ABSTRACT
OBJECTIVE: To identify normative blood pressure (BP) levels for Brazilian newborn infants and to define a cut-off point for high systolic and diastolic BP in this population.METHODS: 634 healthy term neonates, aged 12 to 36 hours, who were born in the Instituto Materno Infantil de Pernambuco (IMIP) were included in this survey. An oscillometric method was used to acess the neonates BP. To identify high BP levels the Second Task Force definition was applied.RESULTS AND CONCLUSIONS: The normative BP values for the study sample was 82.0 -/+ 7.5 mmHg for systolic and 41.7 -/+ 5.8 mmHg for diastolic blood pressure. The cut-off points for high blood pressure were >/= 95 mmHg and >/= 52 mmHg for systolic and diastolic blood pressure respectively. These results are similar to those reported in other surveys done in other countries.
ABSTRACT
AIM: To evaluate performance of a simplified algorithm and treatment instructions for emergency triage assessment and treatment (ETAT) of children presenting to hospital in developing countries. METHODS: All infants aged 7 days to 5 years presenting to an accident and emergency department were simultaneously triaged and assessed by a nurse and a senior paediatrician. Nurse ETAT assessment was compared to standard emergency advanced paediatric life support (APLS) assessment by the paediatrician. Sensitivity, specificity, and predictive values were calculated and appropriateness of nurse treatments was evaluated. RESULTS: The ETAT algorithm as used by nurses identified 731/3837 patients (19.05%); 98 patients (2.6%) were classified as needing emergency treatment and 633 (16.5%) as needing priority assessment. Sensitivity was 96.7% with respect to APLS assessment, 91.7% with respect to all patients given priority by the paediatrician, and 85.7% with respect to patients ultimately admitted. Specificity was 90.6%, 91.0%, and 85.2%, respectively. Nurse administered treatment was appropriate in 94/102 (92.2%) emergency conditions. CONCLUSIONS: The ETAT algorithm and treatment instructions, when carried out by nurses after a short specific training period, performed well as a screening tool to identify priority cases and as a treatment guide for emergency conditions.
Subject(s)
Developing Countries , Emergency Nursing , Practice Guidelines as Topic/standards , Triage/methods , Algorithms , Brazil , Child, Preschool , Clinical Competence , Emergency Nursing/standards , Emergency Service, Hospital , Emergency Treatment , Evaluation Studies as Topic , Humans , Infant , Infant, Newborn , Medical Staff, Hospital/standards , Sensitivity and Specificity , Treatment OutcomeABSTRACT
The objective of this study was to identify a short list of valid signs for the development of standard case management guidelines for severe bacterial infection (SBI) in newborn infants, an important cause of neonatal deaths in low-income countries. The reported and observed signs of 83 sick neonates admitted during 12 consecutive months were recorded. At discharge, 50 cases were classified, using predefined criteria, as SBI, mostly pneumonia, and 33 as other disease. The neonates with other diseases were significantly younger than those with SBI. None of the reported and observed signs, when used alone, had a high sensitivity, an important feature for a severe disease amenable to effective treatment. The best sensitivity (74 per cent) was obtained when a doctor observed severe chest indrawing or fast breathing or 'not looking well'; the specificity was 67 per cent and the positive predictive value 77 per cent. The sensitivity of reported difficult breathing and of observed severe chest indrawing, when measured only for the diagnosis of pneumonia, improved to 77 per cent, with a specificity of 84 per cent and 66 per cent, respectively. Reported fever and the observation that the neonate was 'not looking well' were the best independent predictors of SBI on logistic regression analysis. Simple standard case management (SCM) guidelines based only on reported and observed clinical signs would not identify the majority of neonates with SBI at primary health care level.
Subject(s)
Bacterial Infections/diagnosis , Case Management , Infant, Newborn, Diseases/diagnosis , Bacterial Infections/epidemiology , Brazil/epidemiology , Case-Control Studies , Female , Guidelines as Topic , Humans , Infant, Newborn , Infant, Newborn, Diseases/epidemiology , Logistic Models , Male , Predictive Value of TestsABSTRACT
OBJECTIVE: To identify if there is a relationship between some newborn variables (baby's sex, Apgar score, postnatal age, birth weight, birth length, and head circumference) and blood pressure (BP) in healthy term newborns. STUDY DESIGN: A cross-sectional hospital-based study was carried out to determine BP levels and a cutoff point for hypertension in healthy term newborns. Afterward, a comparative study was conducted to identify fetal factors that could influence BP in this specific group. RESULTS: According to the cutoff point (95th percentile), 34 infants were considered to be hypertensive. During the univariate analyses, infants with higher BP were heavier, longer, and had larger head circumference. After the multivariate analyses, birth weight was the only variable associated with higher BP in babies. Other newborn variables analyzed (baby's sex, Apgar score, and postnatal age) showed no influence on the babies' BP. CONCLUSION: There is a positive relationship between birth weight and BP in healthy term newborns.
