Influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros / Effect of place of birth and transport on morbidity and mortality of preterm newborns

OBJETIVO: Verificar a influência do local de nascimento e do transporte sobre a morbimortalidade de recém-nascidos prematuros na Região Sul do Brasil. MÉTODOS: Estudo de coorte com recém-nascidos prematuros transferidos para a unidade de tratamento intensivo de referência (grupo transporte = 61), tendo sido acompanhados até a alta. Os dados sobre o atendimento no hospital de origem e transporte foram obtidos no momento da internação. Esse grupo foi comparado com neonatos da maternidade de referência, pareados por idade gestacional (grupo controle = 123), tendo como desfecho primário o óbito e desfechos secundários as alterações da glicemia, temperatura e saturação de oxigênio no momento da internação e a incidência de enterocolite necrosante, displasia broncopulmonar e sepses. Na associação entre as variáveis e o desfecho, foi utilizado o risco relativo. Foi adotado um nível de significância de α = 5 por cento e β = 90 por cento. RESULTADOS: A distância média percorrida foi de 91 km. A idade gestacional média foi de 34 semanas. Entre os recém-nascidos transferidos, 23 por cento (n = 14) não tiveram atendimento pediátrico na sala de parto. No transporte, 33 por cento dos recém-nascidos foram acompanhados por pediatra, e os equipamentos utilizados foram: incubadora (57 por cento), bomba de infusão (13 por cento), oxímetro (49 por cento) e aparelho para aferição da glicemia (21 por cento). O grupo transporte apresentou maior incidência de hiperglicemia, risco relativo (RR) = 3,2 (2,3-4,4), hipoglicemia, RR = 2,4 (1,4-4,0), hipertermia, RR = 2,5 (1,6-3,9), e hipoxemia, RR = 2,2 (1,6-3,0). Foram observados 18 por cento de óbitos no grupo dos transferidos e 8,9 por cento no grupo controle, RR = 2,0 (1,0-2,6). CONCLUSÕES: A pesquisa expõe deficiências no atendimento e transporte dos recém-nascidos, sendo necessária uma melhor organização do atendimento perinatal e do transporte na região nordeste do Rio Grande do Sul.

OBJECTIVE: To evaluate the effect of place of birth and transport on morbidity and mortality of preterm newborns in the southern region of Brazil. METHODS: This cohort study included preterm newborns transported to a reference intensive care unit (transport group = 61) and followed up until discharge. Data about care in hospital of origin and transport were obtained at admission. This group was compared with infants born in the maternity ward of the reference hospital paired according to gestational age (control group = 123). Primary outcome was death, and secondary outcomes were changes in blood glucose, temperature and oxygen saturation at admission and the incidence of necrotizing enterocolitis, bronchopulmonary dysplasia and sepsis. Relative risk (RR) was used to evaluate the association between variables and outcome. The level of significance was set at α = 5 percent and β = 90 percent. RESULTS: Mean travel distance was 91 km. Mean gestational age was 34 weeks. Of the neonates in the transport group, 23 percent (n = 14) did not receive pediatric care in the delivery room. During transportation, 33 percent of newborns were accompanied by a pediatrician, and the equipment available was: incubator (57 percent), infusion pump (13 percent), oximeter (49 percent) and device for blood glucose test (21 percent). The transport group had a greater incidence of hyperglycemia (RR = 3.2; 2.3-4.4), hypoglycemia (RR = 2.4; 1.4-4.0), hyperthermia (RR = 2.5; 1.6-3.9), and hypoxemia (RR = 2.2; 1.6-3.0). The percentage of deaths was 18 percent in the transport group and 8.9 percent in the control group (RR = 2.0; 1.0-2.6). CONCLUSIONS: This study revealed deficiencies in neonatal care and transport. Perinatal care and transport should be better organized in the northeastern region of Rio Grande do Sul, Brazil.

Nosocomial infection due to rotavirus in infants in Alzahra Hospital, Isfahan, Iran.

Rotavirus is one of the most common causes of acute diarrhoea during infancy, and the spread of this infection due to rotavirus in paediatric wards can cause acute diarrhoea during hospitalization, and, in turn, prolong hospitalization or rehospitalization. It is, therefore, important to evaluate the problem and to find an appropriate approach to decrease the rate of infection. The incidence of nosocomial infection due to rotavirus was studied in 80 children aged 3-24 months from November 2003 to April 2004 in the Alzahra Hospital, Isfahan, Iran. Rotavirus antigen was detected by latex aggulutation in stool samples obtained during hospitalization and up to 72 hours after discharge from the hospital. The prevalence of nosocomial infection due to rotavirus was 26.25%, which is a considerable prevalence compared to similar studies which reported a prevalence of 27.7%, 19.4%, and 14.6%. Overall, 15% of the 21 children with positive rotavirus antigen in their stools had acute diarrhoea during hospitalization and up to 72 hours after discharge (symptomatic nosocomial infection), and 11.25% of all children (n=80) studied had asymptomatic nosocomial infection. Regarding the low frequency of nosocomial infection due to rotavirus in other studies which have only studied symptomatic cases during hospitalization and reported a prevalence of 3.3 and 9%, it is suggested that the real estimation of nosocomial infection due to rotavirus in asymptomatic cases that might become symptomatic after discharge from hospital should also be considered. Due to the relatively high frequency of nosocomial infection in the Alzahra Hospital, it is necessary to follow stricter health issues, e.g. isolation of patients with diarrhoea and hand-washing before and after the examination of every patient.

Guía de alimentación del niño (a) menor de 2 años (parte 1) / Feeding guidelines for children under 2 years (part 1)

Se espera que los contenidos de esta guía contribuyan a reforzar entre los equipos de salud, nuevos conceptos en alimentación y nutrición y constituyan una buena herramienta informativa y educativa para los profesionales de la salud.

Assistência de enfermagem em unidade de internaçäo neonatal: medidas para prevençäo de infecçöes hospitalares / Nursing care in the Neonatal Nursing Unit: measures for the prevention of hospital infection

Esta investigaçäo tem como objetivo, verificar a relaçäo entre as medidas prescritivas sobre a prevençäo de infecçäo e as atividades efetivas realizadas numa Unidade de Internaçäo Neonatal. As estratégias de investigaçäo adotadas foram a observaçäo participante e a entrevista semi-estruturada possibilitando a coleta de dados. Verificamos que muitas das medidas prescritivas para a prevençäo de infecçäo hospitalar que encontramos na literatura, näo foram observadas nas açöes desempenhadas no berçário escolhido para estudo. Ao analisarmos os resultados, fazemos as seguintes constataçöes: - o cumprimento das medidas profiláticas näo pode ser analisado parceladamente. Elas se constituem numa rede de procedimentos interdependentes e a quebra de uma delas desencadeia uma sucessäo de infraçöes às outras regras. - Na representaçäo de cada funcionário há critérios de prioridade nessa cadeia de medidas profiláticas. Observamos que a superlotaçäo do berçário é o ponto mais susceptível e quando ela ocorre, todas as outras medidas aparecem em suas falas e atitudes como dispensáveis. Pudemos ver com este trabalho que essas medidas têm que ser tomadas em conjunto, num complexo de atividades, fundamentadas em instalacöes e estruturas adequadas, desempenhadas por uma equipe profissional coesa, onde todos trabalhem com os mesmos objetivos. Tomá-las isoladamente näo contribui para o efetivo cumprimento das prescriçöes.

Recém-nascidos de alto risco: manejo metabólico e hidreletrolítico de manutençäo / Newborns at risk: metabolic mangement and hydroelectrolytic maintenance

O autor, após revisäo da literatura selecionada, propöe critérios e condutas frente ao manejo do metabolismo glico-hidreletrolítico dos recém-nascidos de alto risoc, com objetivo de apoiar a homeostase no período neonatal imediato

Status of newborn care in India.

A questionnaire regarding the existing facilities and concept of newborn care was sent to 135 hospitals. A total of 18 teaching, 9 non-teaching and 5 private hospitals responded. Space provided for most of the nurseries was inadequate. Ratios of nurse: baby and doctor: baby fell short of the recommended. Maintenance of asepsis was lacking in many NSCUs. Regarding equipment, the general concept seems to be that having incubators and phototherapy units is adequate and most of the NSCUs did not go beyond it. Only 40% of the hospitals run special antenatal clinic for high risk deliveries and not all hospitals followed up high risk babies. Among the admitted LBW babies, those belonging to 1000-1500 g group outnumbered others, had higher morbidity and mortality, thereby taking away a major share of newborn care. It was a pleasure to note that most nurseries preferred breast milk for LBW babies. It is concluded that status of newborn care in India has a long way to go.