Encaminhamento e resolutividade da consultoria de aleitamento materno em uma unidade de alojamento conjunto / Referral and resolution of breastfeeding consultancy in a joint accommodation unit / Derivación y resolución de consultoría en lactancia materna en unidad de alojamiento conjunta

Objetivo: caracterizar os encaminhamentos e a resolutividade da consultoria em aleitamento materno em uma unidade de alojamento conjunto. Método: estudo transversal descritivo realizado com 231 puérperas e seus recém-nascidos internados em alojamento conjunto no sul do Brasil. A coleta de dados foi realizada no período de agosto de 2016 a maio de 2017. Os dados foram analisados mediante estatística descritiva. Resultados: os motivos prevalentes para o encaminhamento foram dificuldade na técnica de amamentação (81,7%), primiparidade (57,8%), anatomia mamária (28,7%), presença de fissuras mamilares (19,6%) e dor ao amamentar (18,3%). A satisfação com o atendimento foi relatada por 97,8% das puérperas. Quanto a resolutividade, 70,6% consideraram o atendimento totalmente resolutivo, 26,4% parcialmente e 3,0% não resolutivo. Conclusão: a consultoria em aleitamento materno foi resolutiva na maioria dos encaminhamentos, motivados por dificuldades que poderiam predispor uma interrupção precoce da amamentação, demonstrando a eficácia da inserção desse profissional nos serviços de saúde.

Objective: to characterize the referrals and resoluteness of breastfeeding consultancy in a rooming-in unit. Method: descriptive cross-sectional study conducted with 231 postpartum women and their newborns hospitalized in rooming-in in southern Brazil. Data collection was carried out from August 2016 to May 2017. Data were analyzed using descriptive statistics. Results: the prevalent reasons for referral were difficulty in the breastfeeding technique (81.7%), primiparity (57.8%), breast anatomy (28.7%), presence of cracked nipples (19.6%) and pain when breastfeeding (18.3%). Satisfaction with the service was reported by 97.8% of the mothers. As for resoluteness, 70.6% considered the service fully resolute, 26.4% partially and 3.0% non-resolutive. Conclusion:breastfeeding consultancy was resolute in most referrals, motivated by difficulties that could predispose to an early interruption of breastfeeding, demonstrating the effectiveness of the insertion of this professional in health services.

Objetivo: caracterizar las derivaciones y la determinación de la asesoría en lactancia materna en una unidad de alojamiento conjunto. Método: estudio descriptivo transversal realizado con 231 puérperas y sus recién nacidos hospitalizados en alojamiento conjunto en el sur de Brasil. La recolección de datos se llevó a cabo desde agosto de 2016 a mayo de 2017. Los datos se analizaron mediante estadística descriptiva. Resultados: los motivos prevalentes de derivación fueron dificultad en la técnica de lactancia (81,7%), primiparidad (57,8%), anatomía mamaria (28,7%), presencia de pezones agrietados (19,6%) y dolor al amamantar (18,3%). El 97,8% de las madres informó satisfacción con el servicio. En cuanto a la resolución, el 70,6% consideró el servicio plenamente resuelto, el 26,4% parcialmente y el 3,0% no resolutivo. Conclusión: la asesoría en lactancia materna fue resuelta en la mayoría de las derivaciones, motivada por dificultades que pudieran predisponer a una interrupción temprana de la lactancia materna, demostrando la efectividad de la inserción de esta profesional en los servicios de salud.

Breastfeeding in the first six months of life for babies seen by Lactation Consulting.

OBJECTIVE: to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting. METHOD: a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out. RESULTS: at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58). CONCLUSION: lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.

Breastfeeding in the first six months of life for babies seen by Lactation Consulting / Amamentação nos seis primeiros meses de vida de bebês atendidos por Consultoria em Lactação / Lactancia materna en los primeros seis meses de vida de los bebés atendidos por Consultoría de Lactancia

Objective: to identify breastfeeding patterns, survival of exclusive breastfeeding and factors associated with its interruption, in the first six months of life of babies seen by Lactation Consulting. Method: a prospective cohort, with 231 mother-babies in a Baby-Friendly Hospital. An initial questionnaire was applied after 24 hours of birth, after consulting, as well as a follow-up questionnaire, applied by telephone at 15, 30, 60, 120 and 180 days, with sociodemographic and obstetric variables, maternal habits, father's schooling, birth data and baby feeding. Survival Analysis was carried out. Results: at 180 days of age, exclusive breastfeeding was 12.7% and the probability was 19.6% in the analysis of the survival curve. The factors associated with its interruption were smoking during pregnancy (HR 1.66; CI 1.05 - 2.61), age ≥ 35 years old (HR 1.73; CI 1.03 - 2.90), difficulty in breastfeeding after hospital discharge (HR 2.09; CI 1.29 - 3.41), search for professional assistance (HR 2.45; CI 1.69 - 3.54) and use of a pacifier (HR 1.76; IC 1.21 - 2.58). Conclusion: lactation consultancy contributed to the improvement of the exclusive breastfeeding rates, although there are opportunities for advances.

Objetivo: identificar padrões de amamentação, sobrevida do aleitamento materno exclusivo e fatores associados à sua interrupção, nos seis primeiros meses de vida de bebês atendidos por Consultoria em Lactação. Método: coorte prospectiva, com 231 mãe-bebê em Hospital Amigo da Criança. Utilizou-se questionário inicial aplicado após 24 horas do nascimento, depois da consultoria, e de seguimento, aplicado por telefone aos 15, 30, 60, 120 e 180 dias, com variáveis sociodemográficas, obstétricas, hábitos maternos, escolaridade paterna, dados do nascimento e alimentação do bebê. Procedeu-se à Análise de Sobrevivência. Resultados: aos 180 dias de vida, o aleitamento materno exclusivo foi 12,7% e probabilidade de 19,6% na análise da curva de sobrevivência. Os fatores associados à sua interrupção foram tabagismo na gestação (HR 1,66; IC 1,05 - 2,61), idade ≥ 35 anos (HR 1,73; IC 1,03 - 2,90), dificuldade na amamentação pós-alta hospitalar (HR 2,09; IC 1,29 - 3,41), busca por auxílio profissional (HR 2,45; IC 1,69 - 3,54) e uso de chupeta (HR 1,76; IC 1,21 - 2,58). Conclusão: a consultoria em lactação contribuiu para melhoria das taxas de aleitamento materno exclusivo, embora existam oportunidades de avanços.

Objetivo: identificar patrones de lactancia materna, supervivencia de la lactancia materna exclusiva y factores asociados a su interrupción, en los primeros seis meses de vida de los bebés atendidos por Consultoría de Lactancia. Método: cohorte prospectiva, con 231 madres-bebés en el Hospital Amigo del Niño. Se aplicó un cuestionario inicial a las 24 horas del nacimiento, previa consultoría, y de seguimiento, aplicado por teléfono a los 15, 30, 60, 120 y 180 días, con variables sociodemográficas, obstétricas, hábitos maternos, educación del padre, datos de nacimiento y alimentación del bebé. Se llevó a cabo un Análisis de Supervivencia. Resultados: a los 180 días de vida, la lactancia materna exclusiva fue del 12,7% y la probabilidad del 19,6% en el análisis de la curva de supervivencia. Los factores asociados a su interrupción fueron el tabaquismo en la gestación (HR 1,66; IC 1,05 - 2,61), edad ≥ 35 años (HR 1,73; IC 1,03 - 2,90), dificultad para amamantar después del alta hospitalaria (HR 2,09; IC 1,29 - 3,41), búsqueda de asistencia profesional (HR 2,45; IC 1,69 - 3,54) y uso de chupete (HR 1,76; IC 1, 21-2,58). Conclusión: la consultoría en lactancia contribuyó a la mejora de las tasas de lactancia materna exclusiva, aunque existen oportunidades de avances.

Diagnósticos de enfermagem relacionados ao aleitamento materno: uma revisão integrativa / Nursing diagnoses related to breastfeeding: an integrating review / Diagnósticos de enfermería relacionados a lalactancia: una revisión integrativa

Objetivo: identificar na literatura científica os diagnósticos de enfermagem que se relacionam diretamente com o aleitamento materno, bem como elencar os mais utilizados nessa prática. Métodos: trata-se de uma revisão integrativa, realizada em novembro de 2016, nas bases de dados LILACS, CINAHL, SCOPUS, PubMED e SciElo. Para a seleção dos estudos foram utilizados os Descritores em Ciências da Saúde "Diagnóstico de Enfermagem" e "Aleitamento Materno", bem como seus sinônimos e Medical Subject Headings correspondentes. Resultados: os diagnósticos de enfermagem que se sobressaíram na busca realizada foram amamentação eficaz e amamentação ineficaz. Conclusão: os artigos incluídos neste estudo permitiram uma visão do que os enfermeiros encontram na sua assistência frente ao desenvolvimento do aleitamento materno, bem como os diagnósticos mais elencados nessa prática (AU).

Objective: to identify in the scientific literature the nursing diagnoses that are directly related to breastfeeding, as well as to list those most used in this practice. Methods:this is an integrative review, carried out in November 2016, in the LILACS, CINAHL, SCOPUS, PubMED and SciElo databases. For the selection of the studies, the Health Sciences Descriptors "Nursing Diagnosis" and "Breastfeeding", as well as their synonyms and corresponding Medical Subject Headings were used. Results: the nursing diagnoses that stood out in the search were effective breastfeeding and ineffective breastfeeding. Conclusion: the articles included in this study allowed an overview of what nurses find in their care regarding the development of breastfeeding, as well as the most relevant diagnoses in this practice (AU).

Objetivo: identificar en la literatura científica los diagnósticos de enfermería que se relacionan directamente con la lactancia materna, así como enumerar los más utilizados en esa práctica. Métodos: se trata de una revisión integrativa, realizada en noviembre de 2016, en las bases de datos LILACS, CINAHL, SCOPUS, PubMED y SciElo. Para la selección de los estudios se utilizaron los Descriptores en Ciencias de la Salud "Diagnóstico de Enfermería" y "Lactancia Materna", así como sus sinónimos y Medical Subject Headings correspondientes. Resultados: los diagnósticos de enfermería que se sobresalen en la búsqueda realizada fueron la lactancia materna eficaz y la lactancia ineficaz. Conclusión: los artículos incluidos en este estudio permitieron una visión de lo que los enfermeros encuentran en su asistencia frente al desarrollo de la lactancia materna, así como los diagnósticos más enumerados en esa práctica (AU).

Effectiveness of the Baby Friendly Community Initiative in Italy: a non-randomised controlled study.

OBJECTIVE: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months. DESIGN: Controlled, non-randomised trial. SETTING: 18 Local Health Authorities in 9 regions of Italy. PARTICIPANTS: 5094 mother/infant dyads in 3 cohorts were followed up to 12 months after birth in 3 rounds of data collection: at baseline, after implementation of the intervention in the early intervention group and after implementation in the late intervention group. 689 (14%) dyads did not complete the study. INTERVENTION: Implementation of the 7 steps of the BFCI. MAIN OUTCOME MEASURES: The rate of exclusive breast feeding at 6 months was the primary outcome; breast feeding at discharge, 3 and 12 months was also measured. RESULTS: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account. CONCLUSIONS: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Os modos de fazer consultoria: o olhar da gestão para o trabalho dos consultores de saúde da criança nos estados brasileiros / The ways of doing consultancy: the perspective of management for the work of child health consultants in the Brazilian states

Em 2012, o Ministério da Saúde, através da Coordenação-Geral de Saúde da Criança e Aleitamento Materno, propôs a formulação e implementação da Política Nacional de Atenção Integral à Saúde da Criança. Para isto, elaborou um plano de ação centrado no tripé ‘Formação, Gestão e Pesquisa’, com ênfase na atuação do consultor estadual de saúde da criança nos territórios. Este artigo tem como objetivo analisar a atuação dos consultores estaduais, buscando identificar fortalezas e fragilidades desse processo. Foi realizada análise documental a partir de relatórios de trabalho. Evidenciou-se a diversidade das ações desenvolvidas pelos consultores estaduais, a especificidade de sua atuação e a articulação das ações de saúde da criança em todas as redes temáticas de atenção à saúde...

In 2012, the Ministry of Health, through the General Coordination of Child Health and Breastfeeding proposed the formulation and implementation of the National Policy for Comprehensive Child Health Care. In order to do that, it was produced an action plan centeredon the tripod ‘Training, Management and Research’, emphasizing the role of the state consultant of child health in the territories. This article aims to analyze the performance of state consultants seeking to identify strengths and weaknesses of such process. Document analysis from work reports was conducted. It showed the diversity of actions undertaken by state consultants, the specificity of their action and coordination of child health activities in all issues of health care networks...

Counselling sessions increased duration of exclusive breastfeeding: a randomized clinical trial with adolescent mothers and grandmothers.

BACKGROUND: Considering that adolescent mothers may be more vulnerable to discontinuing exclusive breastfeeding (EBF) before 6 months and that their mothers may exert a negative influence on this practice, this study was conducted with the objective of evaluating the efficacy of breastfeeding counselling for adolescent mothers and their mothers in increasing EBF duration. METHODS: A clinical trial was performed in 323 adolescent mothers with newborns and their mothers randomized in four groups: (1) not living with mother, without intervention; (2) not living with mother, with intervention; (3) living with mother, without intervention, (4) living with mother, with intervention. The intervention consisted of five counselling sessions directed to mother and grandmother, in the maternity hospital and on follow-up. Information about feeding practices during the newborn's first six months of life was collected monthly by telephone. Intervention's efficacy was measured through Cox regression and comparison of exclusive breastfeeding medians and survival curves for the different groups. RESULTS: The intervention increased the duration of EBF by67 days for the group which included grandmothers (HR = 0.64; CI 95% = 0.46-0.90) and 46 days for the group which did not include grandmothers (HR = 0.52; CI 95% = 0.36-0.76). CONCLUSIONS: Counselling sessions in the first four months of children's lives proved to be effective in increasing EBF duration among adolescent mothers. TRIAL REGISTRATION: ClinicalTrials.gov NCT00910377.

Prematuridad tardía / Late prematurity

Introducción: el avance científico y tecnológico en la salud perinatal ayudó a mejorar el índice de supervivencia de niños que nacen con tiempo de gestación de entre 34 y 36 semanas y 6 días,denominados pretérmino o prematuros. El estudio tuvo como objetivo conocer la producción científica sobre prematuridad tardía. Métodos: revisión integradora, debido a que permite incluir diferentes tipos de estudios, ofreciendo una perspectiva más amplia sobre el tema en cuestión. Las investigaciones se publicaron en el periodo de julio de 2002 a julio de 2012, en las bases de datos SciELO, CINAHAL y ScienceDirect. Los datos se analizaron y se categorizaron en tres semanas. El primer grupo fue de riesgos relacionados a la morbimortalidad en la prematuridad tardía; el segundo, conducta terapéutica y condición de salud en la prematuridad tardía; y el último consideró las repercusiones de la prematuridad en la infancia. Resultados: la mayoría de las investigaciones publicadas -aun así, escasas- se referían a losriesgos relacionados a la morbimortalidad en la prematuridad tardía, con un incremento en los últimos cuatro años. Predominaron las publicaciones estadounidenses. Conclusión: se percibe la necesidad de publicaciones sobre el cuidado de enfermería pensado para estos prematuros(AU)

Introduction: Scientific and technological advances in perinatal heath have helped improve survival among children born at gestational ages between 34 and 36 weeks and 6 days, known as preterm or premature children. The study was aimed at acquiring knowledge about the scientific production on late prematurity. Methods: An integrating review was conducted which included various types of studies, thus offering a broader outlook on the topic. The papers surveyed were published from July 2002 to July 2012 in databases SciELO, CINAHAL and ScienceDirect. Data were analyzed and classified into three categories: risks related to morbidity and mortality in late prematurity; therapeutic management and health status in late prematurity; and effects of prematurity upon childhood. Results: Most of the studies published -scarce as they were- referred to risks related to morbidity and mortality in late prematurity, with an increase in the last four years. There was a predominance of US publications. Conclusion: A need is perceived of studies about the nursing care of preterm babies(AU)

A controlled study on baby-friendly communities in Italy: methods and baseline data.

AIM: This study reports the research methods and baseline data of a project aimed at assessing the effect of an intervention based on the 7 Steps of the Baby Friendly Community Initiative (BFCI) on the rate of exclusive breastfeeding at 6 months in Italy. SUBJECTS AND METHODS: In this controlled, nonrandomized study, nine Local Health Authorities were assigned to an early and nine to a late intervention group. Data on breastfeeding in infants followed up from birth to 12 months were gathered at baseline and in two subsequent rounds, after the 7 Steps were implemented in the early and late intervention groups, respectively. Step-down logistic regression analysis, corrected for the cluster effect, was used to compare breastfeeding rates between groups. RESULTS: At baseline, there were no significant differences in breastfeeding rates at birth (n=1,781) and at 3 (n=1,854), 6 (n=1,601), and 12 (n=1,510; loss to follow-up, 15.2%) months between groups. At birth, 96% of mothers initiated breastfeeding, 72% exclusively (recall from birth). At 3 months, 77% of infants were breastfed, 54% exclusively with 24-hour and 46% with 7-day recall. At 6 months, the rate of any breastfeeding was 62%, with 10% and 7% exclusive breastfeeding with 24-hour and 7-day recall, respectively. At 12 months, 31% of the children continued to breastfeed. CONCLUSIONS: The project is ongoing and will allow estimation of the effect of the BFCI.

Analysis of four aberrometers for evaluating lower and higher order aberrations.

PURPOSE: To compare the measurements of lower and higher order aberrations (HOA) of 4 commonly used aberrometers. SETTING: Massachusetts Eye & Ear Infirmary, Boston, USA. DESIGN: Prospective, cross-sectional study, in a controlled, single-blinded fashion. METHODS: Multiple readings were obtained in 42 eyes of 21 healthy volunteers, at a single visit, with each of the following aberrometers: Alcon LADARWave®, Visx WaveScan®, B & L Zywave®, and Wavelight Allegro Analyzer®. Results were compared and analyzed in regards to the lower and HOA, to the different wavefront sensing devices and software, Tscherning and Hartmann-Shack and between the Fourier and Zernike algorithms. Statistical analysis included Bland-Altman plots, Intraclass Correlation Coefficient (ICC), multiple comparison tests with Analysis of Variance and Kruskal-Wallis. Significant level was set to p<0.05 and alpha level correction was adjusted under the Bonferroni criteria. RESULTS: Most measurements of all 4 aberrometers were comparable. However, statistically significant differences were found between the aberrometers in total HOA (tHOA), spherical aberration (SA), horizontal coma and astigmatism (2,2). LADARwave and Wavescan showed significant differences in tHOA (P<0.001, ICC = 0.549, LoA = 0.19±0.5) and in SA (P<0.001, ICC = 0.733, LoA = 0.16±0.37). Wavescan showed a significant difference compared to Zywave (p<0.001, ICC = 0.920, LoA = 0.09±0.13) in SA. Comparisons between Allegro Analyzer and Zywave demonstrated significant differences in both Horizontal Coma (3,1) (p<0.001, ICC = -0.207, LoA = -0.15±0.48) and Astigmatism (2,2) (P = 0.003, ICC = -0.965, LoA = 0.2±2.5). Allegro Analyzer also differed from Wavescan in Horizontal Coma (3,1) (P<0.001, ICC = 0.725, LoA = -0.07±0.25). CONCLUSIONS: Although some measurements were comparable predominately in the lower order aberrations, significant differences were found in the tHOA, SA, horizontal coma and astigmatism. Our analysis suggests that sensor design contributes to agreement in lower order aberrations, and Fourier and Zernike expansion might disagree in higher order aberrations. Therefore, comparison between aberrometers was generally possible with some exceptions in higher order measurements.

Floppy eyelid syndrome: review.

Floppy eyelid syndrome is characterized by the easy evertion of the upper eyelid which occurs spontaneously during the sleep, causing the exposure of the eye surface and chronic papillary conjunctivitis. Its pathogenesis is not totally defined yet: it is usually more frequent in middle-aged, male obese patients and it is associated with systemic disorders such as obstructive sleep apnea, high blood pressure and diabetes. On the occasions which conservative treatment fails, surgical procedures present good results, including surgical techniques which are constantly evolving.

Floppy eyelid syndrome: review / Síndrome da frouxidão palpebral: revisão da literatura

Floppy eyelid syndrome is characterized by the easy evertion of the upper eyelid which occurs spontaneously during the sleep, causing the exposure of the eye surface and chronic papillary conjunctivitis. Its pathogenesis is not totally defined yet: it is usually more frequent in middle-aged, male obese patients and it is associated with systemic disorders such as obstructive sleep apnea, high blood pressure and diabetes. On the occasions which conservative treatment fails, surgical procedures present good results, including surgical techniques which are constantly evolving.

A síndrome de frouxidão palpebral é caracterizada pela fácil eversão da pálpebra que ocorre espontaneamente durante o sono causando exposição dos olhos, com consequente conjuntivite papilar crônica. Sua patogênese ainda não está totalmente definida e é mais comum em pacientes masculinos, obesos, de meia idade e está associada a doenças sistêmicas como apnéia obstrutiva do sono, hipertensão arterial e diabetes. Quando o tratamento clínico não apresenta boa resposta, procedimentos cirúrgicos apresentam bons resultados, com técnicas em constante evolução.

Intake of water, herbal teas and non-breast milks during the first month of life: associated factors and impact on breastfeeding duration.

BACKGROUND: The use of non-breast milks seems to cause more harm to the child's health than the isolated introduction of water/herbal teas. AIMS: Study the factors associated with introduction of water/herbal teas or non-breast milks during the first month of life and determine the impact of this supplementation on breastfeeding duration. STUDY DESIGN: Nested cross-sectional study. SUBJECTS: 220 mother-infant pairs contacted in the maternity ward, at 7 days and at the end of 1, 2, 4, and 6 months. OUTCOME MEASURES: Introduction of water/herbal teas or non-breast milks in the first month of life based on data collected during a home visit 30 days after delivery. RESULTS: Introduction of water/herbal teas was associated with maternal age <20 years (prevalence ratio=1.55; 95%CI 1.14-2.09), <6 prenatal consultations (1.48; 1.09-2.01), cohabitation with maternal grandmother (1.51; 1.10-2.10), and poor latch-on at 30 days (1.87; 1.35-2.58). Introduction of non-breast milks was associated with breastfeeding of previous children for <6 months (3.18; 1.18-8.58), cesarean (1.92; 1.07-3.44), poor latch-on at 30 days (2.82; 1.55-5.11), use of pacifier at 7 days (2.75; 1.38-5.48), introduction of herbal teas in the first 7 days (2.75; 1.15-4.15) and breast engorgement at 7 days (2.19; 1.01-3.16). Introduction of non-breast milks negatively influenced breastfeeding duration (p<0.001); this was not observed with water/herbal teas (p=0.277). CONCLUSION: Priority should be given to preventing the early introduction on non-breast milks, especially in mother-infant pairs with associated risk factors.

Effect of intervention to improve breastfeeding technique on the frequency of exclusive breastfeeding and lactation-related problems.

This randomized clinical trial compared frequencies of exclusive breastfeeding and lactation-related problems during the first 30 days among 74 mothers who received a 30-minute counseling session on breastfeeding technique in the maternity ward, and 137 controls. The frequency of exclusive breastfeeding among mothers who had received intervention was similar to controls by 7 days (79.7% vs 82.5%, respectively) and 30 days (60.8% vs 53.3%). There was no difference between groups in the frequency of sore nipples at 7 and 30 days, in breast engorgement and mastitis, and in the quality of breastfeeding technique at 30 days. Therefore, a single intervention at maternity was not sufficient to improve breastfeeding technique, increase exclusive breastfeeding rates, and reduce the incidence of breastfeeding problems during the first month.

[The influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation]. / Influência da técnica de amamentação nas freqüências de aleitamento materno exclusivo e lesões mamilares no primeiro mês de lactação.

OBJECTIVE: To investigate the influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation. METHODS: We searched for unfavorable parameters of breastfeeding (five related to mother/baby positioning and three related to baby's latch on) in 211 mother-baby pairs in the maternity ward and at day 30, at home. We compared the frequencies of these parameters between mothers practicing or not exclusive breastfeeding at days 7 and 30, and between mothers with or without nipple trauma at the hospital. RESULTS: The number of unfavorable parameters in the maternity ward was similar for mother-baby pairs practicing or not exclusive breastfeeding at day 7 and 30. However, at day 30, it was, on average, lower among those under exclusive breastfeeding, regarding positioning (1.7+/-1.2 vs 2.2+/-1.1; p = 0.009) as well as latch on (1.0+/-0.6 vs 1.4+/-0.6; p < 0.001). The number of unfavorable parameters related to latch on in the maternity ward was similar for women with or without nipple trauma, but women without trauma presented a higher number of unfavorable parameters related to positioning. (2.0+/-1.4 vs 1.4+/-1.2; p = 0.04). CONCLUSIONS: The frequencies of exclusive breastfeeding in the first month and of nipple trauma were not influenced by the breastfeeding technique in the maternity ward, but there was an association between a better technique at day 30 and the practice of exclusive breastfeeding. New studies may help to elucidate whether an improvement in breastfeeding practices over time helps the maintenance of exclusive breastfeeding or whether the introduction of bottle-feeding determines a negative effect on breastfeeding.

Influência da técnica de amamentacão nas freqüências de aleitamento materno exclusivo e lesões mamilares no primeiro mês de lactacão / The influence of breastfeeding technique on the frequencies of exclusive breastfeeding and nipple trauma in the first month of lactation

OBJETIVO: Investigar a influência da técnica de amamentacão nas freqüências de aleitamento materno exclusivo e de lesões mamilares no primeiro mês de lactacão. MÉTODOS: Foram pesquisados parâmetros desfavoráveis à amamentacão (cinco relacionados ao posicionamento mãe/bebê e três à pega do bebê) em 211 mães/bebês na maternidade e, aos 30 dias, no domicílio. Foram comparadas as freqüências desses parâmetros entre as duplas com e sem amamentacão exclusiva aos 7 e 30 dias, e entre as mães com e sem lesões mamilares na maternidade. RESULTADOS: O número de parâmetros desfavoráveis na maternidade foi semelhante nas duplas com e sem amamentacão exclusiva aos 7 e 30 dias. Porém, aos 30 dias, foi, em média, menor nas duplas em amamentacão exclusiva, tanto no posicionamento (1,7n1,2 versus 2,2n1,1; p = 0,009) quanto na pega (1,0n0,6 versus 1,4n0,6; p < 0,001). O número de parâmetros desfavoráveis de pega na maternidade foi semelhante entre as mulheres com e sem lesão mamilar, porém as mulheres sem essa complicacão apresentaram um número maior de parâmetros desfavoráveis de posicionamento (2,0n1,4 versus 1,4n1,2; p = 0,04). CONCLUSÕES: As freqüências de amamentacão exclusiva no primeiro mês e de lesões mamilares não foram influenciadas pela técnica de amamentacão na maternidade, mas houve associacão entre melhor técnica aos 30 dias e prática da amamentacão exclusiva. Novos estudos poderão elucidar se uma melhora da técnica ao longo do tempo seria responsável pela manutencão da amamentacão exclusiva ou se a introducão de mamadeira exerceria efeito negativo na técnica.

Perfil das gestantes adolescentes atendidas em consulta de enfermagem / Characteristics of pregnant adolescents attended to by nursing appointments

This article describes the social, obstetric and behavioral characteristics of the pregnant adolescents attended by nursing appointments. It is a quantitative and descriptive research. The data refers to the period between 1989 and 1999. The researcher reviewed 931 files of pregnant adolescents. Results show that the incidence of pregnancy is higher on the period between the ages of 15 and 19 years old; the majority of the adolescents can count on an partner; they begin prenatal nursing appointments from the twentieth week of pregnancy on; and they have three or more appointments.

Expectativas, sentimentos e vivências do pai durante o parto e nascimento de seu filho / Expectations, feelings and experiences of the father during the delivery and birth of his baby

Trata-se de um estudo qualitativo, do tipo exploratório, que busca conhecer as expectativas, sentimentos e vivências do pai durante o processo de parto e nascimento de seu bebê...

As várias faces do contato no cuidar / The many faces of contact on caring

Este trabalho surgiu de uma vivência de grupo sobre um tema, relacionado ao cuidado humano: o contato. Descrevemos esta experiência, desvelando sentimentos e memórias percebidas no desenvolvimento da atividade, construindo um conceito de contato, visto como um dos pilares do cuidado humano...

Enfermeira consultora em aleitamento materno: a construçäo de um novo papel / Lactation consultant nurse: a new role construction

O presente trabalho relata a construçäo das atividades da Enfermeira Consultora em Aleitamento Materno em um hospital universitário por ocasiäo da implantaçäo da iniciativa "Hospital Amigo da Criança". Esta profissional está preparada para prevenir, reconhecer e resolver dificuldades da dupla mäe-bebê no que se refere à amamentaçäo. A principal funçäo da Enfermeira Consultora em Aleitamento Materno é integrar as diferentes atividades que envolvem a Instituiçäo, equipe e clientela em prol do aleitamento materno, desenvolvendo funçöes assistenciais, educativas e administrativas que visam ao atendimento dos "Dez passos para o sucesso do aleitamento materno" preconizados pela UNICEF e OMS.