Unraveling the epidemiology of urinary tract infections in neonates: Perspective from a Brazilian NICU.

BACKGROUND: Urinary tract infections (UTIs) can lead to neonatal complications like sepsis, worsened by empirical treatment, contributing to antimicrobial resistance (AMR). This study examined the incidence, etiology, risk factors, and antimicrobial susceptibility of uropathogens in a Neonatal Intensive Care Unit (NICU) in Brazil. METHODS: Medical records of neonates hospitalized in the NICU from January 2015 to June 2022 were retrospectively analyzed through the National Healthcare Safety Network system. RESULTS: Among 1,474 neonates, 3.9% developed UTI, with an alarming 24-fold increase in incidence from 2015 to 2021. Genitourinary complications (odds ratio = 4.8) were a major risk factor. Of the 71 uropathogens, 74.6% were Gram-negative bacteria (GNB), 21.2% Gram-positive bacteria (GPB), and 4.2% Candida albicans. AMR was notable, with 13.3% of GPB and 20.7% of GNB exhibiting multidrug-resistant (MDR), while 6.6% of GPB and 1.9% of GNB showed extensive drug-resistant (XDR). UTI was associated with prolonged hospitalization (16-59 days). In 57 neonates with UTI, 40.3% had bloodstream infections, elevating the risk of death (odds ratio = 1.8). CONCLUSIONS: The study underscores the urgency of implementing infection prevention and control measures in the NICU to curb rising UTI incidences, combat AMR, and mitigate severe complications in critically ill neonates.

Bronchopulmonary dysplasia: temporal trend from 2010 to 2019 in the Brazilian Network on Neonatal Research.

OBJECTIVE: To evaluate the temporal trend of bronchopulmonary dysplasia (BPD) in preterm infants who survived to at least 36 weeks' post-menstrual age (PMA) and BPD or death at 36 weeks' PMA, and to analyse variables associated with both outcomes. DESIGN: Retrospective cohort with data retrieved from an ongoing national registry. SETTING: 19 Brazilian university public hospitals. PATIENTS: Infants born between 2010 and 2019 with 23-31 weeks and birth weight 400-1499 g. MAIN OUTCOME MEASURES: Temporal trend was evaluated by Prais-Winsten model and variables associated with BPD in survivors or BPD or death were analysed by logistic regression. RESULTS: Of the 11 128 included infants, BPD in survivors occurred in 22%, being constant over time (annual per cent change (APC): -0.80%; 95% CI: -2.59%; 1.03%) and BPD or death in 45%, decreasing over time (APC: -1.05%; 95% CI: -1.67%; -0.43%). Being male, small for gestational age, presenting with respiratory distress syndrome, air leaks, needing longer duration of mechanical ventilation, presenting with treated patent ductus arteriosus and late-onset sepsis were associated with an increase in the chance of BPD. For the outcome BPD or death, maternal bleeding, multiple gestation, 5-minute Apgar <7, late-onset sepsis, necrotising enterocolitis and intraventricular haemorrhage were added to the variables reported above as increasing the chance of the outcome. CONCLUSION: The frequency of BPD in survivors was constant and BPD or death decreased by 1.05% at each study year. These results show some improvement in perinatal care in Brazilian units which resulted in a reduction of BPD or death, but further improvements are still needed to reduce BPD in survivors.

Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Growth phenotypes of very low birth weight infants for prediction of neonatal outcomes from a Brazilian cohort: comparison with INTERGROWTH.

OBJECTIVE: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). METHOD: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. OUTCOME: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. RESULTS: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92-2.31)/1.60 (1.27-2.02) for SGA; 0.90 (0.55-1.47)/1.05 (0.55-1.99) for LGA; 1.65 (1.08-2.51)/1.58 (1.28-1.96) for stunting; and 1.48 (1.02-2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. CONCLUSION: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

Evaluation of respiratory complications in a cohort of preterm infants who did not receive palivizumab monoclonal antibodies.

OBJECTIVES: to analyze the occurrence of respiratory complications over the first year of life in preterm infants who did not receive palivizumab monoclonal antibodies. METHODS: analytical retrospective cohort study with preterm infants born between 2012 and 2016 in Uberlândia, state of Minas Gerais, Brazil. Data collection occurred from January to November 2018, by consulting hospital and primary healthcare medical records. Data were processed with the Poisson regression model, with p<0.05. RESULTS: of a total of 5,213 preterm births, 504 (9.7%) met the inclusion criteria. The preterm infants in this subset were assisted 2,899 times in primary care, which resulted in 1,098 (37.5%) medical diagnoses, of which 803 (78.5%) involved the respiratory tract. Preterm babies fed on formula milk at hospital discharge had more diagnoses of respiratory diseases. Maternal age (p=0.039), respiratory diagnosis at hospital discharge (p=0.028), and number of sporadic appointments (p<0.001) showed a significant association with bronchiolitis; number of sporadic appointments showed a significant association with occurrence of respiratory diseases; and breastfeeding had a protective effect against the development of bronchiolitis. CONCLUSIONS: preterm infants who did not receive palivizumab showed a high percentage of respiratory diseases, and breastfeeding helped protect them against bronchiolitis. It is recommended that these preterm babies be monitored in primary health care.

Protective measures feasibility for infants of low income SARS-CoV-2 positive breastfeeding mothers: a prospective multicenter cohort study.

AIM: The aim was to evaluate the feasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers. BACKGROUND: Breastfeeding mothers with SARS-CoV-2 positive should avoid exposing the infant through protective measures (PM), but it could be challenging in a low-income population. METHODS: A prospective, multicenter study was conducted between July and October 2020 (BRACOVID). The participants were recruited at birth and interviewed through a structured questionnaire at seven and 14 days in the home environment. The feasibility of PM during breastfeeding at home was defined by guidelines recommendations (mask using, handwashing, and distancing from newborn when not breastfeeding). Three groups according to the feasibility of guidelines: complete guidelines feasibility (CG): all PM; partial guidelines feasibility (PG): at least one PM feasible; no guidelines (NG): infeasibility to all of PM. Flu-like neonatal symptoms, mothers' breastfeeding practices. We evaluated the association between PM feasibility and socioeconomic factors. RESULTS: 117 infected mothers from 17 Brazilian hospitals were enrolled. 47 (40%) mothers followed all recommendations, 14 (11.9%) could not practice at least one recommendation, and 50 (42.7%) did not execute any of them. The breastfeeding rate was 98%. Factors associated with infeasibility were monthly family income < 92.7 dollars/person, high housing density (>1 inhabitant/room), teenage mothers, responsive feeding, and poor schooling. Regarding infants' flu-like symptoms, 5% presented symptoms at fourteen days (NG group). CONCLUSION: The guidelines were not applied to infants of SARs-CoV-positive mothers in 54.6% of the dyads since the recommendations were unviable in their environments. During pandemics, we should look for feasible and effective guidelines to protect neonates from low-income populations. IMPLICATIONS FOR NURSING MANAGEMENT: Poor socioeconomic conditions lead to the unfeasibility of protective measures for infants of low-income SARS-CoV-2 positive breastfeeding mothers during the isolation period in the pandemics. The orientations and the support provided to dyad should consider the socioeconomic factors to guide feasible measures in the home environment and promote adequate protections; only an individual approach will allow a safe environment for low-income infants.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding

Abstract Objective Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. Method Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. Results The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p= 0.000). There was a positive association between having remained in the kangaroo (p= 0.003) and the breastfeeding self-efficacy score (p= 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. Conclusion The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

The possible mediating relationship promoted by the self-efficacy of breastfeeding associated with the Kangaroo Method on indicators of exclusive breastfeeding.

OBJECTIVE: Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding. METHOD: Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%. RESULTS: The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator. CONCLUSION: The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association.

Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey.

OBJECTIVE: Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. STUDY DESIGN: Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. RESULTS: In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. CONCLUSION: Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS. KEY POINTS: · Neonatologists overestimate the risk of EOS.. · There is wide variation in diagnostic/treatment thresholds for EOS.. · Clinical decision on EOS is not consistent with risk thresholds.. · Knowledge of risk may increase investigation and treatment of EOS..

Evaluation of respiratory complications in a cohort of preterm infants who did not receive palivizumab monoclonal antibodies / Evaluación de complicaciones respiratorias en cohorte de prematuros no contemplados con el anticuerpo monoclonal palivizumab / Avaliação das intercorrências respiratórias em coorte de prematuros não contemplados com o anticorpo monoclonal palivizumabe

ABSTRACT Objectives: to analyze the occurrence of respiratory complications over the first year of life in preterm infants who did not receive palivizumab monoclonal antibodies. Methods: analytical retrospective cohort study with preterm infants born between 2012 and 2016 in Uberlândia, state of Minas Gerais, Brazil. Data collection occurred from January to November 2018, by consulting hospital and primary healthcare medical records. Data were processed with the Poisson regression model, with p<0.05. Results: of a total of 5,213 preterm births, 504 (9.7%) met the inclusion criteria. The preterm infants in this subset were assisted 2,899 times in primary care, which resulted in 1,098 (37.5%) medical diagnoses, of which 803 (78.5%) involved the respiratory tract. Preterm babies fed on formula milk at hospital discharge had more diagnoses of respiratory diseases. Maternal age (p=0.039), respiratory diagnosis at hospital discharge (p=0.028), and number of sporadic appointments (p<0.001) showed a significant association with bronchiolitis; number of sporadic appointments showed a significant association with occurrence of respiratory diseases; and breastfeeding had a protective effect against the development of bronchiolitis. Conclusions: preterm infants who did not receive palivizumab showed a high percentage of respiratory diseases, and breastfeeding helped protect them against bronchiolitis. It is recommended that these preterm babies be monitored in primary health care.

RESUMEN Objetivos: investigar complicaciones respiratorias en el primer año de vida de prematuros no contemplados con anticuerpo monoclonal palivizumab. Métodos: estudio de cohorte retrospectivo, analítico, con prematuros nacidos entre 2012 y 2016 en Uberlândia, MG. Datos recolectados de enero a noviembre de 2018 en historias clínicas hospitalarias y de atención básica. Se utilizó modelo de regresión de Poisson, considerándose p<0,05. Resultados: de 5.513 nacimientos prematuros, 504 (9,7%) atendieron criterios; estos prematuros recibieron 2.899 consultas en atención básica; 1.098 (37,5%) con diagnóstico médico; 803 (78,5%) del tracto respiratorio. Prematuros con fórmula láctea al alta hospitalaria recibieron más diagnósticos de enfermedades respiratorias. Edad materna (p=0,039), diagnóstico respiratorio al alta (p=0,028), cantidad de consultas eventuales (p<0,001) mostraron asociación significativa con bronquiolitis. Conclusiones: prematuros sin palivizumab mostraron elevado porcentaje de enfermedades respiratorias; se observó efecto protector de la lactancia materna. Se recomienda el seguimiento de dichos prematuros en atención primaria.

RESUMO Objetivos: investigar intercorrências respiratórias no primeiro ano de vida de prematuros não contemplados com anticorpo monoclonal palivizumabe. Métodos: estudo de coorte retrospectivo, analítico, com prematuros nascidos entre 2012 e 2016, em Uberlândia, MG. Coleta realizada de janeiro a novembro de 2018, em prontuários hospitalar e da atenção básica. Utilizou-se modelo de regressão de Poisson; considerou-se p<0.05. Resultados: de 5.213 nascimentos prematuros, 504 (9,7%) atenderam os critérios; esses prematuros tiveram 2.899 atendimentos na atenção básica; 1.098 (37,5%) com diagnóstico médico, 803 (78,5%) do trato respiratório. Prematuros com fórmula láctea na alta hospitalar tiveram mais diagnósticos de doenças respiratórias. Idade materna (p=0,039), diagnóstico respiratório na alta (p=0,028), número de consultas eventuais (p<0,001) apresentaram associação significativa com bronquiolite. Consultas eventuais foram significantes para doenças respiratórias; o aleitamento materno mostrou-se protetor para bronquiolite. Conclusões: prematuros sem palivizumabe apresentaram elevado percentual de doenças respiratórias; observou-se efeito protetor do aleitamento materno. Recomenda-se vigilância desses prematuros na atenção primária.

Hypothermia and neonatal morbimortality in very low birth weight preterm infants / Hipotermia e morbimortalidade neonatal em recém-nascidos pré-termo de muito baixo peso

ABSTRACT Objective: To assess the prevalence of hypothermia in the delivery room, at admission, and 2 to 3 hours after admission in the neonatal intensive care unit (NICU), factors associated and possible relationship with morbidity and mortality in preterm infants with very low birth weight (VLBW). Methods: Cross-sectional study with data collection based on a retrospective review of medical records and including infants born in 2016 and 2017, with birth weights <1500g, and gestational ages <34 weeks. Data about VLBW preterm infants, maternal data and temperature in the delivery room were analyzed. Hypothermia was considered when axillary temperature <36°C. For statistical analysis, the chi-square test or G test, canonical and Spearman correlation, and logistic regression were used. Results: 149 newborns (NB) were included in the study. The prevalence of hypothermia in delivery room, at admission to the NICU and 2 to 3 hours after admission was 25.8%, 41.5% and 40.2%, respectively. The temperature of NBs was directly proportional to gestational age (p<0.010), birth weight (p<0.010), and Apgar score (p<0.050). There was an inverse association with hypothermia in the delivery room and cesarean delivery (OR 0.25; p=0.016). Conclusions: Hypothermia was a prevalent problem in the studied population. The neonatal temperature was directly proportional to gestational age, birth weight and Apgar score. Hypothermia was associated with maternal factors, such as cesarean delivery. It is necessary to implement and improve strategies for its prevention.

RESUMO Objetivo: Avaliar a prevalência da hipotermia na sala de parto, à admissão e 2 a 3 horas após a admissão na Unidade de Terapia Intensiva Neonatal (UTIN), fatores associados e possível associação com morbimortalidade em recém-nascidos pré-termo de muito baixo peso (RNPT MBP). Métodos: Estudo transversal, com coleta retrospectiva de dados em prontuários dos RNPT MBP nascidos em 2016 e 2017, com peso <1500g e idade gestacional <34 semanas. Foram analisados dados dos RNPT MBP, da mãe e a temperatura na sala de parto. Foi considerada hipotermia a temperatura axilar <36°C. Para análise estatística, foram utilizados teste do qui-quadrado ou teste G, correlacçã canônica e de Spearman, e regressaã logística. Resultados: Fizeram parte do estudo 149 recém-nascidos (RN). A prevalência da hipotermia na sala de parto, à admissão na UTIN e 2 a 3 horas após a admissão, foi de 25,8, 41,5 e 40,2%, respectivamente. A temperatura do RN foi diretamente proporcional à idade gestacional (p<0,010), ao peso ao nascimento (p<0,010) e ao índice de Apgar (p<0,050). Observou-se associação inversa entre hipotermia na sala de parto e parto cesáreo (OR 0,25; p=0,016). Conclusões: A hipotermia foi um problema prevalente na população estudada. A temperatura do RN foi diretamente proporcional à idade gestacional, peso ao nascimento e Boletim de Apgar. Esteve também associada a fatores maternos, como parto cesáreo. Portanto, faz-se necessário a implementação e aprimoramento de estratégias para a sua prevenção.

Hypothermia and neonatal morbimortality in very low birth weight preterm infants.

OBJECTIVE: To assess the prevalence of hypothermia in the delivery room, at admission, and 2 to 3 hours after admission in the neonatal intensive care unit (NICU), factors associated and possible relationship with morbidity and mortality in preterm infants with very low birth weight (VLBW). METHODS: Cross-sectional study with data collection based on a retrospective review of medical records and including infants born in 2016 and 2017, with birth weights <1500g, and gestational ages <34 weeks. Data about VLBW preterm infants, maternal data and temperature in the delivery room were analyzed. Hypothermia was considered when axillary temperature <36°C. For statistical analysis, the chi-square test or G test, canonical and Spearman correlation, and logistic regression were used. RESULTS: 149 newborns (NB) were included in the study. The prevalence of hypothermia in delivery room, at admission to the NICU and 2 to 3 hours after admission was 25.8%, 41.5% and 40.2%, respectively. The temperature of NBs was directly proportional to gestational age (p<0.010), birth weight (p<0.010), and Apgar score (p<0.050). There was an inverse association with hypothermia in the delivery room and cesarean delivery (OR 0.25; p=0.016). CONCLUSIONS: Hypothermia was a prevalent problem in the studied population. The neonatal temperature was directly proportional to gestational age, birth weight and Apgar score. Hypothermia was associated with maternal factors, such as cesarean delivery. It is necessary to implement and improve strategies for its prevention.

Invasive mechanical ventilation and biomarkers as predictors of bronchopulmonary dysplasia in preterm infants.

OBJECTIVES: To evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as predictors of bronchopulmonary dysplasia in very low birth weight preterm infants. It was hypothesized that the use of invasive mechanical ventilation in the first hours of life is associated with biomarkers that may predict the chances of preterm infants to develop bronchopulmonary dysplasia. METHODS: Prospective cohort of 40 preterm infants with gestational age <34 weeks and birth weight <1500 g. The following were analyzed: clinical variables; types of ventilator support used (there is a higher occurrence of bronchopulmonary dysplasia when oxygen supplementation is performed by long periods of invasive mechanical ventilation); hospitalization time; quantification of two cytokines (granulocyte and macrophage colony stimulating factor [GM-CSF] and eotaxin) in blood between 36 and 48 h of life. The preterm infants were divided in two groups: with and without bronchopulmonary dysplasia. RESULTS: The GM-CSF levels presented a significantly higher value in the bronchopulmonary dysplasia group (p = 0.002), while eotaxin presented higher levels in the group without bronchopulmonary dysplasia (p = 0.02). The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin (100% sensitivity and 80% specificity; receiver operating characteristic area = 0.9013, CI = 0.7791-1.024, p < 0.0001). CONCLUSIONS: The duration of invasive mechanical ventilation performed in the first 48 h of life in the very low birth weight infants is a significant clinical predictor of bronchopulmonary dysplasia. The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequent progression of the disease.

Impacto da segunda e terceira etapas do método canguru: do nascimento ao sexto mês / Impacto de la segunda y tercera etapas del método canguro: del nacimiento al sexto mes / Impact of the second and third stages of the kangaroo method: from birth to sixth month

Objetivos: Avaliar se o Método Canguru tem impacto nas taxas de aleitamento materno exclusivo, peso, tempo de internação e taxas de reinternação. Método: Trata-se de uma coorte retrospectiva, que incluiu recém-nascidos pré-termo de muito baixo peso ao nascer, os quais foram divididos em dois grupos: GCCo ­ composto por aqueles assistidos na Unidade de Cuidados Intermediários Neonatal Convencionais; GCCa ­ composto por aqueles que foram assistidos na Unidade de Cuidados Intermediários Neonatal Canguru. Resultados: O grupo GCCa apresentou resultados superiores nas taxas de aleitamento materno exclusivo, no momento da alta hospitalar, primeira consulta ambulatorial, quarto mês de idade gestacional corrigida, além de menores taxas de reinternação. Conclusão: As segunda e terceira etapas do Método Canguru favoreceram a prática e manutenção do aleitamento materno exclusivo, além de apresentarem menores taxas de reinternação até o sexto mês de idade gestacional corrigida(AU)

Purpose: To evaluate whether the Kangaroo Method would have an impact on the rates of exclusive breastfeeding, weight, length of hospital stay and rates of hospital readmission. Methods: This is a retrospective cohort, which included very-low-weight preterm newborns. These were divided into two groups: GCCo - composed of those assisted in the Conventional Neonatal Intermediate Care Unit; GCCa - composed of those who were assisted at the Kangaroo Neonatal Intermediate Care Unit. Results: The GCCa group showed better results in exclusive breastfeeding rates at the time of hospital discharge and during outpatient follow-up - first outpatient consultation corrected fourth month of gestational age, in addition to lower rates of readmission. Conclusion: The second and third stages of the Kangaroo Method favored the practice and maintenance of exclusive breastfeeding, in addition to presenting lower rates of readmission until the sixth month of corrected gestational age(AU)

Objetivos: Evaluar si el Método Canguro tendría un impacto en las tasas de lactancia materna exclusiva, peso, tiempo de estancia hospitalaria y tasas de reingreso. Método: Se trata de un grupo retrospectivo, que incluyó a recién nacidos prematuros de muy bajo peso al nacer. Estos se dividieron en dos grupos: GCCo - compuesto por los atendidos en la Unidad de Cuidados Intermedios Neonatales Convencionales; GCCa - compuesto por los que fueron atendidos en la Unidad de Cuidados Intermedios Neonatales Canguro. Resultados: El grupo GCCa mostró resultados superiores en las tasas de lactancia materna exclusiva al momento del alta hospitalaria y durante el seguimiento ambulatorio - primera consulta ambulatoria en el cuarto mes de edad gestacional corregida, además de menores tasas de reingreso. Conclusión: La segunda y tercera etapa del Método Canguro favoreció la práctica y la prolongación de la lactancia materna exclusiva, además de presentar menores tasas de reingreso hasta el sexto mes de edad gestacional corregida(AU)

[Impact of the kangaroo method of breastfeeding of preterm newborn infants in Brazil: an integrative review]. / Impacto do método canguru sobre o aleitamento materno de recém-nascidos pré-termo no Brasil: uma revisão integrativa.

The scope of this integrative review of the literature was to assess if the Kangaroo-Mother Care Method as implemented in Brazil, from the first stage to outpatient follow-up, has an influence on breastfeeding. Brazilian research published in national and international journals in Portuguese, English or Spanish in the leading research databases between the years 2000 to 2017 was included, with full articles available and theme related to the scope of this study. A total of 1328 articles were located and articles not conducted in Brazil, literature review articles and themes not related to the Kangaroo-Mother Care Method were excluded, with 21 studies eventually being selected. The research results indicated a positive influence of the Kangaroo-Mother Care Method on breastfeeding and establishing a mother-child bond. However, the third stage or outpatient follow-up proved not to be effective in maintaining breastfeeding. Greater participation of primary care in home care provided to preterm newborns is necessary, with a view to promoting exclusive breastfeeding up to six months of age and extended up to two years of age.

Esta revisão integrativa da literatura teve como objetivo verificar se o Método Canguru, conforme instituído no Brasil, desde a primeira etapa até o acompanhamento ambulatorial, tem influência sobre o aleitamento materno. Foram incluídas pesquisas realizadas no Brasil, publicadas em periódicos nacionais e internacionais, nas principais bases de dados, em português, inglês ou espanhol, nos anos de 2000 a 2017, disponíveis na íntegra e com a temática relacionada com o objetivo deste estudo. Foram encontrados 1328 artigos sendo excluídos artigos não realizados no Brasil, artigos de revisão da literatura e de temáticas não relacionadas com o Método Canguru, sendo então selecionados 21 estudos. As pesquisas encontradas apontaram para uma influência positiva do Método Canguru sobre o aleitamento materno e estabelecimento de vínculo entre mãe-filho. No entanto, a terceira etapa ou acompanhamento ambulatorial, não se mostrou eficaz na manutenção do aleitamento materno. Faz-se necessário maior participação da atenção básica nos cuidados domiciliares prestados ao recém-nascido pré-termo, com vistas à promoção do aleitamento materno exclusivo até os seis meses de idade e complementado até os dois anos.

Evaluation of usability of a neonatal health information system according to the user's perception / Avaliação da usabilidade de um sistema de informação em saúde neonatal segundo a percepção do usuário

ABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

RESUMO Objetivo: Mensurar o grau de satisfação de profissionais de saúde quanto à usabilidade de um sistema de informação em saúde neonatal e identificar os fatores que podem influenciar na satisfação do usuário frente à usabilidade. Métodos: Estudo transversal e exploratório realizado com 50 profissionais de saúde integrantes dos centros da Rede Brasileira de Pesquisas Neonatais. Para avaliação da usabilidade foi utilizado o instrumento System Usability Scale entre fevereiro e março de 2017. Realizou-se a análise estatística descritiva e inferencial das variáveis coletadas, com a finalidade de descrever a amostra, quantificar o grau de satisfação dos usuários e identificar as variáveis associadas ao grau de satisfação do usuário em relação à usabilidade. Resultados: Da população avaliada, 75% era do sexo feminino, com idade média 52,8 anos, 58% com pós-graduação (doutorado); tempo médio da última formação de 17 anos; área de atuação em medicina (neonatologia), grau intermediário de conhecimento em informática e tempo de utilização média do sistema de 52 meses. Quanto à usabilidade, 94% avaliaram o sistema como "bom", "excelente" ou "melhor impossível". A usabilidade do sistema não foi associada a idade, sexo, escolaridade, profissão, área de atuação, nível de conhecimento em informática e tempo de uso do sistema. Conclusões: O grau de satisfação do usuário do sistema informatizado de saúde foi considerado bom. Não foram identificados fatores demográficos que influenciassem sua avaliação.

EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER'S PERCEPTION.

OBJECTIVE: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. METHODS: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. RESULTS: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as "good", "excellent" or "better than imaginable". The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. CONCLUSION: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.

T-piece versus self-inflating bag ventilation in preterm neonates at birth.

OBJECTIVE: To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. DESIGN: Pragmatic prospective cohort study. SETTING: 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. INTERVENTIONS: Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalacia. Logistic regression adjusted for confounding variables was applied for main outcome. RESULTS: 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 ± 277 vs 941 ± 279 g, gestational age 28.2±2.5 vs 27.8±2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%. Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% CI 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). CONCLUSION: This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.

Prescribing errors in a Brazilian neonatal intensive care unit / Erros de prescrição em uma unidade de terapia intensiva neonatal brasileira / Errores de prescripción en una unidad de terapia intensiva neonatal brasileña

Abstract Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.

Resumo Pacientes pediátricos, principalmente internados em unidades de terapia intensiva (UTI) neonatal, são altamente vulneráveis aos erros de medicação. O objetivo deste trabalho foi conhecer a frequência dos erros de prescrição em uma UTI neonatal de um hospital universitário, bem como os pacientes susceptíveis, os tipos de erros e os medicamentos envolvidos. As variáveis prescritas relacionadas aos medicamentos foram comparadas com a base utilizada como referência para a prescrição na unidade (Neofax). Participaram do estudo 150 recém-nascidos. Foram analisadas 489 prescrições, 1.491 itens de medicamentos, correspondendo a 46 fármacos. A taxa de erros de prescrição foi de 43,5%. Foram encontrados erros de dose, intervalo, diluente e tempo de infusão, distribuídos em sete classes terapêuticas. A ocorrência de erros foi maior em recém-nascidos pré-termos. Os erros de diluente e de dose foram os mais frequentes. As classes de medicamentos mais envolvidas nos erros foram os anti-infecciosos e aqueles que atuam nos sistemas nervoso e cardiovascular.

Resumen Pacientes pediátricos, principalmente internados en unidades de terapia intensiva (UTI) neonatal, son altamente vulnerables a los errores de medicación. El objetivo de este estudio fue conocer la frecuencia de los errores de prescripción en una UTI neonatal de un hospital universitario así como, los pacientes susceptibles, los tipos de errores y los medicamentos involucrados. Las variables prescritas relacionadas a los medicamentos fueron comparadas con la base utilizada como referencia para la prescripción en la unidad (Neofax). Participaron en el estudio 150 recién nacidos. Se analizaron 489 prescripciones, 1.491 ítems de medicamentos, correspondiendo a 46 fármacos. La tasa de errores de prescripción fue de un 43,5%. Fueron encontrados errores de dosis, intervalo, diluyente y tiempo de infusión, distribuidos en 7 clases terapéuticas. La ocurrencia de errores fue mayor en recién nacidos prematuros. Los errores de diluyente y de dosis fueron los más frecuentes. Las clases de medicamentos más involucrados en los errores fueron los anti-infecciosos y aquellos que actúan en el sistema nervioso y cardiovascular.

Prescribing errors in a Brazilian neonatal intensive care unit.

Pediatric patients, especially those admitted to the neonatal intensive care unit (ICU), are highly vulnerable to medication errors. This study aimed to measure the prescription error rate in a university hospital neonatal ICU and to identify susceptible patients, types of errors, and the medicines involved. The variables related to medicines prescribed were compared to the Neofax prescription protocol. The study enrolled 150 newborns and analyzed 489 prescription order forms, with 1,491 medication items, corresponding to 46 drugs. Prescription error rate was 43.5%. Errors were found in dosage, intervals, diluents, and infusion time, distributed across 7 therapeutic classes. Errors were more frequent in preterm newborns. Diluent and dosing were the most frequent sources of errors. The therapeutic classes most involved in errors were antimicrobial agents and drugs that act on the nervous and cardiovascular systems.