Assessment of maternal knowledge of solar exposure and vitamin D in the neonatal period / Avaliação do conhecimento materno sobre exposição solar e vitamina D no período neonatal

ABSTRACT Objective: To assess mothers' knowledge on sun exposure related to serum vitamin D levels in the neonatal period. Methods: Observational, analytical and cross-sectional study, carried out from August 2020 to May 2021 through a questionnaire directed to mothers of newborns, in a maternity hospital in Southern Brazil. Results: From 141 interviewees, 132 (93.6%) believe it is important to expose the neonate to sun, 101 (71.6%) think this exposure can increase vitamin D levels, 86 (61%) received such information from a doctor, 108 (76.6%) believe there are no risks of sun exposure, 88 (62.4%) claim it isn´t necessary to use any kind of protection, 96 (68.1%) said that only exposure to the sun was necessary to maintain adequate levels of vitamin D during the neonatal period. Only two mothers (1.4%) claim that you should not exposure the neonate to the sun, and only one (0.7%) stated that sun expose can cause skin problems. Conclusions: Most mothers lack satisfactory knowledge about sun exposure related to serum vitamin D levels in the neonatal period. The need to inform and clarify the population about sun exposure during this period is remarkable, in addition to disseminating the proper way to maintain serum levels of vitamin D.

RESUMO Objetivo: Avaliar o conhecimento das mães acerca da exposição solar relacionada com níveis séricos de vitamina D no período neonatal. Métodos: Estudo observacional, analítico e transversal, realizado de agosto de 2020 a maio de 2021 por meio de questionário dirigido às mães de recém-nascidos, em uma maternidade no sul do Brasil. Resultados: De 141 entrevistadas, 132 (93,6%) acreditam ser importante expor o lactente ao sol no primeiro mês de vida, 101 (71,6%) acham que essa exposição aumenta os níveis de vitamina D, 86 (61,0%) receberam tal informação de um médico, 108 (76,6%) acreditam que expor o neonato ao sol não causa riscos para a saúde, 88 (62,4%) acham que não é necessário usar proteção contra radiação solar ao expor o neonato ao sol, e 96 (68,1%) afirmaram que apenas a exposição ao sol basta para manter os níveis adequados de vitamina D durante o período neonatal. Apenas duas mães (1,4%) afirmaram que não se deve expor o neonato ao sol e uma (0,7%) que a exposição solar pode causar problemas de pele. Conclusões: A maioria das mães não possui conhecimento satisfatório acerca da exposição solar relacionada aos níveis séricos de vitamina D no período neonatal. É notável a necessidade de informar e esclarecer a população sobre a exposição solar nesse período, além de disseminar a maneira adequada de manter os níveis séricos de vitamina D.

Revisão de literatura sobre os aspectos fisiológicos e nutricionais em bezerros alimentados com colostro acidificado / Literature review on physiological and nutritional aspects in calves fed acidified colostrum / Revisión de la literatura sobre aspectos fisiológicos y nutricionales en terneros alimentados con calostro acidificado

A colostragem é essencial para a saúde dos bezerros neonatos, uma vez que não há a transferência de imunidade através da placenta, ou seja, o contato inicial do organismo com anticorpos se dá através da primeira mamada, onde há transferência da imunidade passiva. Sendo assim, o objetivo do trabalho é revisar os benefícios da acidificação ou silagem do colostro para otimizar a conservação da dieta líquida em fazendas; analisar o impacto no desempenho de bezerros em comparação com o colostro tradicional refrigerado em aleitamentos convencionais. O volume ideal preconizado é, no mínimo, 10% do peso vivo do animal nas primeiras duas horas e mais 5% do peso vivo nas seis a oito horas seguintes a primeira ingestão, para que se obtenha um bom desenvolvimento durante o crescimento, caso contrário, a falta da administração do colostro nas primeiras horas de vida predispõe enfermidades, tais como pneumonia e diarreia, prejudicando assim a saúde e consequentemente o desempenho em relação a outros animais que receberam uma colostragem adequada. Problemas com a qualidade do colostro surgem devido ao armazenamento inadequado, especialmente em propriedades sem refrigeração. A falta de sistemas de congelamento resulta em administração de leite em temperatura ambiente por períodos prolongados, prejudicando assim a imunidade e nutrição dos bezerros durante a colostragem. Todavia, há alternativas para o problema tal como o fornecimento de silagem de colostro. Em alguns casos, o processo de acidificação demanda a adição de ácidos no leite, a fim de evitar o crescimento de microrganismos patogênicos. O principal aspecto positivo do leite acidificado é a manutenção em temperatura ambiente, ou seja, não há a necessidade de passar por processos de refrigeração.

Colostrum is essential for the health of newborn calves, since there is no transfer of immunity through the placenta, that is, the body's initial contact with antibodies occurs through the first feeding, where there is a transfer of passive immunity. Therefore, the objective of the work is to review the benefits of acidifying or colostrum silage to optimize the conservation of liquid diets on farms; analyze the impact on calf performance compared to traditional refrigerated colostrum in conventional sucklers. The recommended ideal volume is at least 10% of the animal's live weight in the first two hours and a further 5% of its live weight in the six to eight hours following the first ingestion, so that good development is achieved during growth, otherwise, the lack of colostrum administration in the first hours of life predisposes diseases, such as pneumonia and diarrhea, thus harming health and consequently performance in relation to other animals that received adequate colostrum. Problems with colostrum quality arise due to inadequate storage, especially in unrefrigerated properties. The lack of freezing systems results in milk being administered at room temperature for prolonged periods, thus damaging the calves immunity and nutrition during colostrum. However, there are alternatives to the problem such as the supply of colostrum silage. In some cases, the acidification process requires the addition of acids to the milk in order to prevent the growth of pathogenic microorganisms. The main positive aspect of acidified milk is that it remains at room temperature, that is, there is no need to undergo refrigeration processes.

El calostro es esencial para la salud de los terneros recién nacidos, ya que no existe transferencia de inmunidad a través de la placenta, es decir, el contacto inicial del cuerpo con los anticuerpos ocurre a través de la primera alimentación, donde existe una transferencia de inmunidad pasiva. Por lo tanto, el objetivo del trabajo es revisar los beneficios de acidificar o ensilar el calostro para optimizar la conservación de dietas líquidas en granjas; analizar el impacto en el rendimiento de los terneros en comparación con el calostro refrigerado tradicional en lechones convencionales. El volumen ideal recomendado es al menos el 10% del peso vivo del animal en las dos primeras horas y otro 5% de su peso vivo en las seis a ocho horas siguientes a la primera ingesta, para que se consiga un buen desarrollo durante el crecimiento, en caso contrario. la falta de administración de calostro en las primeras horas de vida predispone a enfermedades, como neumonía y diarrea, perjudicando la salud y consecuentemente el rendimiento en relación a otros animales que recibieron el calostro adecuado. Los problemas con la calidad del calostro surgen debido a un almacenamiento inadecuado, especialmente en propiedades no refrigeradas. La falta de sistemas de congelación provoca que la leche se administre a temperatura ambiente durante períodos prolongados, dañando así la inmunidad y la nutrición de los terneros durante el calostro. Sin embargo, existen alternativas al problema como el suministro de ensilaje de calostro. En algunos casos, el proceso de acidificación requiere la adición de ácidos a la leche para evitar el crecimiento de microorganismos patógenos. El principal aspecto positivo de la leche acidificada es que se mantiene a temperatura ambiente, es decir, no es necesario someterse a procesos de refrigeración.

Infección congénita por citomegalovirus en neonatos muy bajo peso / Congenital cytomegalovirus infection in very low birth weight neonates

Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 por ciento (6/61). El 5 por ciento de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 por ciento de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 por ciento de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 por ciento). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 por ciento se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección(AU)

Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10 percent (6/61). 5 percent of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10 percent of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83 percent of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67 percent). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33 percent of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection(AU)

A case of neonatal Netherton syndrome / 中国当代儿科杂志

A male infant, aged 6 days, was admitted to the hospital due to respiratory distress and systemic desquamative rash after birth. The infant presented with erythema and desquamative rash, respiratory failure, recurrent infections, chronic diarrhea, hypernatremic dehydration, and growth retardation. Comprehensive treatment, including anti-infection therapy, intravenous immunoglobulin administration, and skin care, resulted in improvement of the rash, but recurrent infections persisted. Second-generation sequencing revealed a homozygous mutation in the SPINK5 gene, consistent with the pathogenic variation of Netherton syndrome. The family opted for palliative care, and the infant died at the age of 2 months after discharge. This report documents a case of Netherton syndrome caused by the SPINK5 gene mutation in the neonatal period, and highlights multidisciplinary diagnosis and therapy for this condition.

Research progress on brain functional near-infrared spectroscopy technology in the field of neonates / 中国当代儿科杂志

Functional near infrared spectroscopy (fNIRS) is an emerging neuroimaging tool that reflects the activity and function of brain neurons by monitoring changes in brain oxygen metabolism based on the neurovascular coupling mechanism. It is non-invasive and convenient, especially suitable for monitoring neonatal brain function. This article provides a comprehensive review of research related to the developmental patterns of brain networks concerning language, music, and emotions in neonates using fNIRS. It also covers brain network imaging in neonatal care, resting-state brain network connectivity patterns, and characteristics of brain functional imaging in disease states of neonates using fNIRS.

Disease spectrum and pathogenic genes of inherited metabolic disorder in Gansu Province of China / 中国当代儿科杂志

OBJECTIVES@#To investigate the disease spectrum and pathogenic genes of inherited metabolic disorder (IMD) among neonates in Gansu Province of China.@*METHODS@#A retrospective analysis was conducted on the tandem mass spectrometry data of 286 682 neonates who received IMD screening in Gansu Provincial Maternal and Child Health Hospital from January 2018 to December 2021. A genetic analysis was conducted on the neonates with positive results in tandem mass spectrometry during primary screening and reexamination.@*RESULTS@#A total of 23 types of IMD caused by 28 pathogenic genes were found in the 286 682 neonates, and the overall prevalence rate of IMD was 0.63 (1/1 593), among which phenylketonuria showed the highest prevalence rate of 0.32 (1/3 083), followed by methylmalonic acidemia (0.11, 1/8 959) and tetrahydrobiopterin deficiency (0.06, 1/15 927). In this study, 166 variants were identified in the 28 pathogenic genes, with 13 novel variants found in 9 genes. According to American College of Medical Genetics and Genomics guidelines, 5 novel variants were classified as pathogenic variants, 7 were classified as likely pathogenic variants, and 1 was classified as the variant of uncertain significance.@*CONCLUSIONS@#This study enriches the database of pathogenic gene variants for IMD and provides basic data for establishing an accurate screening and diagnosis system for IMD in this region.

Interpretation of 2023 American Heart Association and American Academy of Pediatrics focused update on neonatal resuscitation guidelines / 中国当代儿科杂志

In November 2023, the American Heart Association and the American Academy of Pediatrics jointly released key updates to the neonatal resuscitation guidelines based on new clinical evidence. This update serves as an important supplement to the "Neonatal resuscitation: 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care". The aim of this paper is to outline the key updates and provide guidance on umbilical cord management and the selection of positive pressure ventilation equipment and its additional interfaces in neonatal resuscitation.

Traumatismos en neonatos que acuden al departamento de emergencias pediátricas: frecuencia, mecanismos y formas de presentación

Introduccion: La Organización Mundial de la Salud (OMS) estima que aproximadamente 100 niños mueren cada hora a causa de lesiones traumáticas. Objetivo: Describir la frecuencia, mecanismos y tipos de traumatismos en los neonatos en el departamento de emergencias pediátricas de un hospital. Materiales y métodos: Estudio observacional, descriptivo, transversal, ambispectivo. Se incluyeron neonatos con diagnóstico de traumatismo que acudieron al departamento de emergencias pediátricas de un hospital desde enero del 2015 a diciembre del 2019. Variables: edad, sexo, procedencia, peso de nacimiento, edad gestacional, tipo de parto, mecanismo y tipo de traumatismo y evolución, Los datos se analizaron en SPSS. El protocolo fue aprobado por el comité de ética. Resultados: Fueron incluidos 90 neonatos, la frecuencia de traumatismo fue del 1,4%, la media de la edad fue de 14,6 ±7,7 días. El 92% nacieron por parto vaginal ,27% macrosómicos. El mecanismo del trauma fue obstétrico en 75,6%, accidentes en la casa 23,3 %y 1 caso de accidente de tránsito. Los tipos de lesiones fueron fracturas de huesos largos, en 47,8%, lesión del plexo braquial 15,5% y traumatismo cráneo encefálico 13,33%. Fueron hospitalizados el 10%. Conclusiones: La frecuencia de traumatismo neonatal en la urgencia pediátrica fue del 1,4%. La edad media fue 14,6 ±7,7dias. El 75,6% fue de origen obstétrico y 23,3% accidentes en la casa y 1 caso de accidente de tránsito. Los tipos de lesiones fueron fracturas de huesos largos, 47,8%, lesión del plexo braquial 15,5% y 13,3% traumatismo cráneo encefálico 13,3%.

Introduction: The World Health Organization (WHO) estimates that approximately 100 children die every hour from traumatic injuries. Objective: To describe the frequency, mechanisms and types of trauma in neonates in the pediatric emergency department of a hospital. Materials and methods: This was an observational, descriptive, transversal, and ambispective study. Neonates with a diagnosis of trauma who presented to the pediatric emergency department of a hospital from January 2015 to December 2019 were included. Variables: age, sex, town of origin, birth weight, gestational age, type of delivery, mechanism and type of trauma and evolution, Data were analyzed in SPSS. The protocol was approved by the ethics committee. Results: 90 neonates were included, the frequency of trauma was 1.4%, the mean age was 14.6 ±7.7 days. 92% were born by vaginal delivery, 27% were macrosomic at birth. The mechanism of trauma was obstetric in 75.6%, accidents at home in 23.3% and there was 1 case of a traffic accident. The types of injuries were long bone fractures, seen in 47.8%, brachial plexus injury in 15.5%, and head trauma in 13.33%. 10% were hospitalized. Conclusions: The frequency of neonatal trauma in the pediatric emergency was 1.4%. The mean age was 14.6 ±7.7 days. 75.6% were obstetric in origin and 23.3% were accidents at home and 1 case of a traffic accident. The types of injuries were long bone fractures in 47.8%, brachial plexus injury in 15.5%, and head trauma in 13.3%.

Prácticas y creencias con el uso de plantas medicinales en lactantes de San Andrés Isla

Introducción: El uso de plantas medicinales es parte de la cultura tradicional de muchas poblaciones alrededor del mundo, se utilizan para prevenir enfermedades y preservar la salud de los individuos, siendo un conocimiento que conservan las madres y abuelas para el cuidado de la primera infancia. Sin embargo, existen muchos vacíos en la investigación con respecto al uso y propiedades de plantas medicinales en lactantes y población general. Objetivo: Analizar y describir las prácticas y creencias con el uso ancestral de plantas medicinales en lactantes de la comunidad raizal en San Andrés Isla. Materiales y métodos: Estudio cualitativo descriptivo etnográfico aplicado a una muestra por conveniencia de ocho abuelas de la comunidad Raizal de San Andrés Isla. Se realizó la descripción y el análisis de las ideas, prácticas sociales, comportamientos, creencias, significados y conocimientos en torno al uso de plantas medicinales en lactantes. Resultados: Aún se conservan los conocimientos ancestrales con el uso de plantas medicinales liderado por las abuelas. El uso de plantas medicinales en lactantes se rige únicamente por la necesidad de manejo de situaciones de salud. En esta investigación se encontraron 23 ejemplares de plantas medicinales de uso en lactantes, de estas son pocas las que se encuentran registradas en el vademécum colombiano de plantas medicinales. Discusión: Los hallazgos concuerdan con los resultados de otros estudios que evidencian la importancia de la tradición cultural en el cuidado de los lactantes, el protagonismo de la experiencia acumulada de las abuelas en estos saberes y prácticas; además de corroborar que el uso de plantas medicinales en lactantes se rige únicamente por la necesidad de cuidado ante situaciones de salud que lo ameritan. Solo dos ejemplares de las plantas medicinales clasificadas por las mujeres raizales de este estudio se encuentran referenciadas en el vademécum colombiano de plantas medicinales. Conclusiones: Las plantas medicinales abordan un amplio espectro de usos y propiedades que necesitan un extenso estudio para su registro y divulgación.

Introduction: The use of medicinal plants is part of the traditional culture of many populations around the world. Used to prevent diseases and preserve the health of individuals, it is a knowledge that mothers and grandmothers keep for early childhood care. However, there are many gaps in research regarding the use and properties of medicinal plants in infants and the general population. Objective: Analyze and describe the practices and beliefs with the ancestral use of medicinal plants in infants by the Raizal community in San Andrés Island. Materials and methods: It's a qualitative study with a descriptive ethnographic design applied to a convenience sample of 8 grandmothers from the Raizal community of San Andrés Island. We made out a description and analysis of the ideas, social practices, behaviors, beliefs, meanings, and knowledge about the uses of medicinal plants on infants. Results: The ancestral knowledge of medicinal plants use led by the grandmothers still persevered. The use of medicinal plants on infants administers only to the need of health situations. The investigation found 23 specimens of medicinal plants used in infant breastmilk, just a few plants found in this study are registered in the Colombian Vademecum of medicinal plants. Discussion: The findings agree with the results of other studies that show the importance of cultural traditions in the care of infants, the role of the accumulated experience of grandmothers in this knowledge and practices. In addition to corroborating that the use of medicinal plants in infants is governed solely by the need for care in health situations that warrant it. Only two specimens of the medicinal plants classified by the Raizal women in this study are referenced in the Colombian Vademecum of medicinal plants. Conclusion: Medicinal plants address a wide spectrum of uses and properties that need extensive study for their registration and dissemination.

Encefalopatia hipoxica isquemica neonatal avances y nuevos tratamientos basados en las bases patofisiologicas de la injuria / Neonatal hypoxic ischemic encephalopathy: Progress and new treatments according to the pathophysiological basis of the injury

Resumen La encefalopatía hipóxica isquémica del neonato (EIH) es un tipo de injuria causada por la falta de oxí geno en el cerebro durante el periodo neonatal. Es un síndrome clínico claramente reconocible en recién na cidos a término y prematuros debido a asfixia fetal en el momento del nacimiento. Se estima que EHI ocurre a una frecuencia de1 a 3 por cada 1000 nacimientos vivos al año en países desarrollados. En países de bajo o mediano ingreso, la incidencia es hasta 10-20 veces más alta, equivalente a 1-8 nacidos vivos por cada 1000. El impacto social y económico ha sido estimado en cerca de 50.2 millones de dólares por año de vida ajustados a discapacidad. Así mismo, se estima que 7 es el número necesario de pacientes a tratar con hipotermia corporal terapéutica (HCT) para evitar un caso de muerte o minusvalía severa. La etiología es multifactorial e incluye factores prenatales, perinatales o post natales. El diagnóstico se basa en la incapacidad para respirar en el momento del nacimiento requirien do ventilación asistida, Apgar menos de 5 a los 5 y 10 minutos, alteración del estado normal de conciencia, reflejos neonatales y de tono muscular. Este artículo revisa los avances y estrategias terapéuticas estableci das y emergentes basadas en las fases pato-fisiológicas de este proceso.

Abstract Neonatal hypoxic ischemic encephalopathy (HIE) is a type of injury caused by lack of oxygen in the brain during the neonatal period. It is a clinical syndrome clearly rec ognizable in term and premature newborns secondary to asphyxia at the time of delivery. HIE is estimated to occur at a frequency of 1-3 for each 1000 alive newborns per year in developed countries. In countries of low or medium income, the incidence is up to 10-20 times higher, equivalent to 1-8 alive newborns per each 1000. The social and economic impact has been estimated near US$ 50.2 million per year of life adjusted to disability. At the same time, it is estimated in 7, the number of patients needed to treat with corporal cooling therapy (CCT) to prevent one case of death or se vere disability. The etiology is multifactorial and includes prenatal, perinatal and postnatal factors. The diagnosis is based in the inability to support spontaneous breath at the time of delivery requiring assisted ventilation, Apgar less than 5 at 5 and 10 minutes, altered level of consciousness, neonatal reflexes and muscle tone. This article is a review of the stablished and emergent therapeutic strategies based on the pathophysiological disease process.

COVID-19 en las embarazadas. Riesgo de las complicaciones durante el embarazo y en el neonato / COVID-19 in pregnant women. Risk of complications during pregnancy and in the newborn

Sobre el tema COVID-19 se han publicado múltiples estudios que reflejan su elevada incidencia, transmisibilidad, morbilidad y mortalidad, con gran repercusión y severidad en los grupos poblacionales de riesgo. El embarazo no escapa a ello, y la inmunosupresión fisiológica que se presenta en esta condición, hace a la gestante y al neonato, ser más susceptibles a las enfermedades infecciosas. El objetivo de esta comunicación es profundizar en la fisiopatología y la repercusión de la enfermedad COVID-19 en las gestantes y el neonato, para mejorar el conocimiento relacionado con el tema, el cual repercutirá en un mejor manejo de estos pacientes. Para ello, se realizó una revisión de investigaciones publicadas en el período comprendido entre enero y diciembre de 2021, en las bases de datos: SciELO, SCOPUS, Medline, Dialnet, Cumed y Lilacs. De los 44 artículos obtenidos inicialmente, 33 cumplieron los criterios de inclusión.

Several studies on COVID-19 have been published reflecting its high incidence, transmissibility, morbidity and mortality, with great repercussions and severity in population groups at risk. Pregnancy does not escape from this, and the physiological immunosuppression that occurs in this condition makes the pregnant woman and the newborn more susceptible to infectious diseases. The objective of this communication is to deepen the pathophysiology and the repercussion of the COVID-19 disease in pregnant women and the newborn in order to improve knowledge related to the subject, which will have an impact on better management of these patients. For this, a review of research published between January and December 2021 was carried out in the databases such as SciELO, SCOPUS, Medline, Dialnet, Cumed and Lilacs. A number of 33 articles met the inclusion criteria from 44 initially obtained.

EFFECTIVENESS OF SIMULATION BASED TEACHING PROGRAM ON KNOWLEDGE AND SKILL REGARDING BASIC NEONATAL RESUSCITATION PROCEDURES AMONG FEMALE HEALTH WORKERS OF SELECTED AREAS: A STUDY PROTOCOL

Background Of The Study: Worldwide, 136 million babies are born annually. 10 million require some stimulation at birth to breathe, while 6 million require basic resuscitation with a bag and mask. Evidence shows that 1 million neonatal deaths occur yearly on the day of birth. Near about 2 million babies die in the rst week of life and 4 million die in the neonatal period, which accounts for 46% of under-ve mortality. This mortality is estimated to increase to 52% in 2030 unless strategic interventions are implemented. To assess the effect of a simulation-based teaching Objective: program on knowledge and skill regarding basic neonatal resuscitation procedures among female health workers of selected areas. Pre-experimental one group pre-test post-test research design will be used. The duration of the study will Methodology: be one month. 60 female health workers from selected primary health centres and sub-health centres of Nagpur district will be selected as a sample through the simple random sampling technique. The structured questionnaire and standardized observational checklist will be used to assess the knowledge and skill respectively. Validity and reliability of the tool will be determined with appropriate standardized methods. Enhance knowledge and skill after simulation-based Expected Result: teaching program. Female health workers working in primary health centres and sub-health centres of Nagpur Limitation: district will be included in this study. The study ndings will reect the need for simulation based education to Conclusion: enhance the knowledge and skill of female health workers to identify birth asphyxia and its potential complications leading to neonatal mortality during the rst few hours after birth.

Social determinants for health and neonatal anesthesia in Colombia

The social determinants of health are the social characteristics in which people's lives and work develop, giving them the capacity to act in specific contexts and are responsible for the health conditions of individuals and populations. Recent World Bank data show that Colombia has made modest progress in terms of social equity. These data reveal that neonatal mortality in remote areas of the country is similar to that found in Sub-Saharan Africa. In these regions, there is no access to specialized neonatal health services. As for anesthesia services, this age group has the highest mortality and perioperative complication rates related to prematurity, the quality of health services and, especially, the expertise of the anesthesiologist. In Colombia, efforts to implement formal university programs for sub-specialization in pediatric anesthesiology have not received governmental support. Meanwhile, the Colombian Society of Anesthesiology and Resuscitation (S.C.A.R.E.), through its Committee of Pediatric Anesthesiology, has created ongoing education opportunities, which, although important, are insufficient to meet the needs of the country. For this reason, a State policy is required, aimed at meeting its social debt and that considers the specialized training of human resources as a pillar for the promotion of equity in health, so that the surgical neonate does not have to travel in the procurement of services, but rather have the State bring those services to them.

Los determinantes sociales de la salud son las características sociales en las que se desarrollan la vida y el trabajo de las personas, que otorgan capacidad de actuación en contextos específicos y son responsables de las condiciones de salud del individuo y las poblaciones. Datos recientes del Banco Mundial evidencian el poco progreso que tiene Colombia en materia de equidad social. Esos datos revelan cómo la mortalidad neonatal en zonas apartadas del país es similar a la encontrada en el África Subsahariana. En estas regiones es nulo el acceso a servicios de salud especializados en neonatología. En cuanto al servicio de anestesia, este grupo de edad presenta las tasas de mortalidad y complicaciones perioperatorias más altas, relacionadas con la prematurez, la calidad de los servicios de salud y, especialmente, con la experticia del anestesiólogo. En Colombia, los esfuerzos por implementar programas universitarios formales de subespecialización en Anestesiología Pediátrica no han recibido apoyo gubernamental. Entre tanto, la Sociedad Colombiana de Anestesiología y Reanimación (S.C.A.R.E.), a través de su Comité de Anestesiología Pediátrica, ha creado espacios de capacitación y entrenamiento permanentes, que, aunque importantes, resultan insuficientes para las necesidades del país. Por ello, se requiere una política de Estado orientada a sanar la deuda social y que considere la formación especializada del talento humano como un pilar para construir equidad en salud, de tal manera que el neonato quirúrgico no deba desplazarse en búsqueda de los servicios, sino que el Estado llegue a suplirlos.

Fisiología respiratoria: el pulmón al momento de nacer / Respiratory Physiology - the lung at the moment of birth

La adaptación fisiológica de los recién nacidos de la vida intrauterina a la extrauterina incluye cambios fisiológicos complejos. Para que se complete con éxito la transición fetal a neonatal, los recién nacidos deben lograr el aclaramiento de líquido pulmonar, la generación de CRF e inicio de la respiración, para permitir el intercambio de gases y la oxigenación de los tejidos. En este artículo se describen estos mecanismos, algunas bases del desarrollo pulmonar y de la circulación fetal; y las medidas que se requieren para asistir al recién nacido cuando no logran completar esta transición espontáneamente, lo que ocurre en el 5 al 10 % de los casos.

The physiological adaptation of newborns from intrauterine to extrauterine life includes complex physiological changes. For the fetal to neonatal transition to be successfully completed, neonates must achieve lung fluid clearance, FRC generation, and initiation of respiration to allow gas exchange and tissue oxygenation. This article describes these mechanisms, some bases of lung development and fetal circulation; and the measures required to assist the newborn, when they fail to complete this transition spontaneously, which occurs in the 5 to 10% of cases.

Infección osteoarticular multifocal en un recién nacido / Multifocal osteoarticular infection in a neonate / Infecção osteoarticular multi-focal num recém-nascido

Tanto la osteomielitis como la osteoartritis séptica en el período neonatal son patologías infrecuentes. La afectación ósea de la columna cervical es aún más rara, siendo excepcional en neonatos. Son patologías graves, con elevada morbimortalidad, donde el diagnóstico y tratamiento precoz agresivo son de suma importancia para el pronóstico vital y funcional. Presentamos el caso de un neonato que presentó una sepsis a S. Aureus multirresistente, asociada a una osteomielitis de la primera vértebra cervical y a una osteoartritis séptica de la cadera izquierda. Fue tratado precozmente de forma quirúrgica y con antibioticoterapia, presentando una buena evolución.

Both osteomyelitis and septic osteoarthritis in the neonatal period are infrequent pathologies. Bone involvement of the cervical spine is even rarer, being exceptional in neonates. These are serious pathologies, with high morbimortality, where early diagnosis and aggressive treatment are of utmost importance for the vital and functional prognosis. We present the case of a neonate who presented with sepsis due to multidrug-resistant S. Aureus, associated with osteomyelitis of the first cervical vertebra and septic osteoarthritis of the left hip. He was treated early surgically and with antibiotic therapy, presenting a good evolution

Tanto a osteomielite como a osteoartrose séptica no período neonatal são patologias raras. O envolvimento ósseo da coluna cervical é ainda mais raro, sendo excepcional nos recém-nascidos. Estas são patologias graves, com elevada morbimortalidade, onde o diagnóstico precoce e o tratamento agressivo são da maior importância para o prognóstico vital e funcional. Apresentamos o caso de um recém-nascido que apresentou sepse devido a S. Aureus multirresistente, associado a osteomielite da primeira vértebra cervical e osteoartrose séptica da anca esquerda. Foi tratado precocemente cirurgicamente e com terapia antibiótica, com uma boa evolução.

Factores de riesgo asociados a deshidratación hipernatrémica neonatal

Introducción: La deshidratación hipernatrémica neonatal es un problema creciente, en la que la alimentación y los conocimientos sobre cuidados del recién nacido juegan un papel primordial. Objetivo: Determinar los factores de riesgo asociados a la deshidratación hipernatrémica en neonatos. Métodos: Estudio observacional descriptivo retrospectivo en una población de 20 neonatos con deshidratación hipernatrémica ingresados en el servicio de cuidados intermedios de un hospital de Lima, Perú entre junio 2017- septiembre 2018. Todos tenían concentraciones de sodio sérico≥150 mmol/L. La recolección de la información se extrajo de las historias clínicas. Resultados: De los 20 neonatos con deshidratación hipernatrémica; los nacidos por cesárea equivalen a 30 %, mientras que por parto vaginal, a 70% de los casos. Se demostró que hay una relación inversa entre número de gestación y concentraciones de sodio al ingreso, sin embargo, no hubo significación estadística. Se logró una disminución entre sodio de entrada y su primer control, con una media de disminución de 0,57 meq/L/h. Clínicamente los neonatos afectados desarrollaron en mayor porcentaje ictericia y fiebre. No se encontró relación significativa entre el resto de los factores asociados. Conclusiones: Entre los factores de riesgo asociados a la deshidratación hipernatrémica, destaca que el grupo nacidos por cesárea fue menor que los nacidos por parto vaginal, lo que influye en el número de altas precoces al nacimiento. Ictericia y fiebre continúan siendo las características clínicas que debe identificarse tempranamente. Se trata de un cuadro prevenible si se brinda adecuada información a la madre sobre cuidado neonatal.

Introduction: Neonatal hypernatremic dehydration is a growing problem, in which feeding and knowledge about newborn care play a key role. Objective: To determine the risk factors associated with hypernatremic dehydration in neonates. Methods: Retrospective descriptive observational study in a population of 20 neonates with hypernatremic dehydration admitted to the intermediate care service of a hospital in Lima, Peru between June 2017 and September 2018. All of them had serum sodium concentrations≥150 mmol/L. The collection of information was extracted from medical records. Results: Of the 20 neonates with hypernatremic dehydration, those born by cesarean section are equivalent to 30%, while by vaginal delivery, 70% of cases. It was shown that there is an inverse relationship between gestation number and sodium concentrations at admission, however, there was no statistical significance. A decrease was achieved between input sodium and its first control, with a mean decrease of 0.57 meq/L/h. Clinically, the affected neonates developed a higher percentage of jaundice and fever. No significant relationship was found between the rest of the associated factors. Conclusions: Among the risk factors associated with hypernatremic dehydration, it stands out that the group born by cesarean section was lower than those born by vaginal delivery, which influences the number of early discharges at birth. Jaundice and fever continue to be the clinical features that should be identified early. This is a preventable condition if adequate information is provided to the mother about neonatal care.

Unilateral testicular torsion in a neonate / Torsão testicular unilateral em neonato

A male neonate born at gestational age of 40 weeks was found to have an enlarged and darkened right hemiscrotum after birth. Left testicle was descended and normal. No clinical signs of distress were evident. A color Doppler ultrasound showed an absence of testicular blood flow, consistent with perinatal testicular torsion. The patient underwent a bilateral scrotal exploration through an inguinal incision and a necrotic right testicle was found. A right orchiectomy and left orchiopexy were performed. Perinatal testicular torsion is a rare but severe condition. A high clinical suspicion is required since most of perinatal testicular torsion are intrauterine and can often be asymptomatic, only with localized findings of the affected testis. The management of perinatal testicular torsion is still controversial; however, the most consensual approach is a prompt testicle exploration with orchiectomy of the necrotic testicle and contralateral orchiopexy

Recém-nascido do sexo masculino com idade gestacional de 40 semanas, com edema e escurecimento cutâneo do hemiescroto direito constatados após o nascimento. O testículo esquerdo era palpável na bolsa escrotal e não apresentava alterações. A ecografia escrotal com Doppler revelou ausência de fluxo vascular no testículo direito, achado compatível com torção testicular perinatal. O doente foi submetido a exploração escrotal bilateral através de abordagem por via inguinal, tendo sido confirmada a necrose do testículo direito. Foi realizada orquidectomia direita e orquidopexia esquerda. A torção testicular perinatal corresponde a uma patologia rara, mas com possíveis consequências graves. O seu diagnóstico requer elevada suspeição clínica, uma vez que a maioria dos casos ocorre no período pré-natal, podendo ser assintomáticos após o nascimento e manifestar-se com alterações localizadas ao testículo afetado. A abordagem da torção testicular perinatal é ainda controversa, sendo mais consensual uma exploração escrotal célere com orquidectomia do testículo necrosado e orquidopexia contralateral

Effects of Kangaroo Care on the development of oral skills and achievement of exclusive oral feeding in preterm infants / Efeitos do Método Canguru no desenvolvimento das habilidades orais e na aquisição da alimentação oral exclusiva em recém-nascidos pré-termo

ABSTRACT Purpose analyze the effects of hospitalization in the Kangaroo Neonatal Intermediate Care Unit (UCINCa), the second stage of the Kangaroo Care (KC), on the development of oral feeding skills in preterm neonates. Methods an analytical observational study of the prospective longitudinal type, carried out in a public hospital in Southern Brazil, where infants were accompanied until hospital discharge. The sample consisted of 20 preterm neonates hospitalized at the UCINCa and 26 preterm neonates at the Conventional Neonatal Intermediate Care Unit (UCINCo), that were periodically evaluated through the levels of oral skill, in a bottle, according to the criteria of proficiency and milk transfer rate. The outcomes considered were a progression of the oral skill level, days of transition to obtain the full oral route, and days of hospital stay. Results the duration of transition to exclusive oral feeding was shorter for preterm neonates at the UCINCa (4.5 vs. 10 days) relative to those at the UCINCo (p = 0.041). By the third assessment, all preterm neonates at the UCINCa had reached level 4, while participants at the UCINCo only achieved this level of performance on the fifth assessment. The average number of days of hospitalization was four days shorter in UCINCa participants (p=0.098). Conclusion the admission to the UCINCa had been a further acceleration in the maturation of oral skills, which allowed for a faster transition to exclusive oral feeding as compared to neonates admitted in UCINCo.

RESUMO Objetivo verificar os efeitos da internação em Unidade de Cuidado Intermediário Neonatal Canguru (UCINCa), segunda etapa do Método Canguru, no desenvolvimento das habilidades de alimentação oral em recém nascidos pré-termo (RNPT). Método estudo observacional analítico do tipo longitudinal prospectivo, realizado em um hospital público no Sul do Brasil, com acompanhamento até a alta hospitalar. A amostra foi constituída por 20 RNPT internados na UCINCa e 26 RNPT na Unidade de Cuidado Intermediário Neonatal Convencional (UCINCo), que foram avaliados periodicamente por meio dos níveis de habilidade oral, em mamadeira, conforme os critérios de proficiência e taxa de transferência de leite. Os desfechos considerados foram progressão do nível de habilidade oral, dias de transição para obtenção da via oral plena, dias de internação hospitalar. Resultados o tempo de transição para obtenção da via oral exclusiva foi menor nos RNPT da UCINCa (4,5 dias versus 10 dias) quando comparados aos da UCINCo (p=0,041). Na terceira avaliação de habilidade oral, a totalidade de RNPT da UCINCa atingiu o nível 4, já os participantes da UCINCo somente alcançaram esse nível na quinta avaliação. A mediana dos dias de internação foi de quatro dias menor nos participantes da UCINCa (p=0,098). Conclusão a internação na UCINCa favoreceu uma aceleração no processo de maturação das habilidades orais, influenciando positivamente na transição alimentar oral do RNPT, na comparação com os RNPT internados na UCINCo.

The evolution of approach in the resuscitation of neonates born with meconium-stained amniotic fluid: a tale of two countries, China and U.S.A., in the past 60 years / 中国当代儿科杂志

Neonates born through meconium-stained amniotic fluid (MSAF) may develop complications including meconium aspiration syndrome, persistent pulmonary hypertension of newborn and death. The approach to the resuscitation of these neonates has significantly evolved for the past few decades. Initially, under direct visualization technique, neonates with MSAF were commonly suctioned below the vocal cords soon after delivery. Since 2015, Neonatal Resuscitation Program (NRP®) of the American Academy of Pediatrics has recommended against "routine" endotracheal suctioning of non-vigorous neonates with MSAF but favored immediate resuscitation with positive pressure ventilation via face-mask bagging. However, the China neonatal resuscitation 2021 guidelines continue to recommend routine endotracheal suctioning of non-vigorous neonates born with MSAF at birth. This review article discusses the differences and the rationales in the approach in the resuscitation of neonates with MSAF between Chinese and American NRP® guidelines over the past 60 years.

Oculo-facio-cardio-dental syndrome caused by BCOR gene mutations: a case report / 中国当代儿科杂志

A full-term female infant was admitted at 5 hours after birth due to heart malformations found during the fetal period and cyanosis once after birth. Mmultiple malformations of eyes, face, limbs, and heart were noted. The whole-exome sequencing revealed a pathogenic heterozygous mutation, c.2428C>T(p.Arg810*), in the BCOR gene. The infant was then diagnosed with oculo-facio-cardio-dental syndrome. He received assisted ventilation to improve oxygenation and nutritional support during hospitalization. Right ventricular double outlet correction was performed 1 month after birth. Ocular lesions were followed up and scheduled for elective surgery. The possibility of oculo-facio-cardio-dental syndrome should be considered for neonates with multiple malformations of eyes, face, and heart, and genetic testing should be performed as early as possible to confirm the diagnosis; meanwhile, active ophthalmic and cardiovascular symptomatic treatment should be given to improve the prognosis.