Prevention and non-pharmacological management of pain in newborns.

OBJECTIVE: To describe the main non-pharmacological interventions for pain relief in newborns available in Neonatal Intensive Care Unit. METHOD: An exploratory search of the MedLine, Lilacs and Scielo online databases was conducted to retrieve references of studies published from 2004 to 2013. RESULTS: Several non-pharmacological interventions were shown to be effective, to represent low risk for neonates and to have a low operational cost. The ones most often discussed in the literature were: oral administration of glucose/sucrose, non-nutritive sucking, breastfeeding, skin-to-skin contact, facilitated tucking and swaddling. CONCLUSION: Healthcare teams should be familiar with these methods and use them more effectively in Neonatal Intensive Care Unit daily routines, so as to ensure that newborns receive qualified and more human care.

[Late-onset neonatal sepsis in preterm infants with birth weight under 1.500 g]. / Sepse neonatal tardia em recém-nascidos pré-termo com peso ao nascer inferior a 1.500 g.

OBJECTIVE: The research objective was to characterize preterm infants with birth weight under 1500 g, and to identify the incidence of late-onset neonatal sepsis among this population. METHODS: A prospective cohort study with a sample of 30 preterm newborns that weighed under 1500 g and were hospitalized in the NICU of the university hospital. Data were collected from January to December 2013 using a structured instrument. RESULTS: Of the 30 neonates included in the study, 14 developed late-onset neonatal sepsis with a prevalence of coagulase-negative staphylococci. CONCLUSIONS: The incidence of late-onset neonatal sepsis indicates a vulnerability in preterm infants due to immunological immaturity. These results reveal that knowledge of the profile of newborn infants admitted to the NICU and the risk factors to which they are exposed are central to the planning of nursing care for these patients. Future studies should address strategies for preventing nosocomial infection.

Cross-cultural adaptation and clinical validation of the Neonatal Skin Condition Score to Brazilian Portuguese.

OBJECTIVE: To describe the process of cross-cultural adaptation and clinical validation of the Neonatal Skin Condition Score. METHODS: This methodological cross-cultural adaptation study included five steps: initial translation, synthesis of the initial translation, back translation, review by an Committee of Specialists and testing of the pre-final version, and an observational cross-sectional study with analysis of the psychometric properties using the Adjusted Kappa, Intraclass Correlation Coefficient, and Bland-Altman Method statistical tests. A total of 38 professionals were randomly recruited to review the clarity of the adapted instrument, and 47 newborns hospitalized in the Neonatology Unit of the Clinical Hospital of Porto Alegre were selected by convenience for the clinical validation of the instrument. RESULTS: The adapted scale showed approximately 85% clarity. The statistical tests showed moderate to strong intra and interobserver item to item reliability and from strong to very strong in the total score, with a variation of less than 2 points among the scores assigned by the nurses to the patients. CONCLUSIONS: The scale was adapted and validated to Brazilian Portuguese. The psychometric properties of the Brazilian version of the Neonatal Skin Condition Score instrument were similar to the validation results of the original scale.

Adverse events related to the use of central venous catheters in hospitalized newborns.

This study identifies the adverse events related to the use of central venous catheters (CVC) in newborns admitted to a neonatal care unit. This is a quantitative, descriptive and retrospective study. The population consisted of 167 newborns admitted in the neonatal unit of the Hospital de Clínicas at Porto Alegre, RS, Brazil which used CVCs inserted through percutaneous puncture (PICC) and surgical insertion, totaling 241 catheters. There was a higher prevalence of mechanical adverse events in the PICC line insertions, with a preponderance of catheter occlusions (19.44%) and ruptures (8.8%). The surgically inserted CVCs had a higher prevalence of catheter-related infectious adverse events with the most common being clinical sepsis (16%). This study suggests that the correct insertion technique should be used and a specialized team should monitor the CVCs to ensure safety and prevent adverse events.

[Association between newborn vitality and type of delivery]. / Associação da vitalidade do recém-nascido com o tipo de parto.

The objective of this study was to associate the Apgar score at the first and the fifth minutes of life among neonates born by normal vaginal delivery and by Cesarean section. The population of the study comprised 150 term neonates, 75 of whom were born by normal vaginal delivery and 75 by C-section. The results presented a significant difference (P = 0.046) in the 4 to 6 Apgar score at the first minute of life, showing a reduction in vitality after delivery by C-section. Male newborns seemed to be more influenced by the type of delivery than female ones. This was observed in the lower Apgar score during the first minute of life, showing a significant diftfrence (P = 0.004) in the deliveries by C-section. In term neonates the weight was not related to a variation in vitality when associated to the type of delivery.

[Bathing and the colonization of the preterm newborn skin]. / Banho e colonização da pele do pré-termo.

This article aims at determining the bathing role in skin colonization of preterm newborn by reviewing the literature from MEDLINE database. Clinical researches have demonstrated that bathing with soap triggers pH increase interfering with the skin physiological protection and provoking changes in the cutaneous microflora composition. Preterm neonates in NICU tend to acquire nosocomial skin flora from the action of bathing with cleansing products on the epidermal barrier function with direct consequences on the skin colonization.

Effect of bathing on skin flora of preterm newborns.

OBJECTIVE: To assess the effect of bathing with water only or with mild pH neutral soap and water on skin flora of preterm newborns. METHOD: Randomized blinded clinical trial that enrolled 73 preterm newborns whose gestational age was between 28 and 35 weeks and birth weight between 800 and 1800 g. At the age of 3 days the infants were randomly assigned to a group that was given daily baths either with water only, or with soap and water for 7 or more days. Antibiotic treatment delayed onset of the trial in some preterm infants. On the final day of bathing axillary bacterial cultures were obtained before and 30 minutes after bathing. RESULTS: At the time of axillary culturing, the mean age of the newborns was 19 days. Coagulase-negative Staphylococcus was the most prevalent microorganism in both groups. No significant difference was found in the count of microorganism colonies between both groups. The comparison of the number of bacterial colonies between the time before and after bath, carried out by repeated-measures ANOVA showed a significant difference over time in the two groups, without a significant difference between the two groups. CONCLUSIONS: Bathing preterm newborns with water only or with soap and water produces similar effects on skin colonization of a preterm neonate. Both are effective to decrease the number of colonies of Gram-positive and Gram-negative bacteria.

[Skin care in newborns]. / O cuidado com a pele do recém-nascido.

This article is based on brief recent revision of the scientific literature about the care with the skin of the newborn. The text deals with the anatomo-physiology aspects of the skin culminating with the specific care of the skin of newborn in Neonatal Intensive Care Unit. Considering the highest risk of the pre-term newborn to acquire infections, a special nursing care is proposed regarding the skin function as a protective barrier of the organism.