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.

Evaluation of newborn hearing screening program.

OBJECTIVE: To evaluate Newborn Hearing Screening Program of Hospital Regional de Sobradinho, from January 2016 to December 2017, according to Multiprofessional Committee on Auditory Health parameters and Joint Committee on Infant Hearing (JCIH) recommendations, as well as to describe the prevalence of risk factors for hearing loss within the study population and their impact on the respective program. METHOD: This is a quantitative, cross-sectional and retrospective study that carefully analyzed registration books of screened newborns. It was established the prevalence of "pass" and "fail" in test and retest, retest percentage of attendance and referral for audiological diagnosis. Risk factors for hearing loss were described, as well as their influence on "pass" and "fail" rates. Inferential statistical analysis was performed using chi-square test and Anderson-Darling test, with 5% reliability index. RESULTS: A total of 3,981 newborns were screened; 2,963 (74.4%) presented no risk factors whereas 1,018 (25.6%) did, prematurity being the most frequent (51.6%). In the test, 166 (4.2%) failed and 118 (71.1%) attended the retest. The referral rate for diagnosis was 0.3%. CONCLUSION: Regarding the percentage of referral for diagnosis, the program reached indexes recommended by the Joint Committee on Infant Hearing and Multiprofessional Committee on Auditory Health. The most prevalent risk factor within the population was prematurity.

Evaluation of newborn hearing screening program / Avaliação de um programa de triagem auditiva neonatal

ABSTRACT OBJECTIVE To evaluate Newborn Hearing Screening Program of Hospital Regional de Sobradinho, from January 2016 to December 2017, according to Multiprofessional Committee on Auditory Health parameters and Joint Committee on Infant Hearing (JCIH) recommendations, as well as to describe the prevalence of risk factors for hearing loss within the study population and their impact on the respective program. METHOD This is a quantitative, cross-sectional and retrospective study that carefully analyzed registration books of screened newborns. It was established the prevalence of "pass" and "fail" in test and retest, retest percentage of attendance and referral for audiological diagnosis. Risk factors for hearing loss were described, as well as their influence on "pass" and "fail" rates. Inferential statistical analysis was performed using chi-square test and Anderson-Darling test, with 5% reliability index. RESULTS A total of 3,981 newborns were screened; 2,963 (74.4%) presented no risk factors whereas 1,018 (25.6%) did, prematurity being the most frequent (51.6%). In the test, 166 (4.2%) failed and 118 (71.1%) attended the retest. The referral rate for diagnosis was 0.3%. CONCLUSION Regarding the percentage of referral for diagnosis, the program reached indexes recommended by the Joint Committee on Infant Hearing and Multiprofessional Committee on Auditory Health. The most prevalent risk factor within the population was prematurity.

RESUMO OBJETIVO Avaliar o Programa de Triagem Auditiva Neonatal do Hospital Regional de Sobradinho, no período de janeiro de 2016 a dezembro de 2017, segundo os parâmetros do Comitê Multiprofissional em Saúde Auditiva e as recomendações do Joint Committee on Infant Hearing (JCIH), bem como descrever a prevalência dos indicadores de risco para deficiência auditiva na população estudada e seu impacto no respectivo programa. MÉTODO Trata-se de um estudo quantitativo, transversal e retrospectivo no qual foram analisados criteriosamente livros de registros dos neonatos triados. Foi estabelecida a prevalência de "passa" e "falha" no teste e reteste, o percentual de comparecimento para reteste e de encaminhamento para diagnóstico audiológico. Foram descritos os indicadores de risco para deficiência auditiva, bem como sua influência nos índices de "passa" e "falha". Foi realizada análise estatística inferencial utilizando o teste do qui-quadrado e o teste de Anderson-Darling, com índice de confiabilidade de 5%. RESULTADOS Foram triados 3.981 neonatos, 2.963 (74,4%) dos quais sem indicadores de risco e 1.018 (25,6%) com, sendo a prematuridade o mais frequente (51,6%). No teste, 166 (4,2%) falharam e 118 (71,1%) compareceram para o reteste. O índice de encaminhamento para diagnóstico foi de 0,3%. CONCLUSÃO O programa atingiu os índices recomendados pelo Joint Committee on Infant Hearing e pelo Comitê Multiprofissional em Saúde Auditiva quanto à porcentagem de encaminhamento para diagnóstico. O indicador de risco mais prevalente na população foi a prematuridade.

O uso de tecido flanelado sobre incubadoras: repercussão nos níveis de ruído / The use of incubator covers: repercussion on noise levels

Avaliar a efetividade do uso de um tecido flanelado sobre a cúpula das incubadoras na diminuição do nível de pressão sonora (NPS)decorrente da presença do pulso oxímetro e da bomba de infusão em funcionamento e seus alarmes soando. Estudo quase-experimental em que foram mensurados os níveis de pressão sonora de 20 incubadoras, divididas em três grupos conforme a marca, modelo, tempo de uso,com os equipamentos em funcionamento e como soar dos alarmes sobre suas cúpulas, com e sem tecido flanelado. Ao soar o alarme do pulso oxímetro, somente no grupo 1 houve redução significativa dos níveis com o uso do tecido. O uso do tecido aumentou significativamente os níveis produzidos pelo funcionamento da bomba de infusão nos grupos 1 e 3. Ao soar do alarme da bomba de infusão,houve redução significativa deníveis com o uso do tecido nos grupos 2 e 3. Conclui-se que o uso do tecido flanelado, embora tenha reduzido os níveis em algumas situações, não atingiu níveis sonoros seguros e não deve ser utilizado como estratégia de redução de ruído e os equipamentos não devem permanecer sobre a cúpula.

o assess the effectiveness of incubator covers (flannel) in decreasing sound pressure levels (SPL)coming from operating pulse oximeters and infusion pumps with alarms ringing. This quasi-experimental study measured SPL of 20 incubators divided into three groups according to brand, model, and age while they were functioning and had alarms ringing on the tops of the domes, with and without a cover. Only group 1 presented a significant decrease in noise levels when the alarm of the pulse oximeter went off while using a cover. The cover significantly increased noise produced by a working infusion pump in the groups 1 and 3. Noise levels significantly decreased with the use of a cover in the groups 2 and 3 when the alarm of the infusion pump went off. The conclusion is that no safe levels were achieved, despite decreased noise levels observed in some situations. Thus, incubator covers should not be used as a strategy to decrease noise and equipment should not be placed on domes.

Se tuvo por objetivo evaluarla efectividad del uso de un tejido afranelado sobre la cúpula de las incubadoras para disminuir el nivel de presión sonora (SPL) proveniente de la presencia del oxímetro de pulso y del funcionamiento de la bomba de infusión y de sus alarmas sonando. Se trata de estudio casi experimental en que fueron medidos los niveles de presión sonora de 20 incubadoras, divididas en tres grupos de acuerdo con: marca; modelo; tiempo de uso; equipamientos funcionando y con las alarmas sonando sobre sus cúpulas; y, con y sin el tejido afranelado. Al sonar la alarma del oxímetro de pulso, solamente en el grupo 1 hubo reducción significativa de los niveles con el uso del tejido afranelado. El uso de ese tejido aumentó significativamente los niveles producidos por el funcionamiento de la bomba de infusión en los grupos 1 y 3.Al sonar la alarma de la bomba de infusión, hubo reducción significativa de los niveles con el uso del tejido en los grupos 2 e 3. Se concluye que el uso del tejido afranelado, a pesar de que hubiese reducido los niveles de ruido en algunas situaciones, no alcanzó niveles sonoros seguros y no debe ser utilizado como estrategia para reducir el ruido, y los equipamientos no deben permanecer sobre la cúpula.

Desempenho comunicativo em trigêmeos prematuros / Acquisition and development language in premature triplets

OBJETIVO: descrever habilidades do desenvolvimento de trigêmeos aos 18 meses e aos 29 meses de vida, enfocando a comunicação. MÉTODOS: irmãos trigêmeos dizigóticos do sexo masculino. Os procedimentos de avaliação englobaram: Anamnese, Observação do Comportamento Comunicativo e Escala de Desenvolvimento de Gesell e Amatruda (2000). As avaliações foram realizadas aos 18 e aos 29 meses. As crianças apresentaram atraso do desenvolvimento neuropsicomotor e eram expostas a multilingüismo. RESULTADOS: foi verificada alteração nos comportamentos comunicativos nas três crianças, tanto na primeira quanto na segunda avaliação, embora tenha sido observada melhora do desempenho, após as orientações recebidas pela família. Na segunda avaliação foi observada criptofasia. Dos comportamentos motor grosseiro, delicado, adaptativo, pessoal-social e de linguagem, o último foi o mais afetado para as três crianças, apesar de todos estarem alterados considerando a idade cronológica dos trigêmeos. CONCLUSÃO: as habilidades do desenvolvimento dos trigêmeos avaliados neste estudo estavam alteradas, acometendo todas as áreas. Ressalta-se maior comprometimento da linguagem tanto aos 18 como aos 29 meses.

PURPOSE: to describe abilities of triplets' development by 18 months and the 29 months of life, focusing on communication. METHODS: dizygotic male sibling triplets. The evaluation procedures included history of disease, observing the communicative behavior and Escala de Desenvolvimento de Gesell e Amatruda (2000). The evaluations were accomplished by the 18 months and the 29 months. The children showed delay in the neuropshycomotor development and were exposed to multilingualism. RESULTS: alteration was verified in the communicative behaviors in the three children, both in the first as well as in the second evaluation, although an amelioration was shown in the performance, after the orientations received by the family. Cryptophasia was observed in the second evaluation. Of the gross motor, fine motor-adaptive, personal-social and language behaviors, the last one was the most affected as for the three children, in spite of all of them being altered considering the triplets' chronological age. CONCLUSION: the abilities of the triplets' development appraised in this study were altered, affecting all the areas. Larger commitment of the language is emphasized both by the age of 18 months as well as by 29 months.