Malos hábitos de sueño en lactantes: factor de riesgo para síndrome de muerte súbita del lactante: estudio piloto / Bad sleeping habits in infants: risk factor for sudden infant death syndrome: pilot study

INTRODUCCIÓN: La Academia Americana de Pediatría recomienda que los lactantes menores de un año duerman en posición supina para prevenir el síndrome de muerte súbita en lactantes (SMSL). OBJETIVO: Describir la posición en que duermen un grupo de lactantes y factores de riesgo asociados al SMSL. SUJETOS Y MÉTODO: Estudio piloto, prospectivo concurrente, de lactantes < 45 días de vida en control sano en Centro Médico San Joaquín UC Christus. Criterios de exclusión: prematurez (edad gestacional < 37 semanas) y patología de base (respiratorias, metabólicas, cardiológicas). Se aplicó encuesta al cuidador principal respecto a datos demográficos y hábitos de sueño, basada en encuesta BISQ (Brief Screening Questionnaire for Infant Sleep Problems) validada en español, dado la inexistencia de instru mentos para < 3 meses. RESULTADOS: Se obtuvo muestra de 100 lactantes de edad 16,78 ± 12,88 días de vida, siendo 57% mujeres. La madre fue el principal informante (84%). El 79% de los lactantes dor mían en decúbito supino, 19% lo hacía de lado y 2% en prono. El 66% dormía en cuna en habitación de los padres, 31% en la cama de los padres. El 74% se quedaban dormidos durante la alimentación. El 28% de los lactantes estaban expuestos a tabaquismo pasivo. El 91% cuidadores estaba informa do sobre la posición segura de sueño, siendo el principal informante el pediatra (54%). CONCLUSIONES: En esta muestra se encontró alto porcentaje de lactantes < 45 días que duermen en posición no segura, siendo frecuente el colecho. Es importante implementar campañas locales de prevención del SMSL que refuercen el hábito de dormir seguro.

INTRODUCTION: The American Academy of Pediatrics recommends, through the implementation of the "Back to Sleep (BTS)" campaign, the supine sleeping position for infant sleeping since it prevents to prevent Sudden Infant Death Syndrome (SIDS). OBJECTIVE: To describe the sleeping position of a group of infants and the risk factors associated with sudden infant death syndrome (SIDS). SUBJECTS AND METHOD: Prospective pilot study, including infants < 45 days of life in well-child care visits at a medical center. Exclusion criteria: Preterm-born infant (gestational age < 37 weeks) and/or comorbidities (pulmonary, metabolic, cardiologic). A brief parental questionnaire was conducted regarding general demographic data and sleep habits. The questioner was based on the BISQ - Spanish version, due to the lack of validated instruments for infants < 3-month-old. RESULTS: We included a sample of 100 infants between 16.78 ± 12.88 days old (57% girls). Mothers were the main information source (84%). 79% of the infants slept in supine position, 19% slept on their sides, and 2% in prone position. Regarding the place where the infants slept, 66% did in their crib in the parents' room and 31% slept in parents' bed. 74% of infants fell asleep while being fed. 28% of infants were exposed to passive smoking at home. 91% of parents were informed about safe sleep positions, reporting that pediatricians were the main source of information (54%). CONCLUSION: We found a high percentage of infants < 45 days of life who slept in an unsafe position, and frequently co-sleep with their parents. Thus, it is important to implement local SIDS prevention campaigns to reinforce safe infant sleep.

Analysis of the differences between the prescribed and the administered diet to preterm infants using an electronic too / Análise das diferenças entre a dieta prescrita e a dieta administrada aos recém-nascidos pré-termo usando um instrumento eletrônico

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.

Baby friendly hospital initiative: 25 years of experience in brazil / Iniciativa hospital amigo da criança: 25 anos de experiência no brasil

ABSTRACT Objective: To describe the experience of the 25-year-old trajectory of the Baby Friendly Hospital Initiative (BFHI) in Brazil. The first unit was implemented in 1992. Methods: Information and data were collected from publications on the World Health Organization (WHO), the United Nations International Children's Emergency Fund (UNICEF) and the Ministry of Health websites and in national and international journals, about the period 1990-2017. The descriptors used were: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" and "breastfeeding". The number of hospitals in the 25 years, the course of the BFHI and its repercussions on breastfeeding in Brazil were evaluated. Results: The BFHI is an intervention strategy in hospital care at birth focused on the implementation of practices that promote exclusive breastfeeding from the first hours of life and with the support, among other measures of positive impact on breastfeeding, of the International Code of Marketing of Breastmilk Substitutes. Currently, the initiative has been revised, updated and expanded to integrate care for newborns in neonatal units and care for women since prenatal care. It can be concluded that, during these 25 years, the quantity of hospitals varied greatly, with numbers still below the capacity of hospital beds. BFHI shows higher rates of breastfeeding than non-accredited hospitals. However, the number of hospitals are still few when compared to other countries. Conclusions: The BFHI has contributed to breastfeeding in Brazil in recent decades. Greater support for public policies is needed to expand the number of accredited institutions in the country.

RESUMO Objetivo: Descrever a experiência de 25 anos da Iniciativa Hospital Amigo da Criança (IHAC) no Brasil, cuja primeira unidade foi implementada em 1992. Métodos: Informações e dados foram obtidos em publicações nos sites da Organização Mundial da Saúde (OMS), do Fundo Internacional de Emergência para a Infância das Nações Unidas (UNICEF) e do Ministério da Saúde e em periódicos nacionais e internacionais, abrangendo o período de 1990 a 2017. Utilizaram-se os descritores: "iniciativa hospital amigo da criança", "hospital amigo da criança", "baby friendly initiative hospital", "aleitamento materno" e "breastfeeding". Foram avaliados o número de hospitais nos 25 anos, a trajetória da IHAC e suas repercussões sobre o aleitamento materno no Brasil. Resultados: A IHAC é uma estratégia de intervenção na assistência hospitalar ao nascimento com foco na implementação de práticas que promovem o aleitamento materno exclusivo desde as primeiras horas de vida e com o apoio, entre outras medidas de impacto positivo na amamentação, do Código Internacional de Comercialização de Substitutos do Leite Materno. Atualmente, a iniciativa foi revisada, atualizada e expandida para integrar o cuidado aos recém-nascidos nas unidades neonatais e na atenção à mulher desde o pré-natal. Pôde-se concluir que, ao longo desses 25 anos, a quantidade de hospitais variou muito, com números ainda aquém da capacidade de leitos hospitalares. Hospitais credenciados como o Hospital Amigo da Criança mostram índices de amamentação superiores ao de hospitais não credenciados, entretanto o número de hospitais credenciados no Brasil ainda é pouco se comparado com outros países. Conclusões: A IHAC contribuiu para o aleitamento materno no Brasil nessas últimas décadas. Mais apoio pelas políticas públicas é necessário para ampliar o número de instituições credenciadas no país.

Dietary transition difficulties in preterm infants: critical literature review / Dificuldades de transição alimentar em crianças prematuras: revisão crítica de literatura

ABSTRACT OBJECTIVE: To analyze the scientific literature on dietary changes in preterm children during the first years of life. DATA SOURCE: The PubMed database was used for article selection. The texts were analyzed according to their objectives, research design, and research group characteristics. The following were selected to comprise the criteria: (1) publications in the period from 1996 to 2014; (2) participation of infants and children from birth to 10 years of age; (3) development of oral motor skills necessary for feeding; (4) development of the feeding process; and (5) feeding difficulties during childhood. SUMMARY OF THE FINDINGS: There were 282 studies identified, of which 17 were used in the review, and five more articles were identified through the reference list of selected articles, totaling 22 references. CONCLUSION: Very low birth weight preterm newborns are more likely to have feeding problems in early postnatal stages and during childhood when compared with full-term infants. Monitoring the feeding of these infants after hospital discharge is strictly recommended in an early intervention program aiming at better development of feeding skills.

RESUMO OBJETIVO: Analisar a literatura científica sobre alterações alimentares em crianças prematuras durante os primeiros anos de vida. FONTE DOS DADOS: A base de dados do Pubmed foi a precursora para a seleção dos artigos. Os textos foram analisados quanto aos seus objetivos, desenhos da pesquisa e características do grupo pesquisa e foram selecionados os seguintes temas para compor os critérios: (1) publicações de 1996 a 2014; (2) participação de bebês e crianças, do nascimento até os 10 anos; (3) desenvolvimento das habilidades motoras orais necessárias para a alimentação; (4) desenvolvimento do processo de alimentação e (5) dificuldades alimentares durante a infância. SÍNTESE DOS DADOS: Foram identificados 282 estudos, 17 foram usados e cinco artigos foram identificados por meio da lista de referência bibliográfica dos artigos selecionados, totalizando 22 referências bibliográficas. CONCLUSÃO: A revisão permitiu concluir que recém-nascidos pré-termo muito baixo peso (RNPTMBP) são mais propensos a apresentar problemas de alimentação nos estágios iniciais pós-natal e durante a infância quando comparados com crianças a termo. O monitoramento da alimentação após a alta hospitalar é estritamente recomendado em um programa de intervenção precoce com vistas ao melhor desenvolvimento das habilidades alimentares.

Práticas de atenção hospitalar ao recém-nascido saudável no Brasil / La práctica en el cuidado de los recién nacidos sanos en Brasil / Clinical practices in the hospital care of healthy newborn infant in Brazil

O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.

El objetivo del estudio fue evaluar el cuidado de los recién nacidos sanos y determinar si existen desigualdades en la prestación de servicios y durante la primera hora de vida. Se utilizó la base de datos de la encuesta Nacer en Brasil. Las ratios se estimaron a través del producto odds ratio (OR) y se realizó un ajuste bruto entre las características del hospital, la madre y la atención del nacimiento con los siguientes resultados: aspiración gástrica y de las vías respiratorias, uso de oxígeno inhalado, incubadora, contacto piel con piel, alojamiento conjunto y ofrecer lactancia materna en la sala de partos y en la primera hora de vida. Existe una alta variación de las prácticas utilizadas en el cuidado del recién nacido. Prácticas consideradas inapropiadas, como el uso de oxígeno inhalado (9,5%), aspiración vías respiratorias (71,1%) y gástrica (39,7%) y el uso de incubadora (8,8%) fueron altos. La lactancia materna en la sala de partos fue baja (16,1%), hasta en los hospitales especializados en la atención a niños (24%). Los resultados sugieren bajos niveles de la adhesión a las buenas prácticas.

The aim of this study was to evaluate the care of healthy full-term newborns and to identify variations in childbirth care and practices in the first hour of life. We used data from the Birth in Brazil survey. Unadjusted and adjusted odds ratio (OR) of hospital-delivered care for the mother and during childbirth were estimated for the following outcomes: upper airways and gastric aspiration, use of inhaled oxygen, use of incubator, skin-to-skin contact after birth, rooming-in and breastfeeding in the delivery room and within the first hour of life. We observed wide variations in the care of healthy full-term newborn in the delivery room. Practices considered inadequate, such as use of inhaled oxygen, (9.5%) aspiration of airways (71.1%) and gastric suctioning (39.7%), and the use of incubator (8.8%) were excessively used. Breastfeeding in the delivery room was low (16%), even when the Baby-Friendly Hospital Initiative had been implemented (24%). The results suggest poor knowledge and compliance by health practitioners to good clinical practice. Such noncompliance was probably not due to the differences in resources, since most births take place in hospitals where the necessary resources are available.

Demandas de cuidado domiciliar da criança nascida exposta ao HIV na ótica da teoria ambientalista / Demandas de cuidados en casa del niño nacido expuesto al VIH en la óptica de la teoría ambientalista / Demands of home care of children born exposed to HIV in the perspective of the environmental theory

Objetivou-se identificar as demandas de cuidado domiciliar da criança nascida exposta ao HIV, sob a perspectiva da teoria ambientalista. Trata-se de estudo qualitativo exploratório-descritivo realizado de janeiro a abril de 2011. Participaram dez mães infectadas pelo HIV, com crianças nascidas expostas ao vírus, em Fortaleza, Ceará. Constituíram-se como instrumentos de coleta de dados: câmera fotográfica descartável e digital e formulários para captação de informações em saúde associadas ao ambiente domiciliar. Os resultados foram contextualizados de acordo com a teoria e organizados em categorias: "vulnerabilidades associadas à estrutura física da moradia"; "ar intradomiciliar e peridomiciliar impuro"; "água utilizada para consumo"; "rede de esgoto e saneamento"; "iluminação e ventilação da residência". Conclui-se que o ambiente domiciliar oferece condições ambientais desfavoráveis para a criança. Urge a realização de intervenções focalizadas no ambiente domiciliar, para promover a saúde da criança nascida exposta ao HIV.

Se objetivó identificar las demandas de atención en el hogar de los niños nacidos expuestos al VIH en la perspectiva de la teoría ambientalista. Estudio cualitativo exploratorio-descriptivo realizado entre enero y abril de 2011. Participaron diez madres VIH-positivas con bebés expuestos al virus, en Fortaleza, Ceará. Fueron instrumentos de recolección de datos: cámara desechable y digital y formularios para capturar información sobre la salud asociada con el ambiente del hogar. Los resultados fueron contextualizados de acuerdo a la teoría y organizado en categorías: vulnerabilidades asociadas con la estructura física de la casa; aire intra y peridoméstico impuro; agua utilizada para el consumo; saneamiento y alcantarillado; iluminación y ventilación de la residencia. Se concluye que el hogar ofrece condiciones ambientales desfavorables para el niño. Hay necesidad de intervenciones específicas en el entorno del hogar para promover la salud de los niños nacidos expuestos al VIH.

The purpose of this study was to identify the demands of home care of children born exposed to HIV in the perspective of the environmental theory. It consists of an exploratory descriptive qualitative study, developed between January and April of 2011. Study participants were ten HIV-infected mothers with infants exposed to the virus, living in Fortaleza, Ceará. The data collection instruments included: a disposable digital camera and forms to obtain information on health associated with the home environment. Results were contextualized according to the theory and organized into the following categories: vulnerabilities associated with the physical structure of the house; contaminated intra and peridomestic air; unclean water used for drinking; sanitation and sewerage system; lighting and ventilation of the house. In conclusion, the home environment offers unfavorable environmental conditions for the child. Targeted interventions in the home environment are necessary so as to promote the health of children born exposed to HIV.

Evolución de las licencias por enfermedad grave del niño(a) menor de un año 2004-2008: certezas e interrogantes / Sick leaves motivated by severe diseases of children of less than one year of age

Background: The increase in expenses of the health care system caused by sick leaves, especially those granted to mothers with children of less than one year of age with severe diseases, is a topic of concern. Aim: To describe the rates of sick leaves granted to mothers with children of less than one year of age with severe diseases from 2004 to 2008. Material and Methods: Analysis of databases containing information about sick leaves coming from Chilean public and private health care subsystems. Leaves granted to mothers with sick children of less than one year were specifically analyzed in terms of days off work and the amount of monetary benefits. Results: A sustained increase, ranging from 20 to 120% in the number of sick leaves motivated by diseases of children of less than one year, was observed. Thirty four percent of maternity leaves concentrate immediately after finishing the legal period (24 weeks after birth) and almost 60% of them occured within the first 6 months after birth. The most frequent diagnoses that motivated the higher number of leaves were gas-troesophageal reflux and bronchitis. Conclusions: There is probably a bad use of the benefit in a percentage of leaves. The benefit is also regressive since it favors mostly mothers of a better socioeconomic condition. The law that will extend the postnatal maternity leave will solve in part these problems.

Condiciones sociales, factores biológicos y conducta de cuidado materno en prevención de enfermedades respiratorias en lactantes / Social conditions, biological factors and maternal care behavior in respiratory diseases prevention, in infants

Introducción: Las condiciones sociales y factores biológicos representados por variables reproductivas, clínicas, de hábitos y la conducta de cuidado materno en prevención de enfermedades respiratorias, constituyen una prioridad en el contexto socioeconómico cultural de la IX Región. Objetivos: Relacionar la conducta de cuidado materno en prevención de Infecciones Respiratorias Agudas (IRA) con la presencia de SBO y NAC. Metodología: Investigación descriptiva, correlacional, en muestra probabilística, secuencial de 239 lactantes y sus madres. Los datos se recolectaron en cuestionario validado y adaptado a las necesidades de la investigación. Se realizó análisis descriptivo y analítico, con prueba de chi cuadrado, prueba exacta de Fisher. La investigación cumplió con los Requisitos éticos de Ezequiel Emmanuel. Resultados: La conducta "evita fuentes de contagio" frecuentemente 49,8 por ciento, "ventila su hogar" frecuentemente 42,4 por ciento, "se preocupa de calefaccionar su hogar" frecuentemente 43,5 por ciento, "evita exponer al lactante a cambios bruscos de temperatura" frecuentemente 39,0 por ciento y "se siente preparada para entregar cuidados básicos de salud a su hijo" frecuentemente, 42,8 por ciento. Discusión y Conclusiones: El Síndrome Bronquial Obstructivo (SBO) se asoció a la conducta de cuidado; las madres revelaron déficit en la conducta de cuidado hacia su hijo (conducta de calefaccionar, ventilar y evitar fuentes de contagio en su hogar), lo que reafirma el propósito de generar una línea educativa dirigida a madres de lactantes con factores de riesgo.

Introduction: The social and biological factors represented by reproductive variables, clinical, and behavioral patterns of maternal care in respiratory disease prevention are a priority in the socio economic culture of our region. Objectives: Relate the maternal care behavior in prevention of acute respiratory infections (ARI) with the presence of SBO and NAC. Methodology: Descriptive and correlational research with a probability sequence sample of 239 infants and their mothers. A validated questionnaire and adapted to the needs of the investigation, was used for data collection. Descriptive and analytical study with chi-square test and Fisher exact was carried out. Research complied with the ethical requirements of Ezekiel Emanuel. Results: They indicated that the behavior "avoid sources of infection", frequently reaches 49.8 percent, "home fan" 42.4 percent, "cares about heating your home" 43.5 percent, "avoid exposing the infant to sudden temperature changes" 39.0 percent and "feels ready to deliver basic health care to your child", 42.8 percent. Discussion and Conclusions: Bronchial obstructive syndrome (BOS) was associated with protective behavior, mothers showed deficits in behavior toward their child care (behavior of heating, ventilation and avoid sources of infection at home) which reaffirms the purpose of generating an educational line, for mothers of infants with risk factors.

Mortes evitáveis em menores de um ano, Brasil, 1997 a 2006: contribuições para a avaliação de desempenho do Sistema Único de Saúde / Avoidable causes of infant mortality in Brazil, 1997-2006: contributions to performance evaluation of the Unified National Health System

Os óbitos de menores de um ano foram classificados em causas evitáveis, mal definidas e não evitáveis empregando a Lista Brasileira de Mortes Evitáveis, entre 1997-2006. Foram calculados tendências dos coeficientes de mortalidade infantil por causas de morte e se usou regressão não linear para avaliação de tendência. As causas evitáveis e as causas mal definidas apresentaram significativa redução (p < 0,001). As causas reduzíveis de mortalidade apresentaram redução de 37 por cento. A mortalidade por causas reduzíveis por adequada atenção ao parto declinou em 27,7 por cento; adequada atenção ao recém-nascido, 42,5 por cento; e por adequada atenção à gestação cresceu 28,3 por cento. Concluiu-se que os serviços de saúde contribuíram para a redução da mortalidade infantil. O declínio das causas mal definidas de morte indica ampliação do acesso aos serviços de saúde. O aumento do acesso e atenção ao parto e aos cuidados com recém-nascido contribuíram para a redução de óbitos infantis. O aumento da mortalidade por adequada atenção à gestação revela a necessidade de aprimoramento da atenção pré-natal.

Infant deaths were classified as avoidable, non-avoidable, and resulting from ill-defined conditions, from 1997 to 2006, using the Brazilian List of Avoidable Causes of Mortality. Non-linear regression was used to calculate trends in cause-specific infant mortality rates. There was a significant decline in both avoidable deaths and deaths from ill-defined causes (p < 0.001). Avoidable deaths decreased by 37 percent overall. Mortality avoidable through adequate intrapartum care and adequate neonatal care decreased by 27.7 percent and 42.5 percent, respectively, while mortality avoidable through adequate prenatal care increased by 28.3 percent. In conclusion, health services contributed to the reduction in infant mortality. The decrease in ill-defined causes of death indicates expanded access to health services. The increase in access to intrapartum and neonatal care contributed to the reduction in infant deaths. The increase in mortality avoidable through adequate prenatal care indicates the need for improvement in prenatal care.

Frequência de utilização do serviço público de puericultura e fatores associados / Frequency of public child care service use and associated factors

Objetivo: Avaliar os fatores sociodemográficos associados à frequência da utilização do serviço de puericultura por famílias de baixo nível socioeconômico. Métodos: Análise transversal de 393 crianças, com idades entre 12 e 16 meses, que participaram de um ensaio de campo randomizado no primeiro ano de vida em um programa de intervenção nutricional. O estudo iniciou nos setores de atendimento do Sistema Único de Saúde da maternidade da cidade de São Leopoldo (RS). As crianças foram avaliadas quanto ao acompanhamento na puericultura e calendário de vacinação. Para análise dos dados utilizou-se teste qui-quadrado de Pearson e razão de prevalência (RP) com respectivo intervalo de confiança de 95 por cento (IC95 por cento). Resultados: A frequência de crianças que não foram levadas regularmente foi de 53,2 por cento. A análise multivariada sugere que os fatores associados à ausência de utilização regular do serviço foram: escolaridade materna < 8 anos (RP 1,32; IC95 por cento 1,02-1,71), estrutura familiar não nuclear (RP 1,32; IC95 por cento 1,10-1,59) e não ser filho único (RP 1,38; IC95 por cento 1,10-1,72). Os motivos relatados para o não acompanhamento da criança na puericultura foram: 66,2 por cento consideraram desnecessário, 21,7 por cento referiram insatisfação com o serviço, 6,05 por cento impossibilidade devido ao emprego e 6,05 por cento outros motivos. Conclusão: A elevada frequência de crianças que não são levadas para acompanhamento no serviço de puericultura está associada à baixa escolaridade materna e à estrutura familiar, além da percepção de que é desnecessário na ausência de doença da criança.

Objective: Assess the maternal socio-demographic factors associated with the frequency of use of child care services by low income families. Methods: Cross-sectional analysis of 393 children between 12 and 16 months old who participated in a randomized field trial during their first year of life in a program of nutritional intervention. The study began in the Brazilian Unified Health System (Sistema Único de Saúde, SUS) of the maternity hospital in the city of São Leopoldo, state of Rio Grande do Sul, Brazil. Children were examined regarding child care follow-up and vaccination schedule by checking the immunization chart. Data were analyzed using statistical tests Pearsons chi square and prevalence ratio (PR) with respective 95 percent confidence interval. Results: The frequency of children who were not continuously taken to the child care service was 53.2 percent. Multivariate analysis suggests that the factors associated with the lack of continuous use of the service were: mothers educational level < 8 years (PR 1.32 95 percentCI 1.02-1.71), non-nuclear family structure (PR 1.32 95 percentCI 1.10-1.59) and not being an only child (PR 1.38 95 percentCI 1.10-1.72). The reasons for lack of follow-up, according to the mothers were: the fact that they thought it unnecessary for 66.2 percent, problems with the service for 21.7 percent, difficulties related to their jobs for 6.05 percent, and other reasons for 6.05 percent. Conclusion: The high frequency of children who were not taken to the child health care service for follow-up is associated with low maternal educational level and family structure, as well as the perception that follow-up visits are not necessary when the child does not have a disease.

Método Mãe Canguru: uma investigação da prática domiciliar / Mother Kangaroo Method: an investigation about the domestic pratice

Estudo descritivo, inserido na abordagem quantitativa, com o objetivo de conhecer a prática domiciliar do Método Mãe Canguru. Os dados foram coletados a partir da aplicação de um questionário aos pais dos recém-nascidos prematuros que estiveram internados em um hospital universitário, em São Luís (MA), no período de maio a agosto de 2005. De acordo com os dados encontrados, 100 por cento das famílias receberam ensinamentos e orientações no hospital; sendo que em 53,3 por cento dos casos apenas a mãe foi orientada. Os benefícios do trabalho educativo desenvolvido pela equipe foram confirmados na prática domiciliar, com 93,3 por cento das mães realizando adequadamente a posição canguru, onde 86,7 por cento dos bebês encontravam-se ligeiramente vestidos, 86,7 por cento delas amamentando tecnicamente correto e 86,7 por cento sem fazer uso de qualquer tipo de adereços. 46,7 por cento das mães permanecem de cinco a oito horas/dia com o bebê nesta posição e 66,7 por cento identificaram as tarefas do lar como principal obstáculo da prática. Em relação ao seguimento ambulatorial neonatal, 63,3 por cento das mães identificaram a falta de recurso financeiro para cobrir as despesas com o transporte como principal fator de dificuldade. Os dados obtidos demonstram que o apoio da rede familiar e da equipe de saúde parece ser o melhor caminho para garantir a extensão do cuidado em domicílio.

This is a descriptive study, within uantitative approach, aiming at acquiring knowledge regarding the domestic practice of Mother Kangaroo Method. Data were collected from a survey for the parents of prematures hospitalized in a University Hospital in São Luís, Maranhão State, from May to August, 2005. According to the findings, 100 percent of the families received training and guidance in the hospital and only in 53.3 percent of the cases the mothers were guided. The benefits of the education works developed by the team were confirmed by domestic practice with 93.3 percent of the mothers performing the kangaroo position correctly, where 86.7 percent of the babies were slightly dressed, 86.7 percent of the mothers were breast feeding technically in a correct manner and 86.7 percent without any other items being used. 46.7 percent of the mothers stay 5 to 8 hours/day with their babies in this position and 66.7 percent identified house tasks as the principal obstacle of the practice. Regarding neonatal walk-in unit follow-up 63.3 percent of the mothers identified the lack of financial recourses to pay for transportation as the main difficulty factor. The data obtained show that the support from the family network and the health team seem to be the best way to guarantee the extension of domestic care.

Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India.

OBJECTIVE: To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies. METHOD: A observation in the NICU. RESULTS: A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day, were included. The mean birth weight and gestation were 1460 gm and 30 week respectively. 47% babies started KMC within first week of age. Mean duration of KMC was 7 days (3-48) days. The O(2) saturation improved by 2-3%, temperature ( degrees C) rose from 36.75 +/- 0.19 to 37.23 +/- 0.25, respiration stabilized (p<0.05 for all) and heart rate dropped by 3-5 beats. No episodes of hypothermia or apnea were observed during KMC. KMC was accepted by 96 % mothers, 82% fathers and 84% other family members. 94% HCW considered it to be safe and conservative method of care of LBWI. Benefits of KMC on the babies' behavior and on maternal confidence and lactation were reported by 57%, 94% and 80% respectively. A decline in use of heating devices in the NICU was reported by 85% and 79% said it did not increase their work load. CONCLUSION: KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU settings. Positive attitudes were observed in mothers, families and HCW.

Maternal deprivation, acute respiratory infections and immune regulation.

OBJECTIVE: The study was designed to investigate the acute respiratory disease incidence (DI) in deprived infants and test the hypothesis if maternal deprivation effects the processes of immunoregulation in infants. METHODS: The prospective study during 1 year in Tbilisi Infant's House was performed. Cohort of 136 infants at age from 1 to 24 months without any congenital abnormalities formed the basic group. The cohort of 136 healthy infants at age 1 to 24 months of the same population living under the maternal care in three shelters of Tbilisi region was randomized as a control. The study included: DI, age of first attack, duration of illness, outcome, plasma immune parameters. RESULTS: The data have demonstrated that maternal deprivation induces a marked increase in the severity of acute respiratory disease among infants. DI was twice as much in deprived children as in control group. Moreover, there was diagnosed the disruption of normal correlations between plasma CD3, CD4 and CD8 in infants under maternal deprivation. CONCLUSION: Maternal deprivation induces changes in processes of immunoregulation in infants resulted in elevation of acute respiratory DI among them.

Salvadoran fathers' attendance at prenatal care, delivery, and postpartum care

OBJETIVO: Proporcionar información de base acerca de la frecuencia con la cual los hombres salvadoreños acuden a la atención prenatal, al parto y a la atención del bebé sano después del parto, así como acerca de los factores sociodemográficos que se asocian con su asistencia a esas actividades, a fin de orientar acciones encaminadas a ayudar a los hombres a participar de una forma más útil en la salud maternoinfantil. MÉTODOS: Los datos, que se obtuvieron de la Encuesta Nacional de Salud Masculina de 2003 (ENSM-03) de El Salvador, se centran en los padres (n = 418) y en el hijo más joven que haya nacido vivo durante los cinco años anteriores a la encuesta. Mediante modelos de regresión logística y multinomial se exploraron factores asociados con la presencia de los padres en las consultas prenatales, en el parto y en las consultas para la atención del neonato sano.RESULTADOS: Noventa por ciento de los padres salvadoreños que fueron encuestados participaron en una consulta prenatal, asistieron al parto o estuvieron en una consulta para la atención del bebé sano; 34% de ellos participaron en las tres actividades. Lo más frecuente fue la asistencia al parto, notificada por 81% de los padres, y la razón dada con mayor frecuencia para no haber asistido fue la necesidad de ir a trabajar. CONCLUSIONES: La gran mayoría de los padres salvadoreños habían estado en por lo menos una consulta prenatal, en el parto o en una consulta para la atención del bebé sano. Aunque la participación en estas actividades no necesariamente significa que los cónyuges les estén dando a sus parejas el apoyo debido, los resultados parecieran indicar que ya están sentadas ciertas normas para que los hombres puedan desempeñar un papel positivo en el área de la salud maternoinfantil. Además, la participación de los padres en estas actividades relacionadas con la atención de madre e hijo podría ofrecer nuevas oportunidades para educar a los hombres y darles más apoyo en el cuidado de su propia salud y la de su familia.

Bacteriological quality of weaning food and drinking water given to children of market women in Nigeria: implications for control of diarrhoea.

Bacteriological quality of weaning food and drinking water given to 2 groups of children aged < or = years was evaluated by estimating bacterial cell count. One group consisted of those taken to market and the other of those left at home in the care of older siblings or house-helps. Bacterial counts (geometric mean) ranged from 5.02 +/- 1.82 to 8.70 +/- 1.0 log10 cfu per g or mL of food, and from 1.15 +/- 1.67 to 6.53 +/- 0.81 log10 cfu per g or 100 mL of water. Analysis of variance showed no significant difference in counts between types of food and between meals (breakfast and lunch). Bacterial contamination increased significantly with storage time, and was, in all circumstances except the water samples, significantly higher in foods given to children left at home. Reheated leftover foods also had significantly higher bacterial load than the freshly-cooked food. Coliform count varied significantly with source of drinking water. Poor hygiene standard (inferred from bacterial contamination) was generally observed among mothers weaning < or = 2-year-old children, while they were engaged in trading activities in the market, thus exposing their children to high risk of diarrhoea. Hygiene was significantly poorer in weaning of children left at home in the care of older siblings or house-helps. This implies that, in spite of their trading activities in the market, mothers still take better care of their babies than the older siblings or house-helps who may be inexperienced. These mothers may need education on childcare and food hygiene to suit to their trading activities, for example, during their monthly meetings. There is also a need to establish ORT (oral rehydration therapy) corners in the markets as part of the municipal services. This can be used not only for efficient and quick management of diarrhoea in the market but also for reinforcing hygiene education.

Newborn care at peripheral health care facilities.

Primary health centres, sub-district hospitals (first referral units) and district hospitals constitute the backbone of the health services in the country. These facilities are expected to cater to the care of the newborn infants who are delivered there, as well as those brought from the community with sickness. This paper, based on a survey in Orissa, and studies in a district hospital in Himachal Pradesh and a sub-district hospital in Haryana, is an attempt to piece together the present status of neonatal care at these facilities. In Orissa, the district and sub-district hospitals cater to a median of 100 and 30 deliveries per month, respectively. Most of the deliveries at these facilities are conducted by the nurses and not the physicians. Neonates are generally kept in the facility only for a day. Hardly any deliveries take place at primary health centres. Cesarean deliveries are mostly confined to the district hospitals. The commonest diagnosis of neonates admitted in the district and sub-district facilities is sepsis (septicemia pneumonia, skin infections, diarrhea and meningitis). Primary health centres seldom admit a sick neonate. It is reassuring to note that the outcome of sick neonates admitted at a functional district or sub-district hospital manned by a pediatrician is highly rewarding with low mortality rates.

Comparación de los resultados obtenidos con dos fórmulas lácteas, en niños intolerantes a la lactosa / Comparing two infant formulas for the handling of lactose intolerance

Objetivo: Comparar los resultados obtenidos con dos fórmulas diseñadas para el manejo de la intolerancia a la lactosa. Material y métodos: Se estudiaron 20 niños lactantes, divididos aleatoriamente en dos grupos de diez: A y B. El A recibió una fórmula que contiene sólo trazas de lactosa, y el B, con proteína aislada de la soya. En todos los niños se realizaron mediciones de: somatometría, hemoglobina, y sodio, potasio, calcio, fósforo y magnesio séricos, además de creatinuria, Se calcularon: peso/talla, peso/edad, talla/edad y creatinina/talla. Durante la diarrea se cuantificó el gasto fecal y tiempo de retorno a lo normal. Cada semana se realizó una prueba de tolerancia a la lactosa y cuando ésta fue normal, se dio por concluido el estudio. Se usó la prueba de t de Student y la exacta de Fisher. Resultados: Se encontró una diferencia significativa sólo en el tiempo en que toleraron nuevamente la lactosa, a favor del grupo A. Conslusiones: Los resultados parecen sugerir que la fórmula con trazas de lactosa, permite reintroducri la leche con lactosa de manera más temprana

Breast-feeding practices in Schedule Caste communities in Haryana state.

A study was conducted to assess exclusive breast-feeding, continued breast-feeding, bottle-feeding, predominant breast-feeding, timely complementary feeding and other breast-feeding practices in 818 children in the age group of 0-3 years belonging to the Schedule Caste communities of Haryana. The exclusive breast-feeding rate was 0.15 and the predominant breast-feeding rate 0.75 in children < 4 months. Timely complementary feeding rate was 0.42. The continued breast-feeding rate at 1 year and 2 years was 0.84 and 0.58, respectively. The bottle-feeding rate, ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate by mother were 0.09, 1.0, 0.0 and 0.15, respectively. The median duration of breast-feeding was 16 months.