-intraventricular hemorrhage is the most common type of intracranial bleeding in newborns, especially in the first 3 days after birth. Severe periventricular-intraventricular hemorrhage is considered a progression from mild periventricular-intraventricular hemorrhage and is often closely associated with severe neurological sequelae. However, no specific indicators are available to predict the progression from mild to severe periventricular-intraventricular in early admission. This study aims to establish an early diagnostic prediction model for severe PIVH. Method: This study was a retrospective cohort study with data collected from the MIMIC-III (v1.4) database. Laboratory and clinical data collected within the first 24 h of NICU admission have been used as variables for both univariate and multivariate logistic regression analyses to construct a nomogram-based early prediction model for severe periventricular-intraventricular hemorrhage and subsequently validated. Results: A predictive model was established and represented by a nomogram, it comprised three variables: output, lowest platelet count and use of vasoactive drugs within 24 h of NICU admission. The model's predictive performance showed by the calculated area under the curve was 0.792, indicating good discriminatory power. The calibration plot demonstrated good calibration between observed and predicted outcomes, and the Hosmer-Lemeshow test showed high consistency (p = 0.990). Internal validation showed the calculated area under a curve of 0.788. Conclusions: This severe PIVH predictive model, established by three easily obtainable indicators within the NICU, demonstrated good predictive ability. It offered a more user-friendly and convenient option for neonatologists.

Depresión puerperal: impacto en la madre gestante y en el desarrollo físico, emocional y cognitivo posnatal de sus hijas/os. Una mirada ecológica / Postpartum depression: Impact on pregnant women and the postnatal physical, emotional, and cognitive development of their children. An ecological perspective

Los problemas de salud mental materna durante el embarazo, parto y puerperio son un desafío para la salud pública. Su falta de reconocimiento atenta contra el diagnóstico y tratamientos oportunos, e impacta en la madre y el establecimiento del vínculo fundamental del binomio. Debemos reconocer los factores de riesgo (edad, situación socioeconómica, antecedentes psicopatológicos, disfunción familiar, entorno desfavorable), las manifestaciones clínicas y las herramientas de detección. Existen evidencias de que el efecto del estrés, la ansiedad y la depresión durante el embarazo afectan negativamente el neurodesarrollo fetal y condicionan los resultados del desarrollo infantil. Describimos el impacto negativo de la depresión puerperal durante los primeros meses de vida, que afecta el vínculo madre-hija/o, el desarrollo posnatal (emocional, conductual, cognitivo, lenguaje) y el mantenimiento de la lactancia materna. También reconocemos factores protectores que atemperan sus efectos. Es fundamental establecer estrategias preventivas y abordajes diagnósticos y terapéuticos interdisciplinarios para minimizar los riesgos sobre la madre y sus hijas/os.

Maternal mental health problems during pregnancy, childbirth, and the postpartum period are a challenge for public health. Not recognizing them hinders a timely diagnosis and treatment and has an impact on the mother and the establishment of the fundamental bond of the mother-child dyad. We must recognize the risk factors (age, socioeconomic status, mental health history, family dysfunction, unfavorable environment), clinical manifestations, and screening tools. There is evidence that the effect of stress, anxiety, and depression during pregnancy negatively affect fetal neurodevelopment and condition child developmental outcomes. Here we describe the negative impact of postpartum depression during the first months of life, which affects mother-child bonding, postnatal development (emotional, behavioral, cognitive, language), and the maintenance of breastfeeding. We also recognize protective factors that mitigate its effects. It is essential to establish preventive strategies and interdisciplinary diagnostic and therapeutic approaches to minimize the risks to the mother and her children.

Fractura craneal deprimida congénita ("fractura ping-pong") en neonatos como diagnóstico diferencial de maltrato físico / Congenital depressed skull fracture ("ping-pong" fracture) in newborn infants as a differential diagnosis of physical abuse

Las fracturas con hundimiento de cráneo sin una explicación clara sobre su origen orientan al traumatismo con un objeto romo y a la sospecha de maltrato infantil. En el caso de los bebés recién nacidos, su corta edad es un factor de vulnerabilidad y obliga a una exhaustiva evaluación. Ante la sospecha de maltrato infantil, resulta importante evaluar los diagnósticos diferenciales para realizar la intervención más adecuada posible. Es necesario evitar tanto intervenciones excesivas como omitir la intervención que sea necesaria. Las fracturas craneales deprimidas congénitas, descritas como "fracturas pingpong", son raras (0,3 a 2/10 000 partos). Pueden aparecer sin antecedentes traumáticos o en partos instrumentalizados. Se describe en este artículo el caso de un recién nacido con una fractura ping-pong como ejemplo de una fractura no intencional.

Depressed skull fractures without a clear explanation as to their origin point to trauma with a blunt object and suspected child abuse. In the case of newborn infants, their young age is a vulnerability factor and requires an exhaustive assessment. When child abuse is suspected, an assessment of the differential diagnoses is required to make the most appropriate intervention possible. Both an excessive intervention and an omission of a necessary intervention should be avoided. Congenital depressed skull fractures, described as "ping-pong fractures", are rare (0.3 to 2/10 000 births). They may appear without any trauma history or in instrumentalized childbirth. Here we describe the case of a newborn infant with a ping-pong fracture as an example of an accidental fracture.

Percepção de mães sobre a visitação aberta na unidade de terapia intensiva neonatal / Mothers' perception of open visitation in the neonatal intensive care unit / Percepción de las madres sobre las visitas abiertas en la unidad de cuidados intensivos neonatales

Objetivo: compreender a percepção de mães sobre a visitação aberta na unidade de terapia intensiva neonatal. Métodos: estudo descritivo, qualitativo, realizado por meio de entrevista semiestruturada e individualizada, em uma maternidade pública situada no interior de São Paulo, Brasil, em 2019. A amostra foi definida pelo método de saturação de dados e constou de 14 mães. Os dados foram submetidos a Análise de Conteúdo Temática. Resultados: elencaram-se duas categorias: evidenciando os benefícios da visitação aberta e desafios a serem superados. Os benefícios incluíram a satisfação em permanecer com o filho, participar dos cuidados, fortalecer o vínculo maternal, acompanhar a evolução do bebê, evidenciar a qualidade do cuidado e o envolvimento afetivo, redução de sentimentos negativos e visitação do pai no período noturno. Em contrapartida, os desafios incluíram a impossibilidade de permanecer com o filho, estar presente somente em horários pré-estabelecidos para receber informações de médicos, prioriza-las em relação as fornecidas pela enfermagem, receber informações parciais, ter receio em expressar as dúvidas e vivenciar sentimentos negativos. Conclusão: os achados deste estudo fornecem subsídios para que a equipe de saúde e os gestores promovam a adesão de mães à visitação aberta em unidades de terapia intensiva neonatais. (AU)

Objective: understand the perception of mothers about open visitation in the neonatal intensive care unit. Methods: descriptive, qualitative study, carried out through semi-structured and individualized interviews, in a public maternity hospital located in the interior of São Paulo, Brazil, in 2019. The sample was defined by the data saturation method and consisted of 14 mothers. Data were submitted to Thematic Content Analysis. Results: two categories were listed: showing the benefits of open visitation and challenges to be overcome. The benefits included the satisfaction of staying with the child, participating in care, strengthening the maternal bond, monitoring the baby's evolution, showing the quality of care and affective involvement, reducing negative feelings and visiting the father at night. On the other hand, the challenges included the impossibility of staying with the child, being present only at preestablished times to receive information from doctors, prioritizing it in relation to that provided by nurses, receiving partial information, being afraid to express doubts and experience negative feelings. Conclusion: the findings of this study provide support for the health team and managers to promote the adherence of mothers to open visitation in neonatal intensive care units. (AU)

Objetivo: comprender la percepción de las madres sobre la visita abierta en la unidad de cuidados intensivos neonatales. Métodos: estudio descriptivo, cualitativo, realizado a través de entrevistas semiestructuradas e individualizadas, en una maternidad pública ubicada en el interior de São Paulo, Brasil, en 2019. La muestra fue definida por el método de saturación de datos y estuvo conformada por 14 madres. Los datos se enviaron a Análisis de contenido temático. Resultados: se enumeraron dos categorías: mostrando los beneficios de la visita abierta y los desafíos a superar. Los beneficios incluyeron la satisfacción de quedarse con el niño, participar en los cuidados, fortalecer el vínculo materno, monitorear la evolución del bebé, mostrar la calidad del cuidado y el involucramiento afectivo, reducir los sentimientos negativos y visitar al padre por la noche. Por otro lado, los desafíos incluían la imposibilidad de quedarse con el niño, estar presente solo en horarios preestablecidos para recibir información de los médicos, priorizarla en relación a la brindada por enfermeras, recibir información parcial, tener miedo a expresar dudas y experimentar sentimientos negativos. Conclusión: los hallazgos de este estudio brindan apoyo al equipo de salud y gerentes para promover la adherencia de las madres a la visita abierta en las unidades de cuidados intensivos neonatales. básico sobre las conductas frente a los accidentes, a pesar de desconocieren el flujo de atención del servicio. (AU)

Satisfacción de madres neonatales frente a los cuidados de enfermería en hospital de los Andes peruanos / Satisfaction of neonatal mothers with nursing care in a hospital in the Peruvian Andes / Satisfação das mães neonatais com os cuidados de enfermagem em um hospital nos Andes peruanos

La satisfacción de las madres de recién nacidos con los cuidados de enfermería es crucial, dado el impacto emocional que supone la llegada de un nuevo bebé. Durante los primeros días tras el parto, es fundamental establecer un fuerte vínculo madre-recién nacido, así como garantizar un cuidado efectivo del bebé para que las madres se sientan seguras y confiadas en la atención hospitalaria. Además, las enfermeras desempeñan un papel esencial en el apoyo a la lactancia materna, con beneficios significativos para la salud del bebé. Objetivo. Determinar el nivel de satisfacción de las madres de recién nacidos con los cuidados de enfermería en el servicio de atención inmediata del recién nacido - alojamiento conjunto del Hospital de Pampas de Huancavelica. Materiales y métodos. La metodología empleada fue no experimental, de tipo descriptivo, transversal y prospectivo. Se encuestó a 262 madres de recién nacidos durante los meses de marzo a julio de 2023, utilizando un cuestionario estructurado con 24 ítems como instrumento de medición. Resultados. Se indica que el 65.3% de las madres encuestadas expresaron un nivel de satisfacción completa, el 25.2% mostró un nivel de satisfacción intermedia, y el 9.5% manifestó insatisfacción. Conclusiones. Aunque la mayoría de las madres encuestadas están satisfechas o muy satisfechas con los cuidados de enfermería recibidos, aún existe un porcentaje considerable de insatisfacción. Esto sugiere la necesidad de mejorar ciertos aspectos para garantizar una atención óptima a los recién nacidos y sus madres.

New mothers' satisfaction with nursing care is crucial, given the emotional impact of the arrival of a new baby. During the first days after delivery, establishing a strong mother-newborn bond is critical, as is ensuring effective infant care so that mothers feel secure and confident in hospital care. In addition, nurses play an essential role in supporting breastfeeding, with significant benefits for the baby's health. Objective. To determine the level of satisfaction of mothers of newborns with nursing care in the immediate newborn care service - joint accommodation of the Hospital de Pampas de Huancavelica. Materials and methods. The methodology used was non-experimental, descriptive, cross-sectional and prospective. A total of 262 mothers of newborns were surveyed during the months of March to July 2023, using a structured questionnaire with 24 items as a measurement instrument. Results. It is indicated that 65.3% of the mothers surveyed expressed a level of complete satisfaction, 25.2% showed an intermediate level of satisfaction, and 9.5% expressed dissatisfaction. Conclusions. Although most of the mothers surveyed are satisfied or very satisfied with the nursing care received, there is still a considerable percentage of dissatisfaction. This suggests the need to improve certain aspects to guarantee optimal care for newborns and their mothers.

A satisfação das novas mães com os cuidados de enfermagem é crucial, dado o impacto emocional da chegada de um novo bebê. Durante os primeiros dias após o nascimento, estabelecer um forte vínculo entre a mãe e o recém-nascido e garantir o cuidado eficaz do bebê é essencial para que as mães se sintam seguras e confiantes no atendimento hospitalar. Além disso, os enfermeiros desempenham um papel essencial no apoio ao aleitamento materno, com benefícios significativos para a saúde do bebê. Objetivo. Determinar o nível de satisfação das mães de recém-nascidos com o atendimento de enfermagem no serviço de atendimento imediato ao recém-nascido - alojamento conjunto do Hospital Pampas de Huancavelica. Materiais e métodos. A metodologia utilizada foi não experimental, descritiva, transversal e prospectiva. Um total de 262 mães de recém-nascidos foi pesquisado durante os meses de março a julho de 2023, usando um questionário estruturado com 24 itens como instrumento de medição. Resultados. Indicou-se que 65,3% das mães pesquisadas expressaram um nível de satisfação completa, 25,2% mostraram um nível intermediário de satisfação e 9,5% expressaram insatisfação. Conclusões. Embora a maioria das mães pesquisadas esteja satisfeita ou muito satisfeita com a assistência de enfermagem recebida, ainda há uma porcentagem considerável de insatisfação. Isso sugere a necessidade de melhorar certos aspectos para garantir o cuidado ideal para os recém-nascidos e suas mães.

Comparison of the effectiveness of different high-flow devices in neonatal care

Abstract Objective: To evaluate the success rate of high-flow nasal cannula (HFNC) therapy using an adapted obsolete mechanical ventilator (MV), Optiflow™ and Vapotherm™ in newborns (NBs). Method: This was a retrospective observational study conducted in the neonatal intensive care unit (NICU). The sample comprised NBs who underwent HFNC therapy due to ventilatory dysfunction, for weaning from non-invasive ventilation (NIV), or post-extubation. The three groups, stratified according to gestational age (GA) and birth weight, and corrected GA and weight at the beginning of HFNC use, were as follows: Optiflow ™, Vapotherm ™, and obsolete Mechanical Ventilator (MV) adapted for high flow therapy. Subsequently, the NBs were divided into a success group (SG) and a failure group (FG). HFNC success was defined as a therapy duration exceeding 72 h. Results: A total of 209 NBs were evaluated, with 31.1 % using HFNC due to ventilatory dysfunction, 2.4 % after extubation, and 66.5 % after NIV weaning. HFNC success rate was observed in 90.9 % of the NBs, with no difference between equipment types (Vapotherm ™, Optiflow ™, and adapted VM). Conclusion: Different types of HFNC equipment are equally effective when used in neonatology for respiratory dysfunction, as a method of weaning from NIV and post-extubation. Adapted obsolete MV can be an alternative for HFCN therapy in resource-constrained settings.

Correlation between nasal anatomical characteristics in newborns and short binasal prong dimensions

Abstract Objective: To correlate the nasal anatomical characteristics of newborns with the dimensions of short binasal prongs. Method: Observational, cross-sectional study carried out in two hospitals in southern Brazil. The authors evaluated 1620 newborns with neonatal data and nasal dimensions. To measure the dimensions of the nasal region, the authors considered the width of the medial columella, the right nostril diameter, and the left nostril diameter. These data were correlated with the dimensions of two models of short binasal prongs. Results: Of the total newborns evaluated, 807 were female (49.8%), and 813 were male (50.2%). The majority were white (96.2%). The mean gestational age was 37.4 ± 2.9 weeks, ranging from 22 to 42 weeks. The birth weight was 2946.8 ± 699.3 g, ranging from 490.0 to 4740.0 g. Most of the nasal measures were significantly larger than both prong model measurements. Conclusion: The sizes of short binasal prongs available on the Brazilian market do not match the nasal anatomical characteristics of newborns.

Impacto da fisioterapia aquática em UTIN sobre a mobilidade diafragmática avaliada por ultrassonografia cinesiológica: ensaio clínico / Impact of Aquatic Therapy in the NICU on diaphragmatic mobility assessed by ultrasound: clinical trial

INTRODUÇÃO: A fisioterapia aquática é uma modalidade de hidroterapia realizada em recém-nascidos (RN) nas Unidades de Terapia Intensiva Neonatal (UTIN). Os efeitos sobre nível de dor, estado comportamental e função respiratória já são conhecidos, porém pouco se refere aos efeitos sobre a função diafragmática na população recém-nascida a termo prematura. OBJETIVO: Avaliar o efeito da fisioterapia aquática sobre a amplitude diafragmática por meio da ultrassonografia cinesiológica diafragmática (USCD) em RNs internados em UTIN, bem como a segurança de sua realização quanto a estabilidade clínica dos RNs, estado comportamental, dor e desconforto respiratório. MÉTODOS: Ensaio clínico tipo antes e depois, de caráter transversal. Os RNs participantes do estudo receberam uma única intervenção com fisioterapia aquática durante 10 minutos. Foi realizada a avaliação utilizando a USCD antes e depois da sessão, e anotado as frequências cardíaca e respiratória, estado comportamental, dor e desconforto respiratório. RESULTADOS: Participaram 26 RNs. Observou-se aumento significativo da amplitude diafragmática (p= 0,02) e da saturação periférica de oxigênio (p= 0,05); os parâmetros fisiológicos permaneceram nos limites da normalidade e a intervenção não provocou desorganização comportamental, dor ou desconforto respiratório aos RNs. CONCLUSÃO: A fisioterapia aquática promoveu aumento da amplitude diafragmática, sugerindo que esta técnica pode ser utilizada como forma de estimular a contração da musculatura respiratória em RN, além de se mostrar uma técnica segura, pois não gerou instabilidade clínica, desorganização comportamental, dor ou desconforto respiratório aos participantes.

INTRODUCTION: Aquatic physiotherapy is a modality of hydrotherapy performed on newborn babies (NB) in the Neonatal Intensive Care Unit (NICU). The effects on pain levels, behavior, and respiratory function are already known; however, little has been said about the effects on diaphragmatic function in the preterm newborn population. OBJECTIVE: To evaluate the effect of aquatic physiotherapy on diaphragmatic amplitude using diaphragmatic kinesiologic ultrasound (DKUS) in NBs admitted to a NICU, as well as the safety regarding the clinical stability of the NBs, behavioral state, pain, and respiratory distress. METHODS: Crosssectional before-and-after clinical trial. The NBs participating in the study received a single intervention with aquatic physiotherapy for 10 minutes. An assessment was performed using the USCD before and after the session, and heart and respiratory rates, behavioral state, pain, and respiratory discomfort were recorded. RESULTS: Twenty-six NBs participated. There was a significant increase in diaphragmatic amplitude (p= 0.02) and peripheral oxygen saturation (p= 0.05); physiological parameters remained within normal limits, and the intervention did not cause behavioral disorganization, pain, or respiratory discomfort in NBs. CONCLUSION: Aquatic physiotherapy promoted an increase in diaphragmatic amplitude, suggesting that this technique can be used as a way to stimulate the contraction of the respiratory muscles in NB, in addition to being a safe technique, as it did not generate clinical instability, behavioral disorganization, pain, or respiratory discomfort to the participants.

Prevalencia de osteopenia del prematuro antes y después de la implementación de una estrategia temprana de manejo fosfocálcico / Prevalence of osteopenia of prematurity before and after implementing an early strategy with the use of calcium and phosphate

Introducción. Con el uso de la nutrición parenteral agresiva en recién nacidos de muy bajo peso, se detectaron alteraciones del metabolismo fosfocálcico. En 2016 se implementó una estrategia de prevención a través del monitoreo fosfocálcico y su suplementación temprana. El objetivo fue estudiar si esta estrategia disminuye la prevalencia de osteopenia e identificar factores de riesgo asociados. Población y métodos. Estudio cuasiexperimental que comparó la prevalencia de osteopenia entre dos grupos: uno después de implementar la estrategia de monitoreo y suplementación fosfocálcica (01/01/2017-31/12/2019), y otro previo a dicha intervención (01/01/2013-31/12/2015). Resultados. Se incluyeron 226 pacientes: 133 pertenecen al período preintervención y 93 al posintervención. La prevalencia de osteopenia global fue del 26,1 % (IC95% 20,5-32,3) y disminuyó del 29,3 % (IC95% 21,7-37,8) en el período preintervención al 21,5 % (IC95% 13,6-31,2) en el posintervención, sin significancia estadística (p = 0,19). En el análisis multivariado, el puntaje NEOCOSUR de riesgo de muerte al nacer, recibir corticoides posnatales y el período de intervención se asociaron de manera independiente a osteopenia. Haber nacido luego de la intervención disminuyó un 71 % la probabilidad de presentar fosfatasa alcalina >500 UI/L independientemente de las restantes variables incluidas en el modelo. Conclusión. La monitorización y suplementación fosfocálcica precoz constituye un factor protector para el desarrollo de osteopenia en recién nacidos con muy bajo peso al nacer.

Introduction. With the use of aggressive parenteral nutrition in very low birth weight infants, alterations in calcium and phosphate metabolism were detected. In 2016, a prevention strategy was implemented through calcium phosphate monitoring and early supplementation. Our objective was to study whether this strategy reduces the prevalence of osteopenia and to identify associated risk factors. Population and methods. Quasi-experiment comparing the prevalence of osteopenia between two groups: one after implementing the calcium phosphate monitoring and supplementation strategy (01/01/2017­12/31/2019) and another prior to such intervention (01/01/2013­12/31/2015). Results. A total of 226 patients were included: 133 in the pre-intervention period and 93 in the post-intervention period. The overall prevalence of osteopenia was 26.1% (95% CI: 20.5­32.3) and it was reduced from 29.3% (95% CI: 21.7­37.8) in the pre-intervention period to 21.5% (95% CI: 13.6­31.2) in the post-intervention period, with no statistical significance (p = 0.19). In the multivariate analysis, the NEOCOSUR score for risk of death at birth, use of postnatal corticosteroids, and the intervention period were independently associated with osteopenia. Being born after the intervention reduced the probability of alkaline phosphatase > 500 IU/L by 71%, regardless of the other variables included in the model. Conclusion. Calcium phosphate monitoring and early supplementation is a protective factor against the development of osteopenia in very low birth weight infants.

Analysis of the changes in the management of preterm newborns born in a Spanish third-level hospital in the past 10 years / Análisis de los cambios en el manejo de recién nacidos prematuros nacidos en un hospital español de tercer nivel en los últimos 10 años

Abstract Background: Preterm newborns require the use of the best and most current strategies to treat and prevent both acute pathology and associated sequelae. This study aimed to compare the differences in the management of preterm newborns over 10 years in a tertiary hospital in Spain and its impact on height, weight, and neurological development in the medium term. Methods: We conducted a retrospective, observational, and analytical study examining the management and clinical variables in preterm newborns under 32 weeks of gestational age who were born in our hospital in 2011 and 2021. Results: Twenty-six newborns were included in the study. Significant differences in magnesium sulfate use, continuous positive airway pressure immediately after birth, and non-invasive mechanical ventilation during hospitalization were observed. Differences were found in the use of parenteral nutrition and the timing of initiation of enteral feeding. We did not observe differences in the neurological or weight evolution in the medium term. Conclusions: Significant differences in managing preterm newborns in these 10 years were observed. Lower mortality and alterations in central nervous system ultrasound and, significantly, less growth retardation during admission in 2021 have been observed; however, it does not manifest with improvement in long-term somatometrics or neurological prognosis.

Resumen Introducción: La inmadurez de los recién nacidos pretérmino (RNP) requiere el empleo de las mejores y más actuales estrategias para tratar la patología aguda y prevenir sus eventuales secuelas asociadas. El objetivo planteado es comparar las diferencias en el manejo de RNP a lo largo de diez años en un hospital de tercer nivel en España y su impacto en el desarrollo neurológico y póndero-estatural a medio plazo. Métodos: Estudio retrospectivo, observacional y analítico examinando variables del manejo y clínicas de todos los RNP menores de 32 semanas de edad gestacional nacidos en nuestro hospital (nivel III-A) en 2011 y en 2021. Resultados: Se incluyeron 26 infantes (2011: 10 niños, 2021: 16 niños). Observamos diferencias significativas en el uso prenatal de sulfato de magnesio, mayor uso de presión positiva continua en la vía aérea (CPAP) al ingreso y ventilación mecánica no invasiva durante el ingreso, retraso en el uso de surfactante, empleo de alimentación intravenosa e inicio precoz de la alimentación enteral. Existe una menor tasa de mortalidad y desnutrición postnatal en 2021. No observamos diferencias en la evolución neurológica o ponderal a medio plazo. Conclusiones: Existen diferencias en el manejo de los prematuros en estos 10 años con mayor ajuste a las guías nacionales e internacionales vigentes. Esto se relaciona con menor mortalidad y alteraciones en la ecografía del sistema nervioso central y, significativamente, con un menor retraso en el crecimiento durante el ingreso en 2021; no se demostró mejoría del pronóstico somatométrico o neurológico a largo plazo.

Changes in Neonatal Intensive Care Unit statistics during the COVID-19 pandemic / Cambios en las estadísticas de una Terapia Intensiva Neonatal durante la pandemia COVID-19

Abstract Background: With the identification of COVID-19 disease in China, a pandemic began that affected health-care systems. The Neonatal Intensive Care Unit (NICU) of the Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente experienced an increase in patient flow as part of the COVID-19 strategy of the Instituto Mexicano del Seguro Social (IMSS). This study aimed to analyze the impact of the COVID-19 pandemic on neonatal care and mortality indicators in our unit. Methods: We conducted a retrospective study to compare the number of hospital births, pre-term newborns (PTNB), NICU admissions, and deaths. Changes in frequencies between 2019 and 2021 were analyzed using Poisson distribution. Changes in PTNB births, proportion of admissions, and deaths/NICU discharges were analyzed by z-test for two proportions. Results: Between 2019 and 2021, the number of births increased by more than 2-fold. NICU admissions increased from 770 in 2019 to 1045 in 2021 (p < 0.01). The ratio of deaths/discharge from the service was 16.9% in 2019 and 13.1% in 2021 (p = 0.02). Conclusions: Mortality indicators in the NICU decreased from 2019 to 2021, even with the increase in the number of patients admitted during the COVID-19 pandemic.

Resumen Introducción: Con la identificación de la enfermedad por COVID-19 en China, inició una pandemia que afectó a los sistemas de salud. La Unidad de Cuidados Intensivos Neonatales (UCIN) del Hospital de Ginecobstetricia del Centro Médico Nacional de Occidente del Instituto Mexicano del Seguro Social (IMSS) vio incrementado su flujo de pacientes como parte de la Estrategia COVID-19 del IMSS. El objetivo fue analizar el impacto de la pandemia COVID-19 en los indicadores de atención y mortalidad neonatal en nuestra unidad. Métodos: Se realizó un estudio retrospectivo para comparar el número de nacimientos en el hospital, nacimientos de recién nacidos prematuros (RNPT), ingresos a UCIN y defunciones. Se analizaron los cambios en frecuencias entre los años 2019 a 2021 mediante la distribución de Poisson. Los cambios en nacimientos de RNPT, proporción de ingresos y defunciones/egreso en UCIN se analizaron mediante prueba Z para dos proporciones. Resultados: Entre los años 2019 a 2021, el número de nacimientos incrementó más de 2 veces. Los ingresos a UCIN aumentaron de 770 en 2019, a 1045 en 2021 (p < 0.01). La proporción de defunciones/egreso del servicio fue de 16.9% en 2019, y 13.1% en 2021 (p = 0.02). Conclusiones: Los indicadores de mortalidad en la UCIN disminuyeron de 2019 a 2021, aun con el incremento en el número de pacientes atendidos durante la pandemia COVID-19.

Manutenção do cateter central de inserção periférica neonatal: protocolo de revisão de escopo / Maintenance of the neonatal peripherally inserted central catheter: a scoping review protocol

OBJETIVO: Mapear e sintetizar as evidências sobre os cuidados realizados por enfermeiros para a manutenção do cateter central de inserção periférica neonatal. MÉTODO: O protocolo foi construído seguindo as recomendações do Instituto Joanna Briggs (JBI), atendendo às diretrizes Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). A revisão de escopo descreverá e mapeará as evidências científicas relativas à manutenção do cateter central de inserção periférica neonatal presentes nas literaturas nacionais e internacionais.

OBJECTIVE: To map and synthesize the evidence regarding the care provided by nurses for the maintenance of neonatal peripherally inserted central catheters. METHOD: The protocol was developed following the Joanna Briggs Institute (JBI) recommendations, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. The scoping review will describe and map the scientific evidence of maintaining neonatal peripherally inserted central catheters from the national and international literature.

Facteurs associés à la mortalité des urgences chirurgicales néonatales à Douala / Determinants of mortality of neonatal surgical emergencies in Douala

Introduction. Les urgences chirurgicales néonatales (UCN) se manifestent de la naissance au 28e jour de vieet nécéssitent un traitement chirurgical dans un délai court. L'objectif de ce travail est d'identifier les facteurs associés à la mortalité des UCN dans quatre hôpitaux de la ville de Douala.Méthodologie. Nous avons mené une étude transversale analytique avec collecte de données rétrospective sur une période de 10 ans, allant du 1er Janvier 2013 au 31 Décembre 2022 dans 4 hôpitaux de la ville de Douala à savoir: l'Hôpital Général, l'Hôpital Laquintinie, l'Hôpital Gynéco-obstétrique et pédiatrique de Yassa, et l'Hôpital Protestant de Ndogbati. Résultats.Laprévalence hospitalièredes urgences chirurgicales néonatalesétait de6,1%. La tranche d'âge la plus représentée était celle de 2 à 7 jours avec un sex-ratio de 1,7. La mortalité était de 48%avec une majorité de décès en post-opératoire (64,4%).Les déterminants de mortalité sur le plan sociodémographique étaient : l'âge à l'admission inférieur à 8 jours (OR= 1,95 ; P<0,001), le sexe masculin (OR=1,51 ; P=0,002); la moyenne prématurité (OR=0,91 ; P<0,001), le poids de naissance < 2500g (OR= 5,15 ; P=0,009), et le délai d'admission > 2 jours (OR=0,73 ; P<0,001). Sur le plan évolutif, les facteurs de mauvais pronostic étaient : les malformations anorectales (OR=2,23; P< 0,001), l'atrésie de l'œsophage (OR=3,63 ; P=0,001), la présence de complications post opératoires (OR= 3,45 ; P<0,001) et le sepsis (OR= 7,87; P=0,037).ConclusionLa mortalité post opératoire est très élevée. Les facteurs associés sont le long délai diagnostic, la prématurité, les pathologies malformatives digestives et le seps

Introduction.Neonatal surgical emergencies (NSE) occur from birth to the 28th day of life and require surgical treatment within a short timeframe. The objective of this study is to identify factors associated with mortality in NSE in four hospitals in the city of Douala. Methodology.We conducted a cross-sectional analytical study with retrospective data collection over a period of 10 years, from January 1st, 2013 to December 31st, 2022, in 4 hospitals in the city of Douala, namely: General Hospital, Laquintinie Hospital, Gynecological-Obstetric and Pediatric Hospital of Yassa, and Protestant Hospital of Ndogbati. Results.The hospital prevalence of neonatal surgical emergencies was 6.1%. The most represented age group was 2 to 7 days with a sex ratio of 1.7. The mortality rate was 48%, with a majority of deaths occurring in the post-operative period (64.4%). Sociodemographic determinants of mortality were: age at admission less than 8 days (OR=1.95; P<0.001), male sex (OR=1.51; P=0.002); moderate prematurity (OR=0.91; P<0.001), birth weight < 2500g (OR=5.15; P=0.009), and admission delay > 2 days (OR=0.73; P<0.001). In terms of progression, factors associated with poor prognosis were: anorectal malformations (OR=2.23; P<0.001), esophageal atresia (OR=3.63; P=0.001), presence of post-operative complications (OR=3.45; P<0.001), and sepsis (OR=7.87; P=0.037). Conclusion Post-operative mortality is very high. Associated factors include delayed diagnosis, prematurity, digestive malformative pathologies, and sepsis.

Profil épidémiologique et facteurs associés à l'ictère néonatal chez les nouveau-nés malades, hospitalisés aux Cliniques Universitaires de Kinshasa / Epidemiological profile and factors associated with neonatal jaundice in sick newborns attending Kinshasa University Hospital

Contexte et objectifs. L'ictère néonatal est un symptôme fréquent. L'objectif de la présente étude était d'actualiser le profil épidémiologique et d'identifier les facteurs associés à l'ictère néonatal chez les nouveau-nés malades. Méthodes. Une étude transversale descriptive a été menée de juin 2022 à avril 2023 aux Cliniques Universitaires de Kinshasa. L'étude a concerné les nouveau-nés malades ayant présenté un ictère cutanéomuqueux. Les variables sociodémographiques, périnatales, cliniques et paracliniques ont été recherchées. Résultats. Sur 152 nouveau-nés malades, 102 (67,1%) cas d'ictère ont été identifiés. Les nouveau-nés à terme (72,5%), nés par voie basse (67,6%) et dont les mères avaient présenté des infections uro-génitales (98%) et de groupe sanguin O (53%) rhésus positif (97,1%) étaient les plus représentés. L'ictère s'est manifesté dans la première semaine de vie (85,3 %). La bilirubine sérique totale initiale se situait entre 10 et 15 mmol/L (57,8 %). L'origine infectieuse était notée dans 85 % des cas (Klebsiella pneumoniae dans 50 % des cas). La photothérapie conventionnelle a été utilisée chez 74,5 %. L'accouchement par voie basse était le seul facteur associé (p=0,001). Conclusion : L'ictère néonatal est fréquent chez les nouveau-nés malades. L'étiologie infectieuse doit être recherchée systématiquement. Une prise en charge appropriée permet de réduire la survenue de séquelles neurosensorielles.

Context and objective. Neonatal jaundice is a common symptom. The objective of the present study was to update the epidemiological profile and identify the factors associated with neonatal jaundice in sick newborns. Methods. A descriptive cross-sectional study was conducted from June 2022 to April 2023 at the Kinshasa University Hospital. The study included sick newborns who presented with mucocutaneous jaundice. Sociodemographic, perinatal, clinical and paraclinical variables were sought. Results. Out of 152 sick newborns, 102 (67.1 %) cases of jaundice were identified. Fullterm newborns (72.5 %), born vaginally (67.6 %) and whose mothers had presented with urogenital infections (98 %) and blood group O (53 %) rhesus positive (97.1 %) were the most represented. Jaundice appeared in the first week of life (85.3 %). Baseline total serum bilirubin was between 10 and 15 mmol/L (57.8 %). The infectious origin was noted in 85 % of cases (Klebsiella pneumoniae in 50 % of cases). Conventional phototherapy was used in 74.5 %. Vaginal delivery was the only associated factor (p=0.001). Conclusion. Neonatal jaundice is common in sick newborns. The infectious etiology must be systematically sought. Appropriate management helps reduce the occurrence of neurosensory aftereffects.

Assessment of the implementation of respectful maternity care charter in North Central Nigeria (Federal Capital Territory and Kwara State): study protocol

Respectful Maternity Care (RMC) charter is one of the tools for ensuring quality of care in maternity services. Nigeria is a signatory to RMC charter; therefore, the charter is expected to be the standard of care. However, in Nigeria and other countries, reports of disrespectful maternity care abound; this discourages women from accessing facility-birth. Therefore, to improve the quality of care towards increase in uptake, it is expedient to assess the level of implementation of the RMC charter by key stakeholders for sustainability, impact and scale-up of charter-compliant maternity care in Nigeria. The study aims to assess the implementation of RMC charter in North-central Nigeria. The study is a mixed-method, cross-sectional study; the expected participants are key stakeholders in healthcare (Healthcare workers, Healthcare Administrators, Project Managers, Policy makers) in North-Central Nigeria (Federal Capital Territory and Kwara state). A multistage sampling technique would be used to enroll participants from 18 healthcare facilities (Primary, Private, Secondary and Tertiary) in rural and urban areas and Ministries of Health officials at local and state government levels. Expected outcomes: The study is expected to provide information on the current status of knowledge and implementation of the RMC charter in Nigeria. It would also identify the enablers and barriers to the implementation process and provide evidence for effective scale-up of the process in Nigeria. The outcomes will be widely disseminated to healthcare workers, health administrators and decision-makers in healthcare services through post-study meetings, conference presentations, journal publications and policy briefs for effective RMC charter implementation in Nigeria.

Pronostic immédiat des nouveaux nés de poids extrêment faible à l'hôpital Saint Camille de Ouagadougou de 2017 à 2021 / Immediate Prognostic of Extremely Low Weight Newborns at Saint Camille Hospital in Ouagadougou From 2017 To 2021

Les prématurés d'extrême faible poids de naissance, constituent un problème de santé publique dans les pays en voie de développement. L'étude avait pour objectif d'évaluer le pronostic immédiat des nouveau-nés de poids de naissance extrêmement faible hospitalisés à l'Hôpital Saint Camille de Ouagadougou (HOSCO). Methode : Il s'est agi d'une étude descriptive et analytique à collecte de données rétrospectives ayant porté sur les nouveau-nés de poids de naissance < 20ans (p=0,013) étaient les facteurs associés à la mortalité. Conclusion : La prise en charge des extrêmes poids de naissance reste difficile à cause des moyens très limités dans nos pays.Des interventions simples comme la mise en place d'un réseau de périnatalité, peuvent améliorer de manière considérable la survie de ces nouveau-nés.

Extremely low birth weight infants are a public health problem in developing countries. The objective of this study was to evaluate the prognosis of extremely low birth weight newborns hospitalized at Saint Camille Hospital in Ouagadougou (HOSCO). Method: This was a descriptive and analytical study with retrospective data collection on newborns with birth weight <1000g in the neonatology department from January 2017 to December 2021. Results: A total of 319 newborns were admitted giving a hospital frequency of 8.62%. Male sex was predominant with a sex ratio of 1.02. The mean age was 0.18 ± 0.71 days. The main signs on admission were hypothermia 88.40% and respiratory distress 92.16%. The evolution was marked by 92.79% of deaths of which 90.20% occurred during the early neonatal period. Hypothermia, birth outside HOSCO and maternal age less than 20 years were the factors associated with mortality. Conclusion: The management of low birth weight remains difficult because of the very limited resources in our countries. Simple and inexpensive interventions can considerably improve the survival of these newborns

A Prospective Cohort Study Investigating Adverse Perinatal Outcomes in Mosul, Iraq, among Women with Grand Multiparity

@#Introduction: This prospective case-control study aimed to compare the incidence of fetomaternal complications between grand multiparous women under the age of 35 and pregnant women with low parity in the same age group. Methods: The study was conducted at Al-khansaa and Al-Batool Teaching Hospitals from October 1, 2020, to June 1, 2021. One hundred pregnant women with singleton pregnancies in all three trimesters, aged between 18 and 34 years, were selected from the outpatient clinic and the ward. The participants were divided into two groups: Group A consisted of 50 grand multiparous women (with five or more deliveries), and Group B comprised 50 pregnant women with low parity (2-4 pregnancies) in the same age group. Results: The study found that gestational diabetes, anemia, meconium-stained amniotic fluid, cesarean section rate, postpartum hemorrhage, and neonatal intensive care unit admissions were significantly higher in the grand multiparity group compared to the low parity group. The mean Apgar scores at 1 and 5 minutes were significantly lower in Group A compared to Group B. Conclusion: The findings suggest that grand multiparity among younger mothers poses additional risks to pregnancy outcomes, including increased rates of gestational diabetes, anemia, postpartum hemorrhage, cesarean section, and neonatal intensive care unit admissions, especially in cases with inadequate antenatal care. The findings of this study underscore the need for further research in this area. Understanding the underlying mechanisms and risk factors associated with grand multiparity among younger mothers can lead to more targeted interventions and improved outcomes.