Olfactory sensory evaluation in newborn children of women infected with COVID-19 during pregnancy / Avaliação sensorial olfativa em crianças recémnascidas de mulheres infectadas com COVID-19 durante a gravidez

INTRODUCTION: In adults, olfactory loss is one of the earliest and most frequent acute clinical manifestations of SARS-CoV-2 infection. The number of children infected with SARS-CoV-2 is relatively small, perhaps due to the lower expression of Angiotensin Converting Enzyme 2 (ACE2) in children compared to adults. Little is known about foetal impairment in mothers infected with SARS-CoV-2. This paper describes an ongoing scientific project on smell perception in infantsOBJECTIVE: The goal of the study is to develop and validate a behavioural evaluative scale of olfactory perception in healthy newborns and to apply this scale to newborn children of women infected with COVID-19 during pregnancy comparing to newborn children of women without COVID-19 infection history, in order to compare these groupsMETHODS: This is a retrospective comparative analytical cohort study of 300 newborns exposed and unexposed to COVID-19 during pregnancy. The data collection will follow the experimental procedure in a previous study that explored odours of the maternal breastmilk, vanilla (sweet) and distilled water (neutral). A coffee smell was implemented as an addition to this previous study in order to include acid/bitterness category to the categories of stimuliDISCUSSION: It is feasible to argue the hypothesis of the involvement of the foetus' olfactory bulb as one of the indelible pathophysiological manifestations to the clinical diagnosis of COVID-19 with neurosensory olfactory deficit in foetuses and newborns affected by intrauterine infection. This study aims to investigate if newborn children of women infected with COVID-19 during pregnancy have olfactory sensory changes. The clinical trial was registered in the Brazilian Registry of Clinical Trials (ReBEC- RBR-65qxs2

INTRODUÇÃO: Em adultos, a perda olfativa é uma das manifestações clínicas agudas mais precoces e frequentes da infecção por SARS-CoV-2. O número de crianças infectadas com SARS-CoV-2 é pequeno, talvez devido à menor expressão da Enzima Conversora da Angiotensina 2 (ACE2) em crianças em comparação com adultos. Pouco se sabe sobre o comprometimento fetal em mães infectadas com SARS-CoV-2. Este artigo descreve um projeto em andamento sobre a percepção olfativa em bebês recém-nascidosOBJETIVO: o objetivo do presente estudo é desenvolver e validar uma escala de avaliação comportamental da percepção olfativa em recém-nascidos saudáveis e aplicá-la a recém-nascidos de mulheres infectadas com COVID-19 durante a gravidez e comparar a recém-nascidos de mulheres sem histórico de infecção por COVID-19MÉTODO: Este é um estudo de coorte analítico comparativo retrospectivo de 300 recém-nascidos expostos e não expostos ao COVID-19 durante a gravidez. A coleta de dados seguirá o procedimento experimental de estudo anterior que explorou odores do leite materno, baunilha (doce) e água destilada (neutro). Um cheiro de café foi implementado como um complemento a este estudo anterior, a fim de incluir a categoria ácido / amargo nas categorias de estímulosDISCUSSÃO: É possível argumentar a hipótese do envolvimento do bulbo olfatório do feto durante a vida intrauterina como uma das manifestações fisiopatológicas indeléveis para o diagnóstico clínico de COVID-19 com déficit olfatório neurossensorial em fetos e recém-nascidos afetados por infecção intrauterina. Este estudo tem como objetivo investigar se filhos recém-nascidos de mulheres infectadas com COVID-19 durante a gravidez apresentam alterações sensoriais olfativas. O ensaio clínico foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC- RBR-65qxs2

Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study.

BACKGROUND: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2-exposed children. OBJECTIVE: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. METHODS: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children's growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2-exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. RESULTS: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. CONCLUSIONS: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2-exposed mothers and children and support the development of evidence-based public health policies. TRIAL REGISTRATION: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/26477.

Adaptation and validation of the EVENDOL scale to assess pain in neonates in Portuguese language.

BACKGROUND: EVENDOL scale (from the French Evaluation Enfant Douleur) is used to evaluate pain in children in any situation covering a wider age group than other pain scales (birth up to seven years). This study aimed to evaluate pain in hospitalized newborns, to adapt and validate the EVENDOL to Brazilian Portuguese. STUDY DESIGN: Cross-sectional, cross-cultural adaptation and validation study in a convenience sample from a tertiary hospital, Brazil. EVENDOL was translated and tested for reliability and validity using the PIPP and NFCS scales for comparison. For reliability testing, two observers independently evaluated 117 nociceptive procedures from 87 newborns. Internal consistency coefficient Cronbach's alpha, internal class agreement coefficient, and Kappa factor were appropriately measured. RESULTS: The scale's internal consistency reached a value of 0.82, and the estimates of internal consistency and reliability also reached acceptable or very good values. Two-way ANOVA determined statistically significant effect of gestational age on the total score of the EVENDOL (F = 4.14; p = 0.045), younger infants had the lowest values, as lower values of Apgar-5° minute lowered the indicator "Interaction with the Environment" (F = 5.066; p = 0.027). CONCLUSIONS: EVENDOL proved to be an easily applied tool and it was psychometrically robust, reliable and valid for use with both premature and term hospitalized newborns, who were clinically stable, being Apgar score and gestational age relevant factors. It is a reliable method of identifying pain in babies who need more support from the hospital staff and now is available for use in Portuguese language. TWEETABLE ABSTRACT: The EVENDOL pain scale is now validated for babies born at term and prematurely in Portuguese Language allowing its use in all Lusophone countries.

Sleep deprivation, pain and prematurity: a review study.

The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.

Sleep deprivation, pain and prematurity: a review study / Privação do sono, dor e prematuridade: um estudo de revisão

The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.

O objetivo foi descrever o estado atual na literatura científica sobre privação do sono associado a experiências dolorosas no prematuro e o papel na evolução do sono em ambiente de terapia intensiva. Realizou-se uma busca sistemática para estudos sobre sono, dor, prematuridade e programas de atenção ao neonato. Foram consultados as bases Web-of-Knowledge, MEDLINE, LILACS, Biblioteca Cochrane, PubMed, EMBASE, Scopus, BVS e SciELO. A associação entre privação do sono e dor gera efeitos que são observados na atividade cerebral, fisiológica e comportamental dos prematuros. A polissonografia nas unidades intensivas e o manejo da dor em neonatos permitem comparação no primeiro ano de vida com crianças nascidas a termo. Encontraram-se poucas evidências de que programas de cuidado neonatal podem influenciar o desenvolvimento do sono e diminuir o impacto negativo do ambiente. Estas evidências são discutidas na perspectiva de como a intervenção hospitalar pode melhorar o desenvolvimento do prematuro.

Skin conductance as pain indicator in newborns: a comparison study with heart rate, oxygen saturation and pain behavioral scales / Condutancia da pele como indicador de dor em recem-nascidos: um estudo comparativo com frequencia cardiaca, saturacao de oxigenio e escalas comportamentais de dor

Introduction Heart rate (HR), oxygen saturation (OS) and skin conductance activity (SCA) are physiological markers of acute pain. Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS) and modified COMFORT are validated pain behavioral scales. Objective It was to compare whether the scores of these measures fit the psychophysical parameters for a pain marker (intensity, reactivity, direction, regulation and slope). Method Observational prospective study including 41 newborns, in which it were compared the maximum HR, the minimum OS, the SCA variables number of waves per second (NWps) and relative area under the curve of waves (AUC), and the scores of behavioral pain scales in the periods before, during and after heel prick. Results The parameters intensity and regulation were significant for the NWps (p<0.01), AUC (p<0.05), HR (p<0.01), OS (p<0.01), NFCS (p<0.01), NIPS (p<0.01) and modified COMFORT (p<0.01). The reactivity and direction parameters were significant for all variables (all p<0.01), except to AUC (p>0.05). The slope was significant for the minimum OS and NIPS and modified COMFORT scales (p<0.05). Conclusion The responses of SCA, HR, OS and behavioral pain scales are similarly in acute painful events. They fit the psychophysical parameters of a pain marker and serve as measures for pain diagnostic. .

COMFORT behaviour scale and skin conductance activity: what are they really measuring?

AIM: To assess how efficiently the COMFORT behaviour scale measures acute pain in neonates, in comparison with skin conductance activity, a validated measure of pain and stress. METHODS: Images of 36 newborns were analysed before, during and after painful heel pricks to measure glucose levels and compared with skin conductance activity variables. RESULTS: Scale indicators and skin conductance variables were sensitive to changes in the periods 'during-before' and 'during-after' (Wilcoxon's test, p < 0.01). Significant values were found between all scale indicators and number of waves for Kendall's coefficient (p < 0.05), although responses differed when it came to how long they took to increase and correlations varied from fair to moderate (r < 0.6). Facial tension was more closely related to 15 sec after the painful event, while crying and calmness were more closely related to the later intervals (30 and 180 sec). CONCLUSION: All scale indicators were related to skin conductance activity in all periods, indicating pain perception. Facial tension was the most efficient indicator, while others varied in performance after painful events and possibly indicated stress after trauma. These results are discussed from a phenomenological approach and in an anxiety paradigm.

Acondroplasia: diagnóstico clínico precoce / Achondroplasia: early clinical diagnosis

A acondroplasia é uma síndrome genética que afetaa ossificação endocondral, sendo uma das causas denanismo. Acomete um recém-nascido em cada oitoa dez mil nascimentos. Embora o defeito genéticotenha caráter autossômico dominante, cerca de 85%dos casos resultam de novas mutações. Os portadoresda acondroplasia apresentam características clínicastípicas como macrocefalia, baixa estatura, membroscurtos com predomínio do segmento proximal e limitaçãoda extensão dos cotovelos. Entretanto, essascaracterísticas clínicas no período neonatal podempassar despercebidas dos pais e pediatras, uma vezque os recém-nascidos normais apresentam os membroscurtos em relação ao tronco, o que dificulta aobservação dessa desproporção. No presente estudode caso, registra-se um caso típico de acondroplasiadiagnosticado imediatamente após o nascimento.

Achondroplasia is a genetic syndrome that affects the endochondralossification, being one of the causes of dwarfism.It affects one newborn in every 8 to 10 thousandbirths. Although the genetic defect is of autosomal dominantorigin, about 85% of cases result from new mutations.The typical clinical features of achondroplasia are macrocephaly,short stature, short limbs with predominanceof the proximal segment and limitation of elbow extension.However, these clinical features may go unnoticedin the neonatal period, since newborns? limbs are shorterin relation to the trunk, making it difficult for parents andpediatricians to notice this disproportion. This case reportdescribes a typical case of achondroplasia diagnosed immediatelyafter birth.

Heart rate, oxygen saturation, and skin conductance: a comparison study of acute pain in Brazilian newborns.

Heart rate variability (HRV), oxygen saturation variability (OSV) and skin conductance activity (SCA) are recognized physiological markers of acute pain. In order to verify which of them has the best correlation with psychophysical parameters of pain (intensity, reactivity, direction, regulation and slope), an observational prospective study was performed, including 41 healthy full term newborns. The measurements studied were the HRV, the OSV, and the following SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC). The measurements were performed in periods labeled before, during, and after a heel prick. The variation measured for intensity between periods was significant for the NWps (p=0.001), AUC (p=0.03), HRV (p=0.001) and OSV (p=0.004). Also, the reactivity and direction were significant for all variables, except AUC. The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), HRV (p<0.01) and OSV (p<0.01). The slope was statistically significant only for the OSV variable (p=0.000). We concluded that the responses of the SCA, HRV and OSV to painful events fit the psychophysical parameters of a physiological marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context.

Neoliberalismo e Estado Mínimo: repercussões na atenção à saúde no Distrito Federal / Neoliberalism and the Minimal State: implications for the health care in the Federal District

Trata-se de um ensaio sobre como a política neoliberal de um governo pode repercutir na promoção e atenção à saúde no Distrito Federal. O presente artigo apresenta as bases do neoliberalismo, estabelece os pressupostos da reorganização em torno de um estado mínimo perante a economia e a sociedade e analisa as possíveis repercussões sobre a promoção e atenção à saúde. Para tanto aborda as bases política-administrativas do Programa de Eficiência em Saúde do Governo do Distrito Federal nos últimos dois anos, seus valores de financiamento, comparando-o com outros sistemas nacionais e internacionais que adotaram essa política. Citam ainda experiências que resultaram negativas para a consolidação do SUS um sistema de saúde com características de universalidade e integralidade e chama a atenção para a vulnerabilidade dos sistemas de saúde às políticas governamentais com características neoliberais.

This is an essay where the impact of a neoliberal policy on health promotion and medical care in the Federal District is analysed. This article presents the basis of neoliberalism, and it establishes the reorganizational premises of a minimal State related to economics and society, and it analyzes possible implication for health promotion and care. To this end, it addresses the political-administrative basis of the Government of Federal District Health Efficiency Program during the past two years and its financed amounts, and compares it to other domestic and international systems which have adopted this policy. It also quotes experiments resulting negatively to SUS, a health system with universality and integrality features. Also, it calls attention to vulnerability of health systems concerning policies of a government with neoliberal characteristics.