Assuntos
Unidades de Terapia Intensiva Neonatal , Sono , Criança , Humanos , Recém-Nascido , Terapia Intensiva NeonatalRESUMO
OBJECTIVE: To evaluate the association between birth route and late-onset sepsis (LOS), and coagulase-negative Staphylococcal (CONS)-related LOS in preterm neonates. STUDY DESIGN: In this observational study, data from 20,038 infants born between 22 and 32 weeks' gestation and admitted to Canadian neonatal intensive care units between 2010 and 2014 were analyzed retrospectively. The impact of birth route on LOS was assessed using univariate analysis and multiple logistic regression. RESULTS: A total of 8218 neonates were born via vaginal route and 11,820 via cesarean section. Incidence rates of LOS for infants born vaginally and via a cesarean section were 13.1 and 13.2%, respectively, and there was no significant difference in odds of LOS between the groups (adjusted odds ratio (AOR): 0.99; 95% CI 0.87 to 1.12); however, the odds of CONS sepsis were higher in the cesarean group (AOR: 1.15; 95% CI: 1.01 to 1.32). CONCLUSION: Birth route did not have an impact on LOS, but was associated with CONS-related LOS.
Assuntos
Parto Obstétrico/efeitos adversos , Lactente Extremamente Prematuro , Doenças do Prematuro/epidemiologia , Sepse Neonatal/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Idade Gestacional , Humanos , Lactente , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Gravidez , Estudos Retrospectivos , Fatores de Risco , Infecções Estafilocócicas/epidemiologiaRESUMO
Recent experimental data suggest a strong role for sleep in brain development. As sleep is the predominant behavioral state in the term and especially the preterm newborn, these data underline the importance of respecting sleep duration and organization within the different sleep states. Polysomnography is the preferred technique used for identification of sleep state; however, behavioral observations-under the condition that the observer is well trained-may prove as efficient. Newborns hospitalized in the neonatal intensive care unit are exposed to many stimuli and care activities that disrupt their sleep organization and may have irreversible effects on their brain development. In order to improve the long-term neurobehavioral outcome of these high-risk subjects, a consistent care approach is proposed. Application of the Neonatal Individualized Developmental Care and Assessment Program decreases environmental stressful events and promotes harmonious well-being behaviors, based on an individual approach. This strategy has encouraging results, showing an increase in sleep duration under Neonatal Individualized Developmental Care and Assessment Program conditions, but further studies are needed to assess its long-term neurobehavioral impact.
