Catheter-related thrombosis in a neonatal intensive care unit: a case-control study / Trombose relacionada a cateter em unidade de terapia intensiva neonatal: um estudo de caso-controle

INTRODUCTION: Catheter-related thrombosis (CRT) accounts for most thrombotic events in the neonate. OBJECTIVE: Investigate CRT frequency, association with days of catheter use until diagnosis, and number of catheters used, in a single-center Neonatal Intensive Care Unit. METHODS: A case-control study that included 14 cases and 42 controls. Data collection occurred between January 2017 and December 2020 in a public NICU. Crude odds ratios (COR) were calculated. The study complied with ethical standards from national guidelines. RESULTS: Two hundred and ninety-four neonates used central venous catheters, of which 14 (4.7%) were diagnosed with CRT. Catheter in use when diagnosis was made was centrally inserted central catheters in 8 (57.1%). Before diagnosis, the cumulative duration of catheter use was 34.5 days and the median number of catheters used was three. A higher SNAPPE-II (COR 1.03; 95% CI 1.01-1.06; p=0.03), cumulative days of catheter use >30 (COR 19.11; 95% CI 2.28-160.10; p=0.007) and number of catheters used ≥3 (COR 7.66; 95% CI 1.51-38.70; p=0.01) were associated with CRT. CONCLUSION: CRT cases were associated with clinical severity; number of catheters and cumulative days of catheter use. We suggest that screening for thrombosis should be performed in neonates who need a long time of catheter use and more than three catheters. Reducing the duration and number of venous catheters used will help to reduce CRT.

INTRODUÇÃO: A trombose relacionada ao cateter (TRC) é responsável pela maioria dos eventos trombóticos no neonato. OBJETIVO: Investigar a frequência da TRC, a associação com os dias de uso do cateter até o diagnóstico e o número de cateteres utilizados em uma Unidade de Terapia Intensiva Neonatal unicêntrico. MÉTODOS: Estudo caso-controle que incluiu 14 casos e 42 controles. A coleta de dados ocorreu entre janeiro de 2017 e dezembro de 2020 em uma UTIN pública. Foram calculadas razões de chances brutas (COR). O estudo respeitou os padrões éticos das diretrizes nacionais. RESULTADOS: Duzentos e noventa e quatro neonatos utilizaram cateter venoso central, dos quais 14 (4,7%) foram diagnosticados com TRC. O cateter em uso no momento do diagnóstico foi o cateter central inserido centralmente em 8 (57,1%). Antes do diagnóstico, o tempo acumulado de uso do cateter foi de 34,5 dias e a mediana do número de cateteres utilizados foi de três. Um maior número de dias de uso do cateter >30 (COR 19,11; IC 95% 2,28-160,10; p=0,007) e número de cateteres utilizados >3 (COR 7,66; IC 95% 1,51-38,70; p=0,01). CONCLUSÃO: Os casos de TRC foram associados à gravidade clínica; número de cateteres e dias cumulativos de uso do cateter. Sugerimos que o rastreamento de trombose seja realizado em neonatos que necessitem de longo tempo de uso do cateter e mais de três cateteres. Reduzir a duração e o número de cateteres venosos usados ajudará a reduzir a TRC.

Factors associated with early initiation of breastfeeding / Fatores associados ao aleitamento materno na primeira hora de vida

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.

INTRODUÇÃO: O aleitamento materno na primeira hora de vida ainda é pouco estimulado em vários hospitais do Brasil. OBJETIVO: Analisar a prevalência e os fatores associados ao aleitamento materno na primeira hora de vida (AMP) entre recém-nascidos a termo. MÉTODOS: Estudo transversal, de natureza quantitativa, com coleta de dados secundários retrospectivos em prontuários hospitalares de 250 recém-nascidos a termo, independentemente do tipo de parto, com histórico de gestacional de risco habitual, atendidos nos últimos seis meses anteriores ao período de coleta de dados, em uma maternidade pública da Grande São Paulo. Os dados foram coletados entre novembro de 2018 e janeiro de 2019, por meio de roteiro estruturado, mediante aprovação do hospital e do Comitê de Ética em Pesquisa da FMABC (Parecer n.º 2.924.393). O banco de dados e o tratamento estatístico foram realizados através do programa STATA®. Para a análise, utilizou-se proporções e teste qui-quadrado, adotando-se um nível de significância de 5% e 95% o intervalo de confiança. RESULTADOS: A prevalência de AMP foi de 66%. O AMP está associado a anestesia no parto (p<0,001), APGAR menor ou igual a 8 no 1º e 5º minutos (p<0,001) e ao parto cesárea (p<0,001), cuja proporção na amostra foi de 29,2%. Desconforto respiratório (38,82%), hipotonia (24,70%), seguido de condições maternas desfavoráveis (18,82%), mostraram-se como fatores impeditivos para o AMP, embora 90% dos recém-nascidos tenham recebido Apgar 9/10 no 5º minuto. CONCLUSÃO: A prevalência do aleitamento materno precoce é inferior ao recomendado, porém compatível com as proporções de frequência nacional mais recentes.

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.

Comparación del inicio de terapia antirretroviral antes versus durante la gestación como factor de riesgo asociado a resultados neonatales adversos en el tratamiento del VIH en el Hospital de Referencias Regional en Trujillo, periodo 2015-2023 / Comparing starting antiretroviral therapy for hiv before pregnancy versus during pregnancy as a risk factor associated to poor neonatal outcomes in a regional reference hospital in trujillo in 2015-2023

RESUMEN Objetivo: determinar si el inicio de tratamiento antirretroviral (TARV) preconcepción es factor de riesgo para resultados adversos neonatales comparado con el inicio de TARV durante la gestación en el tratamiento de VIH en mujeres mayores de 18 años en Hospital Belén de Trujillo (HBT). Materiales y métodos: estudio analítico, observacional de cohorte retrospectiva. El tamaño muestral estuvo conformado por 168 gestantes con diagnóstico de VIH en tratamiento antirretroviral, divididos en dos grupos: 84 gestantes que inician TARV preconcepción y 84 gestantes que inician TARV después de la gestación. El análisis se realizó con la prueba chi cuadrado y el cálculo del riesgo relativo (RR) con intervalos de confianza al 95% y significancia del 5%. Resultados: la frecuencia de resultados adversos neonatales fue 48,8% en mujeres que iniciaron TARV antes de la concepción y 21,4% en las que iniciaron terapia posconcepción, siendo esta diferencia significativa (p<0,001). Resultados neonatales adversos como el peso bajo al nacer (p=0,015) y recién nacido pequeño para la edad gestacional (p=0,035) se asociaron de manera significativa al inicio de TARV antes de la gestación. Conclusiones: el inicio de TARV antes de la gestación pareciera estar asociado con resultados adversos neonatales comparado con el inicio de TARV durante la gestación, aunque requiere ser ajustado por posibles confusores.

ABSTRACT Objective: To determine whether pre-conception initiation of antiretroviral (ARV) therapy compared to pregnancy ARV initiation is a risk factor for adverse neonatal outcomes in women more than 18 years old in Belen Hospital in Trujillo (BHT). Material and Methods: This is an analytical observational study performed in a retrospective cohort. Sample size was 168 pregnant women diagnosed with HIV infection and receiving antiretroviral (ARV) therapy, who were divided in two groups: 84 women who started ARV prior to conception and 84 who started ARV after conception. The analysis was performed using the Chi-square test and relative risk (RR) was calculated, with 95% confidence intervals (CI) and 5% significance. Results: The rate of adverse neonatal outcomes was 48.8% in women starting ARV after conception and 21.4% in those who started ARV after conception, and this difference was significant (p<0.001). Adverse neonatal outcomes, such as low birthweight (p= 0.015) and being small for gestational age (p= 0.035) were significantly associated with ARV initiation before pregnancy. Conclusion: ARV initiation before pregnancy seems to be associated with adverse neonatal outcomes when compared with ARV initiation during pregnancy, although this may be adjusted for potential confounding factors.

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.

Generation of an induced pluripotent stem cell line from a patient with surfactant metabolism dysfunction carrying ABCA3 mutations / 中华实用儿科临床杂志

Objective:Induced pluripotent stem cells (iPSCs) cell lines were established using peripheral blood mononuclear cells (PBMCs) from a patient suffering from neonatal respiratory distress syndrome (NRDS) who carried Adenosine triphosphate-binding cassette transporter A3 ( ABCA3) compound heterozygous mutations. Methods:Cell experimental research.Peripheral venous blood was collected and PBMCs were isolated and cultured in vitro. PBMCs were transfected with non-integrated Sendai vector carrying reprogramming factors.The chromosome karyotypes of the established iPSCs were analyzed.Immunofluorescence and flow cytometry were used to detect pluripotency markers of stem cells and verify their differentiation potential.Sanger sequencing was performed to analyze gene mutations.In addition, short tandem repeat (STR) analysis was performed, polymerase chain reaction(PCR) and agarose gel electrophoresis were used to detect virus residual. Results:Karyotype analysis of established iPSCs cell lines showed normal diploid 46, XY karyotype.Immunofluorescence showed positive staining of stem cell pluripotency markers OCT4, SSEA4, Nanog and Sox2.Flow cytometry was used to detected stem cell pluripotency markers and showed expression of TRA-1-60, SSEA-4 and OCT4.After differentiation into all three germ layers, immunofluorescence was performed to detect ectoderm (Pax-6), mesoderm (Brachyury) and endoderm alpha-fetoprotein markers, and the results showed positive staining, which confirmed that the iPSCs had the potential to differentiate.Sanger sequencing showed c. 3997_3998del and c. 3137C>T compound heterozygous mutations.STR analysis showed they originate from PBMCs, and no Sendai virus residual was detected by PCR and agarose gel electrophoresis.Conclusions:In this study, PBMCs from patient carrying ABCA3 compound heterozygous mutations was used to establish iPSCs cell lines.The research lays a foundation for the study of pathogenesis, therapeutic drug screening and cell therapy of NRDS caused by ABCA3 gene mutations.

Establishment of a Chinese neonatal model of early-onset sepsis based on the Kaiser Permanente sepsis risk calculator / 中华实用儿科临床杂志

Objective:To construct a Chinese neonatal model of early-onset sepsis (EOS) using the Kaiser Permanente sepsis risk calculator and laboratory indicators and validate its clinical prediction potential.Methods:Newborns with a gestational age of ≥34 weeks, who were hospitalized in the Department of Neonatology, the First Affiliated Hospital of Zhengzhou University from January 2020 to June 2022 were retrospectively recruited.Their clinical data were collected.Predictors were screened via the multivariate regression analysis, and the Nomogram model was constructed using R software and RStudio software.Hosmer-Lemeshow test, receiver operating characteristic curve, the decision curve analysis (DCA) were used to evaluate the prediction potential of the Nomogram.Results:A total of 769 patients were enrolled, including 107 patients in the EOS group (5 culture-confirmed cases and 102 clinically diagnosed cases), and 662 cases in the non-EOS group.Ten variables were screened and introduced into the Nomogram, including the gestational age, birth weight, body temperature, white blood cell count, C-reactive protein, procalcitonin, premature rupture of membranes≥18 h, infection of Group B Streptococcus, ventilator application, and prenatal antibiotics.The predictive model showed good discrimination and consistency, with the area under the curve of 0.834 (95% CI: 0.771-0.896). The DCA of the prediction model showed that it was effective in clinical application within the effective threshold of 6%-95%, with a net benefit following the application of corresponding treatment measures. Conclusions:A Chinese neonatal model of EOS was created by using the Kaiser Permanente sepsis risk calculator and laboratory indicators, which has been validated effective.It provides references for clinical management and the guidance for the use of antibiotics.

Case report of neonatal kaposiform hemangioendothelioma in the spinal canal and mediastinum with Kasabach-Merritt phenomenon / 中华实用儿科临床杂志

Clinical data of one patient diagnosed with kaposiform hemangioendothelioma (KHE) in the spinal canal and mediastinum at the Children′s Hospital, Zhejiang University School of Medicine in October 2022 were retrospectively analyzed.Additionally, a literature review on mediastinal KHE was performed to summarize prior clinical characteristics and treatments.The patient, a 25-day-old boy, presented with refractory thrombocytopenia.Multiple chest radiographs suggested significant widening of the mediastinum and atypical atelectasis in the left upper lung, and enhanced chest CT and magnetic resonance imaging suggested KHE.After cocktail therapy with Prednisolone, Vincristine and Sirolimus, platelets increased to normal, and coagulation function improved.After 3 months of follow-up, hematologic parameters were stable, the mass became smaller, and no side effects occurred.

The value of new coagulation markers in the diagnosis and prognosis evaluation of neonatal disseminated intravascular coagulation / 天津医药

Objective To investigate the value of thrombomodulin(TM),thrombin-antithrombin complex(TAT),α2 plasmin inhibitor-plasmin complex(PIC)and tissue plasminogen activator-inhibitor complex(t-PAIC)in the diagnosis and prognosis of neonatal disseminated intravascular coagulation(DIC).Methods Eighty-seven DIC neonates(the observation group)were included and divided into the survival group(66 cases)and the death group(21 cases)based on their outcomes at discharge.And 50 healthy newborns born in the same period were selected as the control group.The clinical data of neonates were collected,and risk factors of neonatal DIC were analyzed by Logistic regression.The differences of TM,TAT,PIC and t-PAIC levels in different groups were analyzed.The receiver operating characteristic(ROC)curve was used to analyze values of TM,TAT,PIC and t-PAIC in the diagnosis and prognosis of neonatal DIC.Results The incidence of low Apgar score,birth asphyxia,IVH,sepsis and maternal pregnancy induced hypertension syndrome(PIH)were higher in the observation group than those in the control group(P＜0.05).Multivariate Logistic regression analysis showed that low Apgar score,birth asphyxia,sepsis and PIH were independent risk factors for neonatal DIC.TM,TAT,PIC and t-PAIC levels were higher in the observation group than those in the control group(P＜0.05).ROC curve showed that the combined diagnosis value of TM,TAT,PIC and t-PAIC was better than that of single diagnosis of neonatal DIC.TM and TAT levels were higher in the death group than those in the survival group(P＜0.05),and there were no significant differences in PIC and t-PAIC levels between the two groups.Multivariate Logistic regression analysis showed that elevated TAT level was an independent risk factor for neonatal DIC prognosis.ROC curve showed that when TAT was 21.72 μg/L,the area under the curve for predicting neonatal DIC prognosis was 0.772(95%CI:0.666-0.878),and the sensitivity and specificity were 76.2%and 71.2%,respectively.Conclusion The combined application of TM,TAT,PIC and t-PAIC has important clinical value in diagnosis and prognosis evaluation of neonatal DIC.

Predictive value of esophageal deviation index for clinical outcomes of patients with left-sided congenital diaphragmatic hernia / 中华围产医学杂志

Objective:To evaluate the predictive value of postnatal esophageal deviation index for clinical outcomes of fetuses with left-sided congenital diaphragmatic hernia (L-CDH).Methods:This retrospective study analyzed the clinical data of 103 neonates with prenatally diagnosed L-CDH who were admitted to Guangzhou Women and Children's Medical Center from January 2016 to February 2023. These patients were divided into the survival group ( n=82) and the death group ( n=21) according to the outcomes, and the extracorporeal membrane oxygenation (ECMO) group ( n=25) and the non-ECMO group ( n=78) according to whether ECMO support was required. Thoracoabdominal X-ray screening was performed on all neonates within 24 h after admission and the esophageal deviation index and cardiac deviation index were calculated. Independent sample t-test or Fisher's exact probability test were used to analyze the differences in general condition and postnatal imaging features between different groups. Receiver operating characteristic (ROC) curve was used to evaluate the value of postnatal imaging features in predicting the prognosis of L-CDH. Results:The esophageal deviation index and the cardiac deviation index of neonates in the survival group were lower than those in the death group [(10.5±5.3)% vs. (18.0±4.5)%, t=－5.47; (37.7±7.1)% vs. (42.8±8.2)%, t=－2.62; both P<0.05], while that were both higher in the ECMO group compared with the non-ECMO group [(18.0±4.3)% vs. (10.1±5.2)%, t=6.34; (42.4±7.9)% vs. (37.6±7.1)%, t=2.63; both P<0.05]. ROC curve showed that the area under the curve (AUC) for predicting the need for ECMO support was 0.879 (95% CI: 0.805-0.953) for esophageal deviation index and 0.712 (95% CI: 0.570-0.854) for cardiac deviation index, with the optimal cut-off values of 11.7% and 41.7%, respectively. The AUC for predicting the survival rate in patients with L-CDH by esophageal deviation index and cardiac deviation index were 0.854 (95% CI: 0.761-0.947) and 0.735 (95% CI: 0.582-0.887), respectively, with the corresponding optimal cut-off values of 15.8% and 41.7%. Conclusion:Postnatal esophageal deviation index is of value in predicting the need for ECMO support and survival rate in patients with L-CDH.

Umbilical cord milking on neonatal outcomes following cesarean section: a meta-analysis / 中华围产医学杂志

Objective:To evaluate the effect of umbilical cord milking (UCM) on neonatal outcomes after cesarean section.Methods:Chinese and English databases (including CNKI, Wanfang, China Biology Medicine Disc, VIP, Yiigle, PubMed, Embase, CINAHL, Web of Science, the Cochrane Library, and Google Scholar) and ClinicalTrials.gov were retrieved from the inception to July 2023. Randomized controlled trials regarding UCM in neonates from different races who were born by cesarean section were included. The outcomes were postnatal hemoglobin level, hematocrit value, peak serum bilirubin level, phototherapy, cord blood pH value, intraventricular hemorrhage, death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score. The risk of bias among the included studies was confined to low or possible risk according to the Cochrane Risk of Bias Assessment Tool 2.0. RevMan5.3 was used for meta-analysis, and subgroup analysis was performed among neonates with different gestational ages. The certainty of evidence was evaluated using the grades of recommendations assessment, development, and evaluation (GRADE) framework.Results:A total of 11 articles involving 2 347 neonates (1 322 full-term and 1 025 preterm infants) were included. Meta-analysis results showed that: (1) Compared with the immediate cord clamping, UCM increased the hemoglobin level within 24 h and 48-72 h after birth ( MD=1.40, 95% CI: 1.11-1.70, Z=9.32; MD=0.86, 95% CI: 0.69-1.02, Z=10.02, both P<0.01), hematocrit value within 24 h and 48-72 h after birth ( MD=2.73, 95% CI: 0.18-5.29, Z=2.09, P=0.04; MD=3.57, 95% CI: 2.29-4.85, Z=5.46, P<0.01). However, no significant differences were found in the peak bilirubin level, phototherapy, cord blood pH, and Apgar score at 1 and 5 min (all P>0.05). (2) Compared with delayed cord clamping, UCM increased the hemoglobin level ( MD=0.83, 95% CI: 0.75-0.91, Z=20.11, P<0.01) and hematocrit value ( MD=2.34, 95% CI: 1.25-3.43, Z=4.20, P<0.01) within 24 h after birth, but not in the hematocrit value at 48-72 h after birth ( MD=－0.38, 95% CI:－2.27-1.52, Z=0.39, P=0.70) or the peak bilirubin level ( MD=－0.65, 95% CI:－2.16-1.04, Z=0.69, P=0.49). Sensitivity analysis showed that for full-term neonates born by cesarean section, the peak bilirubin level in the UCM group was significantly lower than that in the delayed cord clamping group ( MD=－1.30, 95% CI:－2.26-0.34, Z=2.66, P<0.01). Still, the incidence of phototherapy, intraventricular hemorrhage (grade Ⅰ-Ⅳ), death, polycythemia, neonatal necrotizing enterocolitis, and Apgar score at 1 min and 5 min showed no statistical differences (all P>0.05). Conclusions:UCM could increase the short-term postnatal hemoglobin and hematocrit levels in neonates born by cesarean section, which might prevent neonatal anemia in the short term without increasing the adverse neonatal outcomes. Little effects were observed on the peak bilirubin level, phototherapy, polycythemia, etc. More high-quality and large-sample randomized controlled trials are needed in the future.

Effects of epidural labor analgesia on early neonatal sucking and breastfeeding / 中华围产医学杂志

Objective:To investigate the effects of epidural labor analgesia on neonatal sucking ability and breastfeeding.Methods:This was a prospective cohort study. Convenience sampling was used to enroll women who delivered with or without epidural analgesia (epidural analgesia and non-analgesia groups) in the Affiliated Maternity and Child Health Care Hospital of Nantong University from January 2022 to December 2022. Intra-oral negative pressure values during breastfeeding were measured by a pressure measuring instrument within 3 d after birth (0-24 h, >24-48 h, and >48-72 h), and the mean, maximum, and minimum pressure values were recorded. The Infant Breastfeeding Assessment Tool (IBAT) (Chinese version) was used to evaluate sucking posture. Breastfeeding status during hospitalization and within 1, 4, and 6 months after discharge were followed up. Two independent samples t-test, Chi-square (Fisher's exact) test, and generalized estimating equations were used for data analysis. Results:A total of 156 mother-infant pairs were analyzed in this study, with 78 pairs in the epidural analgesia group and 78 pairs in the non-analgesia group. The whole, first, and second stages of labor were longer in the analgesia group than those in the non-analgesia group [ M( P25- P75), total: 430 min (353-541 min) vs. 300 min (235-422 min), Z=－5.65; first stage: 385 min (310-490 min) vs. 260 min (205-347 min), Z=－5.81; second stage: 40 min (26-67 min) vs. 33 min (18-45 min), Z=－2.33; all P<0.05], and more women in the analgesia group accepted oxytocin and doula before delivery [94.8% (74/78) vs. 43.6% (34/78), χ2=48.15; 42.3% (33/78) vs. 19.2% (15/78), χ2=9.75; both P<0.05]. There was no significant difference in scores on the Fatigue Scale-14, Edinburgh Postnatal Depression Scale, Pittsburgh Sleep Quality Index, and Life Events Scale for Pregnant Women between the two groups. After adjusting for confounding factors by generalized estimating equations, the mean intra-oral negative pressure values in the epidural analgesia group were lower than those in the non-analgesia group at 0-24 h, >24-48 h, and >48-72 h after birth [5.14 (3.39-6.52) vs. 6.39 (4.95-9.15) kPa, 5.07 (3.94-7.38) vs. 6.20 (5.08-8.54) kPa, and 6.19 (4.64-8.36) vs. 6.81 (5.88-8.05) kPa, Wald χ2=5.59, P=0.018]; the peak value in the epidural analgesia group was also lower than that in the non-analgesia group [15.81 (9.74-21.68) vs. 16.21 (13.58- 24.88) kPa, 13.50 (9.83-16.50) vs. 17.62 (14.01-22.40) kPa, and 14.66 (10.47-18.71) vs. 18.04 (15.33- 19.85) kPa, Wald χ2=7.25, P=0.007]; there were no significant differences in the trough value between the two groups. The daily IBAT scores for the sucking position of neonates in the epidural analgesia group were all lower than those in the non-analgesia group in the first three days after delivery [10 (9-10) vs. 10 (10- 11) scores, 10 (9-11) vs. 11 (10-11) scores, and 10 (10-11) vs. 11 (11-12) scores, Wald χ2=17.05, P=0.001]. The rates of early exclusive breastfeeding within postpartum 3 d were also lower in the epidural analgesia group than those in the non-analgesia group [67.9% (53/78) vs. 75.6% (59/78), 41.0% (32/78) vs. 44.9% (35/78), and 38.5% (30/78) vs. 55.1% (43/78), Wald χ2=4.21, P=0.040]. No significant differences were found in the exclusive breastfeeding rates between the two groups at 1, 4, and 6 months after delivery. Conclusion:Epidural labor analgesia can lead to decreased early intra-oral negative pressure in neonates, affect neonatal sucking posture, and reduce the rate of exclusive breastfeeding during hospitalization, but has no significant correlation with the exclusive breastfeeding rate within six months after delivery.

Effect of intrapartum artificial rupture of membrane on maternal and infant outcomes among pregnant women infected with group B streptococcus / 中国基层医药

Objective:To investigate the effect of intrapartum artificial rupture of the membrane on maternal and infant outcomes among pregnant women infected with group B streptococcus (GBS).Methods:A total of 468 women with a singleton pregnancy who had a GBS infection were included in this case-control study. The enrolled women were divided into an artificial membrane rupture group ( n = 155) and a natural membrane rupture group ( n = 313) according to different methods of membrane rupture. Women in the artificial rupture of membrane group received antibiotic treatment after delivery or before membrane rupture, and the incidence of adverse pregnancy outcomes was compared between the two groups. Results:The incidences of chorioamnionitis, puerperal infection, and postpartum hemorrhage in the artificial membrane rupture group were 1.29% (2/155), 6.45% (10/155), and 4.52% (7/155), respectively, while those in the natural membrane rupture group were 1.92% (6/313), 3.83% (12/313), and 1.92% (6/313), respectively. There were no significant differences between the two groups in terms of incidence of chorioamnionitis, puerperal infection, or postpartum hemorrhage between the two groups ( χ2 = 0.01, 1.58, 1.72, all P > 0.05). The incidences of neonatal sepsis, neonatal asphyxia, neonatal GBS infection, and neonatal pneumonia in the artificial membrane rupture group were 0, 1.29% (2/155), 9.68% (15/155), and 0.65% (1/155), respectively, while those in the natural membrane rupture group were 1.60% (5/313), 0.64% (2/313), 11.82% (37/313), and 1.60% (5/313), respectively. There were no significant differences between the two groups in terms of neonatal sepsis, neonatal asphyxia, neonatal GBS infection, and neonatal pneumonia ( χ2 = 1.22, 0.03, 0.48, 0.18 both P > 0.05). Conclusion:Under the premise of effective antibiotic treatment, artificial rupture of membranes for pregnant women infected with GBS does not increase the incidence of adverse pregnancy outcomes. Artificial rupture of membranes technology can be used as an effective supplement to natural rupture of membranes.

Analyses of high-risk factors for poor neurologic prognosis in full-term neonatal purulent meningitis based on clinical and MRI characteristics / 中华放射学杂志

Objective:To analyze high-risk factors for poor neurological prognosis in full-term neonatal purulent meningitis based on clinical and brain MRI features.Methods:This study was a case-control study. The clinical and brain MRI data of 79 neonates with purulent meningitis were retrospectively collected at Beijing Children′s Hospital, Capital Medical University from January 2016 to January 2022. Follow-up assessments including growth and development, as well as neurological sequelae, were conducted over a minimum follow-up period of 6 months. The patients were divided into two groups with good ( n=49) and poor prognosis ( n=30) according to follow-up results. Chi-square tests were used to compare clinical and brain MRI features between the two groups, and a multivariate logistic regression analysis was performed to explore the high-risk factors for poor neurologic prognosis in full-term neonates with purulent meningitis. Results:There were statistically differences between two groups regarding the incidence of seizures, early-onset manifestations, positive cerebrospinal fluid (CSF) culture, CSF white cell counts, and CSF protein concentration ( P<0.05). Statistically differences were also found in the occurrence rates of ependymitis, obvious ventricular dilatation/hydrocephalus, spotty and patchy brain injury/hemorrhage, and destructive lesions within the brain parenchyma ( P<0.05). The results of multivariate logistic regression analysis indicated that seizures ( OR=5.722, 95% CI 1.126-29.072, P=0.035), early-onset neonatal purulent meningitis ( OR=3.657, 95% CI 1.073-12.459, P=0.038), ependymitis ( OR=8.851, 95% CI 1.169-67.017, P=0.035), obvious ventricular dilatation/hydrocephalus ( OR=12.675, 95% CI 1.085-148.110, P=0.043), and destructive lesions within the brain parenchyma ( OR=16.370, 95% CI 1.575-170.175, P=0.019) were independent risk factors for poor prognosis. Conclusions:The occurrence of seizures, early-onset manifestations as well as ependymitis, obvious ventricular dilatation/hydrocephalus, and destructive lesions within the brain parenchyma on MRI are high-risk factors for poor prognosis in the full-term neonate with purulent meningitis.

Ocular manifestation of vertical transmission of dengue: case report / Manifestação ocular de transmissão vertical de dengue: relato de caso

ABSTRACT A 7-week-old male delivered by cesarean section presented with a positive serology for dengue along with preretinal and retinal hemorrhages, vitreous opacities and cotton wool spots. The patient and his mother had positive serologies for Non Structural Protein 1 (NS1) by ELISA. Retinal and vitreous findings improved over a sixteen-week period. Spectral domain optical coherence tomography (OCT) showed preserved macular architecture. In this case report, we suggest that retinal and vitreous changes may be the ocular presenting features of vertically transmitted dengue in newborns, and that those findings may resolve with no major structural sequelae.

RESUMO Neonato de 7 semanas, do sexo masculino, nascido de parto cesárea, apresentou sorologia positiva para dengue com hemorragias retinianas e pré-retinianas, opacidades vítreas e manchas algodonosas. O paciente e sua mãe haviam apresentado sorologias positivas para Non Structural Protein 1 através de ELISA. Achados na retina e no vítreo melhoraram em um período de dezesseis semanas. O exame de tomografia de coerência óptica de domínio espectral demonstrou arquitetura macular preservada. Neste relato de caso, sugerimos que alterações na retina e no vítreo podem ser os achados oculares aparentes em neonatos com infecção vertical por dengue, e que estes podem se resolver sem maiores sequelas estruturais.

Aleitamento materno exclusivo e uso da bolsa canguru em bebês a termo entre o primeiro e segundo mês de idade / Exclusive breastfeeding and the use of kangaroo slings among full-term infants between their first and second months of age / Amamantamiento materno exclusivo y uso de la bolsa canguro en bebés a término entre el primer y segundo mes de edad

Objetivo: verificar a associação entre o uso da bolsa canguru, desde a maternidade até o domicílio, e aleitamento materno exclusivo, entre o 1o e 2o mês de idade, em bebês a termo saudáveis; identificar o nível de autoeficácia para o aleitamento materno, das mães que utilizaram a bolsa canguru. Métodos: estudo transversal com mães que receberam uma bolsa canguru após o parto, na maternidade, e foram orientadas sobre manterem seus bebês nesta postura, pelo menos uma hora por dia. Entre um e dois meses após o nascimento, foram investigadas a frequência do uso da bolsa canguru, autoeficácia materna da amamentação e tipo de alimentação dos bebês. Para análise foi empregado o teste ꭓ2 ou Exato de Fisher e o coeficiente V de Cramer (p < 0,05). Resultados: participaram 98 mães. Todas utilizaram a bolsa canguru no alojamento conjunto, 39,8% utilizaram três ou mais vezes por semana, no domicílio entre o primeiro e segundo mês após o parto; 70,4% dos bebês permaneceram em Aleitamento Materno Exclusivo (AME), o nível da autoeficácia materna para amamentação foi alto. AME esteve associado ao uso da bolsa canguru no domicílio (p = 0,014). Conclusão: bebês a termo saudáveis podem se beneficiar do uso da bolsa canguru desde a maternidade, estendido até o domicílio.

Objectives: to verify the association between kangaroo slings used from maternity hospital to home, and exclusive breastfeeding among healthy full-term babies between the 1st and 2nd months of age; to identify breastfeeding self-efficacy level of those mothers using a kangaroo sling. Method: this cross-sectional study addressed mothers who received a kangaroo sling after giving birth, at maternity hospital, and were instructed to keep the babies in this posture at least one hour daily. The frequency with which the mothers used the kangaroo sling, breastfeeding self-efficacy, and the type of feeding were investigated between one and two months after delivery. ꭓ2 or Fisher's exact test and Cramer's V coefficient (p < 0.05) were adopted in the analysis. Results: ninety-eight mothers participated in the study. All of them used the kangaroo sling in rooming-in; 39.8% used it three or more times a week at home between the 1st and 2nd months after giving birth; 70.4% of the babies remained on Exclusive Breastfeeding (EBF), the level of breastfeeding self-efficacy was high, and EBF was associated with the use of a kangaroo sling at home (p = 0.014). Conclusion: healthy full-term babies can benefit from using a kangaroo sling, starting at the maternity hospital and extending its use to home.

Objetivo: verificar la asociación entre el uso de la bolsa canguro, desde la maternidad hasta el domicilio, y amamantamiento materno exclusivo, entre el 1o e 2o mes de edad, en bebés a término saludables; identificar el nivel de autoeficacia para el amamantamiento materno, de las madres que utilizaron la bolsa canguro. Métodos: estudio transversal con madres que recibieron una bolsa canguro después del parto, en la maternidad, y fueron orientadas sobre mantener sus bebés en esta postura, por lo menos una hora por día. Entre uno y dos meses después del nacimiento, fueron investigadas la frecuencia del uso de la bolsa canguro, autoeficacia materna del amamantamiento y tipo de alimentación de los bebés. Para el análisis fue empleado el test ꭓ2 o Exacto de Fisher y el coeficiente V de Cramer (p < 0,05). Resultados: participaron 98 madres. Todas utilizaron la bolsa canguro en alojamiento conjunto, 39,8% utilizaron tres o más veces por semana, en el domicilio entre el primero y segundo mes después el parto; 70,4%, de los bebés, permaneció en Lactancia Materno Exclusivo (LME); el nivel de la autoeficacia materna para amamantamiento fue alto. El LME estuvo asociado al uso de la bolsa canguro en el domicilio (p = 0,014). Conclusión: bebés a término saludables pueden beneficiarse del uso de la bolsa canguro desde la maternidad, extendido hasta el domicilio.

Bundle para regulação da temperatura corporal de recém-nascidos maiores de 34 semanas: construção e validação / Bundle for regulating the body temperature of newborns over 34 weeks: Construction and validation / Paquete para regular la temperatura corporal de recién nacidos de más de 34 semanas: construcción y validación

Objetivo: Descrever o processo de construção e validação de um bundle para promoção da regulação da temperatura corporal de recém-nascidos maiores de 34 semanas. Métodos: Pesquisa metodológica executada em três etapas: revisão de escopo, construção da primeira versão do bundle e validação de conteúdo realizada por 15 experts, sendo nove enfermeiros e seis médicos, selecionados conforme critérios adaptados de referencial na área. O índice de validade de conteúdo acima de 0,80 foi considerado aceitável para a concordância entre os experts sobre cada cuidado. Foram necessárias duas rodadas de avaliação para a confecção da versão final. Resultados: O bundle foi estruturado em cuidados: na sala de parto, no transporte e no alojamento conjunto, com total de 15 itens, todos com concordância acima de 0,90 após a segunda rodada de avaliação. Conclusão: O bundle elaborado foi considerado válido quanto ao conteúdo e estabelece cuidados baseados em evidências científicas de maneira padronizada e segura para a equipe de assistência ao parto.

Objective: Describe the process of building and validating a bundle to promote body temperature regulation in newborns over 34 weeks of age. Methods: This methodological research was carried out in three stages: a scoping review, construction of the first version of the bundle, and content validation by 15 experts, nine nurses and six physicians, selected according to criteria adapted from references in the field. A content validity index above 0.80 was considered acceptable for the agreement among the experts on each type of care. Two rounds of evaluation were required to produce the final version. Results: The bundle was structured into care in the delivery room, during transportation, and in the rooming- in unit, with a total of 15 items, all with agreement above 0.90 after the second round of evaluation. Conclusion: The bundle developed was considered valid in terms of content and establishes care based on scientific evidence in a standardized and safe way for the childbirth care team.

Objetivo: Describir el proceso de creación y validación de un paquete para promover la regulación de la temperatura corporal en recién nacidos de más de 34 semanas de edad. Métodos: Investigación metodológica realizada en tres etapas: una revisión del alcance, la construcción de la primera versión del paquete y la validación del contenido llevada a cabo por 15 expertos, nueve enfermeras y seis médicos, seleccionados según criterios adaptados a partir de referencias en la materia. Se consideró aceptable un índice de validez de contenido superior a 0,80 para el acuerdo entre los expertos sobre cada tipo de atención. Fueron necesarias dos rondas de evaluación para elaborar la versión final. Resultados: El paquete se estructuró en cuidados: en la sala de partos, durante el transporte y en la unidad de alojamiento, con un total de 15 ítems, todos ellos con una concordancia superior a 0,90 tras la segunda ronda de evaluación. Conclusión: El paquete se consideró válido en cuanto a su contenido y establece una atención basada en pruebas científicas de forma estandarizada y segura para el equipo de atención al parto.

Prevalence of exclusive breastfeeding up to six months of age in full-term newborns during the pandemic and factors associated with early weaning / Prevalência de aleitamento materno exclusivo até seis meses de vida em bebês nascidos a termo em período da pandemia e fatores associados ao desmame precoce

ABSTRACT Purpose: to investigate the prevalence of exclusive breastfeeding up to 6 months old in full-term newborns at a public hospital and the main factors associated with early weaning, during the pandemic caused by severe acute respiratory syndrome. Methods: an observational, cross-sectional study with 98 mothers of full-term babies, conducted from January to August 2021, during the COVID-19 pandemic. The participants answered two structured questionnaires. One was applied immediately after childbirth, with questions on identification and socioeconomic data, obstetric-gynecological background, and current pregnancy and childbirth. The second questionnaire, applied 6 months after childbirth, had questions about the child's feeding status. Statistical tests were used to associate the prevalence of exclusive breastfeeding up to 6 months old and other variables, at the 5% significance level. Results: 16.3% of the babies were exclusively breastfeeding until the sixth month, during the COVID-19 pandemic, in the public hospital where the study was carried out. Exclusive breastfeeding up to 6 months old was not associated with the study variables. Conclusion: the prevalence of exclusive breastfeeding until the sixth month in full-term babies, in a public hospital, during the COVID-19 pandemic, was 16.3%. None of the variables analyzed was associated with early weaning.

RESUMO Objetivo: investigar a prevalência de aleitamento materno exclusivo aos seis meses de vida em bebês nascidos a termo em um hospital público e os principais fatores associados ao desmame precoce em período de pandemia causada pela síndrome respiratória aguda grave. Métodos: estudo observacional, transversal, realizado com 98 mães de bebês a termo, no período de janeiro a agosto de 2021, intervalo marcado pela pandemia da COVID-19. As participantes responderam a dois questionários, um no pós-parto imediato, com questões de identificação e socioeconômicas, antecedentes gineco-obstétricos, gestação e parto atual; e, o segundo, seis meses após o parto, continha questões sobre a situação alimentar da criança. Para verificar a associação entre a prevalência do aleitamento materno exclusivo aos seis meses de vida e as demais variáveis foram aplicados os testes Qui-quadrado, Exato de Fisher, Qui-quadrado de comparações múltiplas e Teste T, com nível de significância de 5%. Resultados: 16,3% dos lactentes encontravam-se em aleitamento materno exclusivo no sexto mês, no período da pandemia da COVID-19, no hospital público onde o estudo foi realizado. Não houve associação entre o aleitamento materno exclusivo aos seis meses de vida e as variáveis pesquisadas. Conclusão: a prevalência de amamentação exclusiva no sexto mês em bebês nascidos a termo em um hospital público, durante a pandemia da COVID-19, foi de 16,3% e nenhuma das variáveis analisadas apresentou associação com o desmame precoce.

Mode of delivery according to Robson classification and perinatal outcomes in restricted and small for gestational age fetuses

Abstract Objective To evaluate the mode of delivery according to Robson classification (RC) and the perinatal outcomes in fetal growth restriction (FGR) and small for gestational age (SGA) fetuses. Methods Retrospective cohort study by analyzing medical records of singleton pregnancies from two consecutive years (2018 and 2019). FGR was defined according to Delphi Consensus. The Robson groups were divided into two intervals (1-5.1 and 5.2-10). Results Total of 852 cases were included: FGR (n = 85), SGA (n = 20) and control (n=747). FGR showed higher percentages of newborns < 1,500 grams (p<0.001) and higher overall cesarean section (CS) rates (p<0.001). FGR had the highest rates of neonatal resuscitation and neonatal intensive care unit admission (p<0.001). SGA and control presented higher percentage of patients classified in 1 - 5.1 RC groups, while FGR had higher percentage in 5.2 - 10 RC groups (p<0.001). FGR, SGA and control did not differ in the mode of delivery in the 1-5.1 RC groups as all groups showed a higher percentage of vaginal deliveries (p=0.476). Conclusion Fetuses with FGR had higher CS rates and worse perinatal outcomes than SGA and control fetuses. Most FGR fetuses were delivered by cesarean section and were allocated in 5.2 to 10 RC groups, while most SGA and control fetuses were allocated in 1 to 5.1 RC groups. Vaginal delivery occurred in nearly 60% of FGR allocated in 1-5.1 RC groups without a significant increase in perinatal morbidity. Therefore, the vaginal route should be considered in FGR fetuses.