The impact of advanced paternal age on the live birth rate in patients undergoing Assisted Reproduction treatment: Findings from an analysis at a public reproductive center in Brazil.

OBJECTIVE: Human reproduction presents a challenge for our species, as evidenced by the escalating rates of infertility. This trend has prompted inquiries into diverse strategies aimed at mitigating infertility and enhancing conception rates. Despite the extensive research on advanced maternal age as a risk factor for reproductive outcomes, paternal age has historically garnered comparatively less attention. The aim of this study was to assess the impact of paternal age on embryos and its subsequent repercussions on fertilization rate, biochemical pregnancy, clinical pregnancy, and live birth rate in individuals undergoing assisted reproductive treatment in a public reproductive center located in Brazil. METHODS: This investigation adopted a retrospective cohort, cross-sectional, analytical design, utilizing the analysis of secondary data, covering the period from July 2015 to July 2021. RESULTS: A total of 350 couples grappling with infertility and undergoing intrauterine insemination (IUI), in vitro fertilization (IVF), and intracytoplasmic sperm injection (ICSI) were included in the analysis. Examination of age groups revealed a notable correlation between the ages of women and men (correlation coefficient R=0.12, p<0.0001). In the analysis of IVF techniques, a discernible trend towards a negative correlation with paternal age was observed, signifying that higher paternal age was linked to lower fertilization rates (p=0.004). CONCLUSIONS: Advanced paternal age significantly impacts full-term birth rates in IVF procedures, emphasizing the need for preconception public health advisories that underscore the risks associated with delaying parenthood for both men and women, particularly among those necessitating assisted reproductive techniques.

Reliability and reference values for diaphragmatic excursion, thickness, and thickening fraction and quadriceps femoris muscle thickness in full-term newborns evaluated by ultrasound.

To determine the diaphragm thickness, thickening fraction, and excursion and thickness of the quadriceps femoris muscle in full-term newborns and to evaluate the intra- and interrater reliability of these measurements. This was a prospective, observational clinical study including full-term newborns born within the first 48 h after birth. Serial measurements of the thickness, thickening fraction, and mobility of the diaphragm muscles and the thickness of the quadriceps muscle were obtained using ultrasound images. A total of 69 newborns with a mean gestational age of 39 weeks were included. The following measurements were obtained and are expressed as the mean (standard deviation): inspiratory diaphragm thickness, 0.19 cm (0.04); expiratory diaphragm thickness, 0.16 cm (0.04); diaphragm thickness fraction, 16.70 cm (10.27); diaphragmatic excursion, 0.68 cm (0.22); and quadriceps thickness, 0.99 cm (0.14). Intrarater reliability was assessed using intraclass correlation coefficients (ICCs). Excellent intrarater agreement was observed for the two groups of operators (ICC > 0.86, p < 0.001) for all measurements except for the diaphragm thickening fraction, which showed good agreement for both operator groups (ICC = 0.70, p < 0.001). Regarding interrater reliability, moderate agreement between the raters was observed in the means of all measures (ICC > 0.49, p < 0.001), except for the diaphragm thickening fraction, which showed poor agreement.    Conclusion: Good intrarater and moderate interrater reliability were achieved in ultrasound evaluations of the thickness and mobility of the diaphragm and quadriceps femoris muscles in full-term newborns, demonstrating the feasibility of this technique for clinical use. This pioneering study offers reference values for these muscles in a single study, allowing comparisons between different clinical conditions. What is Known: • Ultrasound is a highly reliable tool for muscle assessment that can be used to assess muscular atrophy in critically ill patients. • Muscle atrophy worsens the patient's condition and has been associated with worse outcomes. What is New: • To our knowledge, this is the first study to jointly evaluate the diaphragm and quadriceps muscle thickness and evaluate the reliability of all measurements. • Our study presents reference values for both muscles, enabling comparisons between different clinical conditions.

Assessment of the Integrity and Function of Human Term Placental Explants in Short-Term Culture.

Human placental explants (HPEs) culture has generated significant interest as a valuable in vitro model for studying tissue functions in response to adverse conditions, such as fluctuations in oxygen levels, nutrient availability, exposure to pathogenic microorganisms, and toxic compounds. HPEs offers the advantage of replicating the intricate microenvironment and cell-to-cell communication involved in this critical and transient organ. Although HPEs culture conditions have been extensively discussed, a protocol for assessing the viability and function of HPEs during short-term culture has not been previously outlined. In this study, we have developed a short-term HPEs culture protocol, specifically up to 72 h, and have employed quantitative, semi-quantitative, and qualitative analyses to evaluate tissue viability and function over time. Under our standardized conditions, placental villi explants began to regain their structural properties (the integrity of the trophoblast and villous stroma) and the functionality of the HPEs (production of angiogenic, endocrine, and immunological factors) starting from 48 h of culture. This restoration ensures a suitable environment for several applications. The data presented here can be highly valuable for laboratories aiming to implement an HPEs model, whether in the process of standardization or seeking to enhance and optimize working conditions and timing with placental tissue.

Human Milk Microbiota Profile Affected by Prematurity in Argentinian Lactating Women.

To study (16S rRNA-sequencing) the impact of gestational and corrected ages on the microbiota profile of human milk (HM) of mothers that delivered full-term and pre-term children, HM samples were obtained and classified according to the gestational age as group T (full-term births ≥37 weeks), and group P (pre-term births <37 weeks). Group P was longitudinally followed, and the samples were collected at the full-term corrected gestational age: when the chronological age plus the gestational age were ≥37 weeks (PT group). The HM microbiota composition differed depending on the gestational age (T vs. P). Group T had lower levels of Staphylococcus and higher levels of Rothia and Streptococcus, as compared to group P. The alpha Simpson diversity value was higher in group T than in P, whereas no differences were found between groups T and PT, suggesting a microbial evolution of the composition of group P towards group T over chronological age. Full-term delivery was associated with a greater diversity of microbes in HM. The microbial composition of pre-term HM, at the corrected age, did not show significant differences, as compared to the samples obtained from the full-term group, suggesting that it would be appropriate to consider the corrected age in terms of the composition and the diversity of the milk in future studies.

Metabolic impact of infant formulas in young infants. An outlook from the urine metabolome.

Introduction: Although breast milk is the ideal food source for newborns during the first six months of life, a high percentage of children receive infant formulas. There is evidence that specific diet habits may influence individual metabolic profile. Therefore, in newborns, such profile can be influenced by the use of infantile formulas given the composition differences that display compared to human milk. Up to now, there are no reports in the literature that address this issue. Objectives: this work aims to compare the metabolic profile of full-term newborns that were feed with either breast milk (n = 32) or infantile formulas (n = 21). Methods: Metabolic profile was established based on urine analysis through gas chromatography-mass spectrometry (GC-MS) and nuclear magnetic resonance (H-NMR). Results: our results evidenced a more gluconeogenic profile in breast-fed infants characterized by elevation of Kreb's cycle intermediaries like fumaric, succinic and ketoglutaric acids compared to infants receiving infant formula. In addition, infant formula fed infants presented urinary excretion of metabolites derived from specific compounds present in this type of diet that were not observed in breast-fed infants, for instance D-glucitol, and 4-deoxytetronic. Moreover, in infant formula fed infants there was excretion of basal levels of metabolites of clinical relevance like 3-hydroxy-3-methyl-glutaric, 2-methyl-3-keto-valeric and 3,4-dihydroxybutyric. Conclusion: These results show the importance of understanding the metabolic impact of diet in newborn population in normal and pathological contexts.

Por que devemos nos preocupar com os bebês a termo internados em uma unidade de terapia intensiva neonatal / Por qué deberíamos preocuparnos por los bebés nacidos a término ingresados en una unidad de cuidados intensivos neonatal / Why we should care about full-term infants admitted to a neonatal intensive care unit

RESUMO O objetivo deste estudo foi analisar a razão pela qual devemos nos preocuparmos com os bebês a termo internados em uma unidade de terapia intensiva neonatal. Trata-se de estudo documental, descritivo e retrospectivo de 262 recém-nascidos (RNs) a termo. As variáveis utilizadas foram: características dos RN; diagnóstico principal, tempo de permanência e acompanhamento pela equipe multiprofissional; e encaminhamento pós-alta. Houve prevalência do sexo masculino (52%), de Apgar 9 no 5º minuto e da raça/cor branca do RN e da mãe (61,1% e 48,9%, respectivamente). O diagnóstico principal foi a disfunção respiratória (28,8%), e o tempo de permanência foi de oito dias. Houve diferença significativa entre os tempos de permanência (p=0,013), em que as doenças cardiorrespiratórias e outras doenças levaram a um menor tempo de internação em relação à má formação ou às doenças maternas. O serviço social foi o mais procurado para o acompanhamento (81,2%) e a fisioterapia, o menos buscado (18%). RNs com maior peso ficaram menos tempo internados, e os acompanhados por fisioterapia apresentaram tempo de permanência mais elevados (p<0,001). O principal desfecho foi a alta hospitalar (68,7%) e encaminhamentos para a Unidade Básica de Saúde (57%). Os achados deste estudo apontam a presença de bebês menos graves, baixo número de estudos específicos para a população a termo e outros diagnósticos que nos remetem a cuidados não intensivos.

RESUMEN El objetivo de este estudio fue analizar el motivo de preocupación por los recién nacidos a término ingresados en una unidad de cuidados intensivos neonatal. Se trata de un estudio documental, descriptivo y retrospectivo, realizado con 262 recién nacidos (RN) a término. Las variables utilizadas fueron: características de los RN; diagnóstico principal, tiempo de estancia y seguimiento por el equipo multidisciplinar; y derivación posterior al alta. Hubo predominio del sexo masculino (52%), Apgar 9 al 5º minuto y raza/color blanca del RN y de la madre (61,1% y 48,9%, respectivamente). El principal diagnóstico fue disfunción respiratoria (28,8%), y la estancia hospitalaria fue de ocho días. Hubo una diferencia significativa entre el tiempo de estancia (p=0,013), en que las enfermedades cardiorrespiratorias y otras enfermedades resultaron en una menor estancia hospitalaria con relación a malformaciones o enfermedades maternas. El trabajo social fue el más buscado para el seguimiento (81,2%), y la fisioterapia, el menos buscado (18%). Los RN con mayor peso tuvieron una menor estancia hospitalaria, y aquellos que recibían seguimiento de fisioterapia tuvieron mayor tiempo de estancia (p<0,001). El principal desenlace fue el alta hospitalaria (68,7%) y las derivaciones a la Unidad Básica de Salud (57%). Los hallazgos de este estudio apuntan a la presencia de recién nacidos menos graves, un bajo número de estudios específicos para la población a término y otros diagnósticos que nos remiten a cuidados no intensivos.

ABSTRACT This study aims to analyze why we should care about full-term newborns admitted to a neonatal intensive care unit. This is a documented, descriptive, and retrospective study of 262 full-term newborns. Variables used: newborns' characteristics; main diagnosis, length of stay, follow-up by a multidisciplinary team; post-discharge referral. Most newborns were boys (52%), had a 5-minute Apgar score of nine, and most newborns and their mothers were white (61.1% and 48.9% respectively). Respiratory dysfunction was the main diagnosis (28.8%). Length of stay was eight days. There was a significant difference regarding length of stay (p=0.013), in which those with cardiorespiratory and other diseases stayed less time compared to those with malformation or maternal diseases. The social service was the most sought (81.2%) service, whereas physical therapy the least sought (18%). Newborns with higher weight were hospitalized for less time. Those that underwent physical therapy had longer stay (p<0.001). Main outcome was hospital discharge (68.7%) and referrals to the Basic Health Unit (57%). This study outcomes indicated newborns with less severe conditions, low number of specific studies for the full-term population, other diagnoses that refer to non-intensive care.

Newborn infants who received skin-to-skin contact with fathers after Caesarean sections showed stable physiological patterns.

AIM: Separating infants and their parents after a Caesarean section is still the routine care worldwide. This study investigated three caregiving models on the wakefulness and physiological parameters of full-term infants after an elective Caesarean section. METHODS: Newborn infants born in a Chilean public hospital in 2009-12 were randomised to three groups: cot, fathers' arms or skin-to-skin contact with their father. They were assessed at 15-minute intervals, from 45 to 120 minutes after the Caesarean section. Their physiological parameters were measured, and their wakefulness was assessed using the Neonatal Behavioural Assessment Scale. RESULTS: We studied 95 infant (53% girls) born at a mean gestational age of 38.9 ± 0.9 weeks. Heart rates were significantly higher in the skin-to-skin than cot or fathers' arms groups and showed greater stability over time. Wakefulness was initially higher in the skin-to-skin group, but there were no significant differences by the end of the observation. There were no differences between the groups in peripheral oxygen saturation. Skin-to-skin contact had no negative impact on the infants. CONCLUSION: The skin-to-skin group showed some advantages over the cot and fathers' arms groups when it came to establishing stable physiological parameters and wakefulness. This approach should be supported during mother-infant separation.

Fatores materno-infantis associados ao desenvolvimento de bebês prematuros e a termo / Maternal-infant factors associated to the development of preterm and full-term babies / Factores materno-infantiles asociados al desarrollo de bebés prematuros y a término

Conhecer a influência de variáveis materno-infantis e ambientais no processo desenvolvimental torna possível que atrasos sejam minimizados. Pretendeu-se comparar variáveis sociodemográficas e de desenvolvimento de bebês prematuros e a termo aos três meses de idade e identificar as influências de fatores materno-infantis associadas ao desenvolvimento destes bebês. Participaram 275 díades mãe-bebê, sendo 168 prematuros e 107 a termo. Aplicou-se uma entrevista para coleta das variáveis materno-infantis e as Escalas Bayley III para avaliar o desenvolvimento. Os resultados indicaram que há diferenças significativas entre a termo e prematuros em relação à escolaridade materna, presença de irmãos e não planejamento materno da gravidez. Prematuros apresentaram maiores atrasos no desenvolvimento cognitivo, em linguagem expressiva, motor fino e motor amplo. A identificação de atrasos aos três meses apontou para a importância de programas de estimulação precoce como fator de proteção para evitar atrasos no desenvolvimento e como orientação aos cuidadores primários do bebê.

Knowing the influence of maternal-infant and environmental factors in the developmental process makes it possible to minimize delays. We intended to compare socio-demographic and developmental variables of preterm and full-term babies at three months of age, and to identify the influences of maternal-infant factors associated with the development of these babies. Participants were 275 mother-baby dyads, 168 being preterm and 107 full-term babies. We applied an interview to collect maternal-infant variables and we used the Bayley III Scales to evaluate development. The results indicated that there are significant differences between full-term and preterm babies regarding maternal education, the presence of siblings, and lack of maternal pregnancy planning. Preterm babies displayed more delays in cognitive development, expressive language, fine and gross motor development. The identification of delays at three months pointed to the importance of early stimulation programs as a protective factor to avoid developmental delays and as guidance to the primary caregivers of the baby.

Conocer la influencia de variables materno-infantiles y ambientales en el proceso de desarrollo hace posible que atrasos sean minimizados. Se pretendió comparar variables sociodemográficas y de desarrollo de bebés prematuros y a término a los tres meses de edad e identificar la influencia de factores materno-infantiles asociadas al desarrollo de estos bebés. Participaron 275 díadas madre-bebé, siendo 168 prematuros y 107 a término. Se aplicó una entrevista para la colecta de las variables materno-infantiles y las Escalas Bayley III para evaluar el desarrollo. Los resultados indicaron que hay diferencias significativas entre bebés a término y prematuros con respecto a la escolaridad materna, presencia de hermanos y falta de planeamiento materno del embarazo. Los prematuros presentaron mayores atrasos en el desarrollo cognitivo, en lenguaje expresivo, control motor fino y grueso. La identificación de atrasos a los tres meses mostró la importancia de programas de estimulación temprana como factor de protección para evitar atrasos del desarrollo y como orientación a los cuidadores primarios del bebé.

Prevalence of exclusive breastfeeding in the healthy newborn. / Prevalencia de la alimentación exclusiva con lactancia materna en recién nacidos sanos

Background: The best nourishment for infants during the first 6 months of life is exclusive breastfeeding. It is recommended along with other food to complement the diet until the child is 2 years old, as long as the mother and the child are willing to continue with it. The objectives of this study were to determine he exclusive breastfeeding rate in full term newborns at hospital discharge and 15 days later and to analyze the factors that positively affect the exclusive breastfeeding. Methods: A prospective study was conducted in which a sample of postpartum women with full term newborns was recruited during hospital admission. Different variables were compiled and two interviews were made to determine the kind of feeding they were giving their children and if it was maintained at 15 days of birth. Results: Exclusive breastfeeding rate at hospital discharge is much lower than recommended. It significantly decreases at 15 days of birth, increasing artificial feeding. It seems that having a vaginal birth, no complications giving birth, providing early breastfeeding and skin-to-skin contact in the delivery room are predisposing factors necessary to establish a good breastfeeding at hospital discharge. Conclusions: Despite the efforts of professionals, the percentage of newborns with exclusive breastfeeding at birth is not enough for the current recommendations.

Introducción: El mejor alimento para los niños durante los primeros seis meses de vida es la lactancia materna exclusiva (LME); se recomienda continuar con el amamantamiento junto con otros alimentos que complementen la alimentación hasta los dos años o más, mientras madre e hijo lo deseen. Los objetivos de este estudio fueron determinar la tasa de LME en los recién nacidos a término (RNT) en el momento del alta hospitalaria y a los 15 días y analizar los factores que influyen positivamente en la LME. Métodos: Estudio prospectivo en el que se reclutó una muestra de puérperas con hijos a término durante su ingreso. Se recogieron diferentes variables y se realizaron dos entrevistas para determinar el tipo de alimentación que estaban dando a sus hijos y si se mantenía a los 15 días del parto. Resultados: La tasa de LME al recibir el alta hospitalaria es muy inferior a lo recomendado. Ésta disminuye de manera importante a los 15 días del parto, cuando aumenta la lactancia artificial (LA). Al parecer, el parto eutócico, no presentar complicaciones en el parto, realizar lactancia materna (LM) precoz y el contacto piel con piel en el paritorio son factores favorecedores para establecer una buena LM en el alta hospitalaria. Conclusiones: A pesar de los esfuerzos de los profesionales, el porcentaje de recién nacidos (RN) alimentados con LME al nacer no alcanza las recomendaciones actuales.

Prevalencia de la alimentación exclusiva con lactancia materna en recién nacidos sanos / Prevalence of exclusive breastfeeding in the healthy newborn

Resumen Introducción: El mejor alimento para los niños durante los primeros seis meses de vida es la lactancia materna exclusiva (LME); se recomienda continuar con el amamantamiento junto con otros alimentos que complementen la alimentación hasta los dos años o más, mientras madre e hijo lo deseen. Los objetivos de este estudio fueron determinar la tasa de LME en los recién nacidos a término (RNT) en el momento del alta hospitalaria y a los 15 días y analizar los factores que influyen positivamente en la LME. Métodos: Estudio prospectivo en el que se reclutó una muestra de puérperas con hijos a término durante su ingreso. Se recogieron diferentes variables y se realizaron dos entrevistas para determinar el tipo de alimentación que estaban dando a sus hijos y si se mantenía a los 15 días del parto. Resultados: La tasa de LME al recibir el alta hospitalaria es muy inferior a lo recomendado. Ésta disminuye de manera importante a los 15 días del parto, cuando aumenta la lactancia artificial (LA). Al parecer, el parto eutócico, no presentar complicaciones en el parto, realizar lactancia materna (LM) precoz y el contacto piel con piel en el paritorio son factores favorecedores para establecer una buena LM en el alta hospitalaria. Conclusiones: A pesar de los esfuerzos de los profesionales, el porcentaje de recién nacidos (RN) alimentados con LME al nacer no alcanza las recomendaciones actuales.

Abstract Background: The best nourishment for infants during the first 6 months of life is exclusive breastfeeding. It is recommended along with other food to complement the diet until the child is 2 years old, as long as the mother and the child are willing to continue with it. The objectives of this study were to determine he exclusive breastfeeding rate in full term newborns at hospital discharge and 15 days later and to analyze the factors that positively affect the exclusive breastfeeding. Methods: A prospective study was conducted in which a sample of postpartum women with full term newborns was recruited during hospital admission. Different variables were compiled and two interviews were made to determine the kind of feeding they were giving their children and if it was maintained at 15 days of birth. Results: Exclusive breastfeeding rate at hospital discharge is much lower than recommended. It significantly decreases at 15 days of birth, increasing artificial feeding. It seems that having a vaginal birth, no complications giving birth, providing early breastfeeding and skin-to-skin contact in the delivery room are predisposing factors necessary to establish a good breastfeeding at hospital discharge. Conclusions: Despite the efforts of professionals, the percentage of newborns with exclusive breastfeeding at birth is not enough for the current recommendations.

Uso da sacarose para o alívio da dor: repercussão na amamentação materna durante a internação do recém-nascido a termo / Use of sucrose for pain relief: consequences on breastfeeding of fullterm newborns during hospitalization

Durante o período de internação, o recém-nascido (RN) é submetido a uma série de procedimentos dolorosos ou não, que podem incidir sobre o seu comportamento e sobre a confiança da mãe para o cuidado e para a amamentação materna. Temos como questionamento, se sacarose 25% que é oferecida como medida de alivio da dor em RN a termo internado em alojamento conjunto interfere negativamente na amamentação materna exclusiva durante a internação. Objetivo: Verificar a associação entre uso da sacarose 25% que é oferecida como medida de alívio dor aguda em RN a termo, e a amamentação materna durante a internação em alojamento conjunto. Métodos: Trata-se de um estudo observacional, transversal, descritivo e analítico. A amostra foi constituída por 215 binômios cujo nascimento e internação ocorreram entre os meses de Junho a Setembro de 2017 em uma maternidade do interior paulista intitulada "Amiga da Criança". Os binômios foram incluídos no estudo somente após autorização da mãe, com assinatura de um termo de consentimento livre e esclarecido. Os dados foram coletados por meio do prontuário e planilhas especificas. Os RN foram divididos em dois grupos: RN expostos e não expostos ao uso da sacarose durante a internação. Como houve diferença estatística entre os grupos para o tempo de internação, para analisar a influência do uso da sacarose na amamentação durante toda internação, foi feita uma relativização das variáveis de aleitamento materno pelo total de dias de internação do RN. As associações foram verificadas pelo teste "U" de Mann-Whitney, com valor de p significativo para ? <= 0,05. Resultado: Dos 215 RN estudados durante toda internação, 111 (51,6%) RN foram expostos ao uso da sacarose. Foi utilizado sacarose para 188 (60,1%) dos procedimentos dolorosos, sendo que a mesma foi usada associada a outros métodos como o colo em 18 (5,7%) e sucção não nutritiva 64 (20,4%) dos procedimentos. Somando-se o uso isolado ou em associação a outras medidas, a sacarose foi utilizada 270 (86,2%) vezes sendo a medida mais aplicada na prática clínica da maternidade. No grupo que utilizou sacarose as médias de frequência de mamadas, uso de copo, translactação, tempo médio por mamada e amamentação assistida foram respectivamente: 7,9, 0,2, 0,5, 11,4 e 1,0 . No grupo que não utilizou a sacarose, respectivamente, as a médias das mesmas variáveis foram de 8,7, 0,03, 0,06, 18,6 e 0,8. Houve diferença estatisticamente significativa entre os grupos para as variáveis de alimentação: frequência de mamada (p=0,03), utilização de copo (p=0,01), realização de translactação (p=0,00), tempo médio por mamada (p=0,00) e amamentação assistida (p=0,02). Conclusão: As associações dos dados encontrados comprovaram a hipótese do presente estudo, ou seja o uso da sacarose a 25% para alívio da dor aguda influenciou negativamente na amamentação materna do RN durante a internação, pois, o grupo de RN que recebeu esta substância adocicada durante os procedimentos de punção arterial, venosa e capilar, apresentou menor frequência de mamada, menor tempo médio por mamada, maior uso de complemento lácteo, mais necessidade de translactação e necessitou de mais amamentação assistida por um profissional de enfermagem, quando comparado ao grupo de RN não expostos a ela. Faz-se necessária a inclusão de medidas não farmacológicas com a participação da mãe em substituição à sacarose, uma vez que tratou-se de pesquisa em uma Maternidade Amiga da Criança

Introduction: During the period of hospitalization, full-term newborns (NB) undergo a series of painful procedures, which may affect his behavior and the mother's confidence in both taking care of and breastfeeding the baby. We question whether 25% sucrose, which is offered as a measure of pain relief in hospitalized NB infants, negatively interferes with exclusive mother's breastfeeding during hospitalization in rooming-in care. Aim: Verify the association between the use of 25% sucrose offered as pain relief in full-term newborns and exclusive mother's breastfeeding during hospitalization in shared rooms. Methods: This is a study based on observation, and it is transversal, descriptive and analytical study. The sample consisted of 215 binomials whose birth and hospitalization occurred between June and September of 2017 in a maternity hospital in the countryside of São Paulo, in a Child-Friendly Maternity. The binomials were included in the study only after authorization obtained from the mother, with the signing of a free and previously informed consent form. The data were collected through medical records and specific worksheets. The NB were divided into two groups: NB exposed and not exposed to the use of sucrose during hospitalization, respectively. There was a statistical difference between the groups due to the hospitalization period; thus, to analyze the influence of sucrose use on breastfeeding during all hospitalization, a relative analysis of the variables of breastfeeding by the total number of days of hospitalization of the newborn was made. Associations were verified by the Mann-Whitney "U" test, with a significant p value for ? <= 0.05. Results: From 215 NBs studied during all hospitalization, 111 (51.6%) were exposed to the use of sucrose. Sucrose was applied for 188 (60.1%) of the painful procedures, and it was used in association with other methods such as lap in 18 (5.7%) and non-nutritive suction in 64 (20.4%) of the procedures. Added the isolate use or in association with other measures, sucrose was used 270 (86.2%) times, being the most applied measure in clinical practice of maternity. In the sucrose group, the average of frequency of feeding, cupping, translactation, average time per feeding and assisted breastfeeding were respectively: 7.9, 0.2, 0.5, 11.4 and 1.0. In the nonsucrose group, the average of the same variables were 8.7, 0.03, 0.06, 18.6 and 0.8, respectively. There was a statistically significant difference between the groups for feeding variables: feeding frequency (p = 0.03), cup use (p = 0.01), translactation (p = 0.00), average time per feed (p = 0.00) and assisted breastfeeding (p = 0.02). Conclusion: The associations of the data confirmed the hypothesis of the present study, that is, the use of sucrose at 25% for acute pain relief influenced negatively the maternal breastfeeding of newborns during hospitalization, since the group of newborns who received this sugary substance during the venous and capillary puncture procedures, presented lower breastfeeding frequency, lower average time for breastfeeding, greater use of milky complement, higher need for translactation and required more breastfeeding assisted by a nursing professional, when compared to the NB group who was not exposed to it. It is necessary to include non-pharmacological measures with the participation of the mother instead of sucrose, since it was a research in a Child-Friendly Maternity

Uso da sacarose para o alívio da dor: repercussão na amamentação materna durante a internação do recém-nascido a termo / Use of sucrose for pain relief: consequences on breastfeeding of fullterm newborns during hospitalization

Introdução: Durante o período de internação, o recém-nascido (RN) é submetido a uma série de procedimentos dolorosos ou não, que podem incidir sobre o seu comportamento e sobre a confiança da mãe para o cuidado e para a amamentação materna. Temos como questionamento, se sacarose 25% que é oferecida como medida de alivio da dor em RN a termo internado em alojamento conjunto interfere negativamente na amamentação materna exclusiva durante a internação. Objetivo: Verificar a associação entre uso da sacarose 25% que é oferecida como medida de alívio dor aguda em RN a termo, e a amamentação materna durante a internação em alojamento conjunto. Métodos: Trata-se de um estudo observacional, transversal, descritivo e analítico. A amostra foi constituída por 215 binômios cujo nascimento e internação ocorreram entre os meses de Junho a Setembro de 2017 em uma maternidade do interior paulista intitulada "Amiga da Criança". Os binômios foram incluídos no estudo somente após autorização da mãe, com assinatura de um termo de consentimento livre e esclarecido. Os dados foram coletados por meio do prontuário e planilhas especificas. Os RN foram divididos em dois grupos: RN expostos e não expostos ao uso da sacarose durante a internação. Como houve diferença estatística entre os grupos para o tempo de internação, para analisar a influência do uso da sacarose na amamentação durante toda internação, foi feita uma relativização das variáveis de aleitamento materno pelo total de dias de internação do RN. As associações foram verificadas pelo teste "U" de Mann-Whitney, com valor de p significativo para ? <= 0,05. Resultado: Dos 215 RN estudados durante toda internação, 111 (51,6%) RN foram expostos ao uso da sacarose. Foi utilizado sacarose para 188 (60,1%) dos procedimentos dolorosos, sendo que a mesma foi usada associada a outros métodos como o colo em 18 (5,7%) e sucção não nutritiva 64 (20,4%) dos procedimentos. Somando-se o uso isolado ou em associação a outras medidas, a sacarose foi utilizada 270 (86,2%) vezes sendo a medida mais aplicada na prática clínica da maternidade. No grupo que utilizou sacarose as médias de frequência de mamadas, uso de copo, translactação, tempo médio por mamada e amamentação assistida foram respectivamente: 7,9, 0,2, 0,5, 11,4 e 1,0 . No grupo que não utilizou a sacarose, respectivamente, as a médias das mesmas variáveis foram de 8,7, 0,03, 0,06, 18,6 e 0,8. Houve diferença estatisticamente significativa entre os grupos para as variáveis de alimentação: frequência de mamada (p=0,03), utilização de copo (p=0,01), realização de translactação (p=0,00), tempo médio por mamada (p=0,00) e amamentação assistida (p=0,02). Conclusão: As associações dos dados encontrados comprovaram a hipótese do presente estudo, ou seja o uso da sacarose a 25% para alívio da dor aguda influenciou negativamente na amamentação materna do RN durante a internação, pois, o grupo de RN que recebeu esta substância adocicada durante os procedimentos de punção arterial, venosa e capilar, apresentou menor frequência de mamada, menor tempo médio por mamada, maior uso de complemento lácteo, mais necessidade de translactação e necessitou de mais amamentação assistida por um profissional de enfermagem, quando comparado ao grupo de RN não expostos a ela. Faz-se necessária a inclusão de medidas não farmacológicas com a participação da mãe em substituição à sacarose, uma vez que tratou-se de pesquisa em uma Maternidade Amiga da Criança

Introduction: During the period of hospitalization, full-term newborns (NB) undergo a series of painful procedures, which may affect his behavior and the mother's confidence in both taking care of and breastfeeding the baby. We question whether 25% sucrose, which is offered as a measure of pain relief in hospitalized NB infants, negatively interferes with exclusive mother's breastfeeding during hospitalization in rooming-in care. Aim: Verify the association between the use of 25% sucrose offered as pain relief in full-term newborns and exclusive mother's breastfeeding during hospitalization in shared rooms. Methods: This is a study based on observation, and it is transversal, descriptive and analytical study. The sample consisted of 215 binomials whose birth and hospitalization occurred between June and September of 2017 in a maternity hospital in the countryside of São Paulo, in a Child-Friendly Maternity. The binomials were included in the study only after authorization obtained from the mother, with the signing of a free and previously informed consent form. The data were collected through medical records and specific worksheets. The NB were divided into two groups: NB exposed and not exposed to the use of sucrose during hospitalization, respectively. There was a statistical difference between the groups due to the hospitalization period; thus, to analyze the influence of sucrose use on breastfeeding during all hospitalization, a relative analysis of the variables of breastfeeding by the total number of days of hospitalization of the newborn was made. Associations were verified by the Mann-Whitney "U" test, with a significant p value for ? <= 0.05. Results: From 215 NBs studied during all hospitalization, 111 (51.6%) were exposed to the use of sucrose. Sucrose was applied for 188 (60.1%) of the painful procedures, and it was used in association with other methods such as lap in 18 (5.7%) and non-nutritive suction in 64 (20.4%) of the procedures. Added the isolate use or in association with other measures, sucrose was used 270 (86.2%) times, being the most applied measure in clinical practice of maternity. In the sucrose group, the average of frequency of feeding, cupping, translactation, average time per feeding and assisted breastfeeding were respectively: 7.9, 0.2, 0.5, 11.4 and 1.0. In the nonsucrose group, the average of the same variables were 8.7, 0.03, 0.06, 18.6 and 0.8, respectively. There was a statistically significant difference between the groups for feeding variables: feeding frequency (p = 0.03), cup use (p = 0.01), translactation (p = 0.00), average time per feed (p = 0.00) and assisted breastfeeding (p = 0.02). Conclusion: The associations of the data confirmed the hypothesis of the present study, that is, the use of sucrose at 25% for acute pain relief influenced negatively the maternal breastfeeding of newborns during hospitalization, since the group of newborns who received this sugary substance during the venous and capillary puncture procedures, presented lower breastfeeding frequency, lower average time for breastfeeding, greater use of milky complement, higher need for translactation and required more breastfeeding assisted by a nursing professional, when compared to the NB group who was not exposed to it. It is necessary to include non-pharmacological measures with the participation of the mother instead of sucrose, since it was a research in a Child-Friendly Maternity

A comparison between preterm and full-term infants' preference for faces / Uma comparação entre recém-nascidos prematuros e a termo na preferência por faces

Abstract: Objective: Visual preference for faces at birth is the product of a multimodal sensory experience experienced by the fetus even during the gestational period. The ability to recognize faces allows an ecologically advantageous interaction with the social environment. However, perinatal events such as premature birth, may adversely affect the adequate development of this capacity. In this study, we evaluated the preference for facial stimuli in preterm infants within the first few hours after birth. Methods: This is a cross-sectional observational study of 59 newborns, 28 preterm and 31 full-term infants. The babies were assessed in the first hours of life, with two white boards in the shape of a head and neck: one with the drawing of a face similar to the human face (natural face), and one with the drawing of misaligned eyes, mouth and nose (distorted face). After the newborn fixated the eyes on the presented stimulus, it was slowly moved along the visual field. The recognition of the stimulus was considered present when the baby had eye or head movements toward the stimulus. Results: The preterm infants, in addition to showing a lower occurrence of orientation movements for both stimuli, on average (1.8 ± 1.1 to natural faces and 2.0 ± 1.2 for distorted ones) also showed no preference for any of them (p = 0.35). Full-term newborns showed a different behavior, in which they showed a preference for natural faces (p = 0.002) and a higher number of orientations for the stimulus, for both natural (3.2 ± 0.8) and distorted faces (2.5 ± 0.9). Conclusion: Preterm newborns recognize facial stimuli and disclose no preference for natural faces, different from full-term newborns.

Resumo: Objetivo: A preferência visual por faces ao nascimento é produto de uma experiência sensorial multimodal vivenciada pelo feto ainda no período gestacional. A habilidade de reconhecer faces possibilita uma interação ecologicamente vantajosa com o ambiente social. Entretanto, eventos perinatais, como o nascimento prematuro, podem prejudicar o desenvolvimento adequado dessa habilidade. Neste trabalho, avaliamos a preferência por estímulos faciais de recém-nascidos prematuros nas primeiras horas após o nascimento. Métodos: Trata-se de um estudo observacional transversal feito com 59 recém-nascidos, 28 prematuros e 31 nascidos termos. Os bebês foram avaliados, nas primeiras horas de vida, com duas pranchas brancas em formato de cabeça e pescoço: uma com o desenho de uma face similar ao rosto humano (face natural) e outra com o desenho de olhos, boca e nariz desalinhados (face distorcida). Após o recém-nascido fixar o olhar no estímulo apresentado, era lentamente movimentado ao longo do campo visual. O reconhecimento do estímulo foi considerado presente quando o bebê apresentou movimentos dos olhos ou cabeça em direção ao estímulo. Resultados: Os recém-nascidos prematuros, além de apresentar menor ocorrência de movimentos de orientação para ambos os estímulos, em média (1,8 ± 1,1 para faces naturais e 2 ± 1,2 para faces distorcidas), também não apresentaram preferência por qualquer um deles (p = 0,35). Diferente foi o comportamento dos recém-nascidos a termo, que apresentaram preferência por faces naturais (p = 0,002) e um número maior de orientações para o estímulo, tanto para faces naturais (3,2 ± 0,8) quanto para faces distorcidas (2,5 ± 0,9). Conclusão: Recém-nascidos prematuros reconhecem os estímulos faciais e não apresentam preferência por faces naturais, diferentemente de recém-nascidos a termos.

Morbimortalidad del recién nacido a término precoz en el hospital Hipólito Unanue de Tacna durante los años 2000 a 2014 / Morbimortality of early term newborns at Tacna's Hipólito Unanue hospital during the years 2000 to 2014

Objetivo: Determinar la frecuencia, tasa de cesárea y riesgos de morbimortalidad del recién nacido a término precoz (RNTP). Material y métodos: Estudio observacional, retrospectivo, analítico. Se incluyó a neonatos únicos vivos a término, nacidos en el hospital Hipólito Unanue de Tacna durante los años 2000 a 2014 (n=45332). Se comparó a los nacidos a termino precoz de 37 a 38 6/7 semanas (n=11276), y los nacidos a termino completo de 39 a 41 6/7 semanas (n=34056). Se utilizó frecuencia y tasa por 100 nacidos vivos, odds ratio (OR) con intervalos de confianza al 95% (IC 95%), regresión logarítmica y prueba "t" para muestras independientes. Se utilizó la base de datos del Sistema Informático Perinatal. Resultados: La frecuencia de nacidos a término precoz fue 22,5 por 100 nacidos vivos, con un crecimiento logarítmico significativo (p=0,03). Representó 24,9% de todos los recién nacidos a término. La tasa de cesárea se incrementó de 31,2% a 51,1% y su crecimiento fue similar al de los término completo. Se asoció al RNTP con mayor probabilidad de tener bajo peso al nacer (OR:5,33; IC 95%: 4,50-6,30), ser pequeño para la edad gestacional (OR:3,14; IC 95%: 2,69- 3,66), nacer por cesárea (OR: 3,15; IC 95%: 3,01-3,29), tener estancia hospitalaria de 3 días a más (OR: 1,46; IC 95%: 1,39-1,54), morbilidad respiratoria (OR: 1,81; IC 95%: 1,38-2,37) como neumonía (OR:3,02; IC 95%: 1,70-5,38), membrana hialina (OR: 4,17; IC 95%: 1,56-11,33) y taquipnea transitoria (OR: 2,95; IC 95%: 1,79-4,85); y malformaciones congénitas (OR: 1,46; IC 95%: 1,17-1,82), hiperbilirrubinemia (OR: 1,23; IC 95%: 1,02-1,49) y mortalidad neonatal (OR: 2,17; IC 95%: 1,45-3,23). Conclusión: La frecuencia de recién nacidos a término precoz en el hospital Hipólito Unanue de Tacna se incrementó en los últimos 15 años y se asoció a mayor riesgo de problemas respiratorios y mortalidad neonatal

Objective: To determine the frequency, cesarean section rate and morbidity and mortality risks for early term newborns. Material and methods: Non-experimental, cross-sectional study. We included single term live neonates born in Hipolito Unanue Hospital in Tacna from 2000 to 2014 (n= 45332). Early term newborns from 37 to 38 6/7 weeks (n= 11276), were compared with full term newborns from 39 to 41 6/7 weeks (n= 34056). We used frequencies and rates per 100 live births, odds ratios (OR) with 95% confidence intervals (95% CI), logarithmic regression and "t" test for independent samples. The Perinatal Computer System database was used. Results: The frequency of preterm infants was 22.5 per 100 live newborns, with a significant logarithmic growth (p= 0.03). This accounted for 24.9% of all full term newborns. The cesarean section rate increased from 31.2% to 51.1% and its growth was similar to that of full term newborns. It was associated with a higher risk of low birth weight (OR: 5.3; 95% CI:4.5-6.3), small for gestational age babies (OR: 3.14; 95% CI: 2.69-3.66), being born by cesarean section (OR: 3.15; 95% CI: 3.01-3.29), hospital stay of 3 days or more (OR: 1.46; 95% CI: 1.39-1,54), respiratory morbidities (OR: 1.81; 95% CI: 1.38-2.37), such as pneumonia (OR: 3.02; 95% CI: 1.70-5.38), hyaline membrane (OR: 4.17; IC 95% CI: 1.56-11.33), and transient tachypnea (OR: 2.95; 95% CI: 1.79-4.85); and congenital malformations (OR: 1.46; IC 95% CI: 1.17-1.82), hyperbilirubinemia (OR: 1.23; 95% CI: 1.02-1.49), and neonatal mortality (OR: 2.17; 95% CI: 1.45-3.23). Conclusion: The frequency of early term newborns in Hipolito Unanue Hospital in Tacna increased in the last 15 years, and it was associated with an increased risk of respiratory problems and neonatal mortality

A comparison between preterm and full-term infants' preference for faces.

OBJECTIVE: Visual preference for faces at birth is the product of a multimodal sensory experience experienced by the fetus even during the gestational period. The ability to recognize faces allows an ecologically advantageous interaction with the social environment. However, perinatal events such as premature birth, may adversely affect the adequate development of this capacity. In this study, we evaluated the preference for facial stimuli in preterm infants within the first few hours after birth. METHODS: This is a cross-sectional observational study of 59 newborns, 28 preterm and 31 full-term infants. The babies were assessed in the first hours of life, with two white boards in the shape of a head and neck: one with the drawing of a face similar to the human face (natural face), and one with the drawing of misaligned eyes, mouth and nose (distorted face). After the newborn fixated the eyes on the presented stimulus, it was slowly moved along the visual field. The recognition of the stimulus was considered present when the baby had eye or head movements toward the stimulus. RESULTS: The preterm infants, in addition to showing a lower occurrence of orientation movements for both stimuli, on average (1.8±1.1 to natural faces and 2.0±1.2 for distorted ones) also showed no preference for any of them (p=0.35). Full-term newborns showed a different behavior, in which they showed a preference for natural faces (p=0.002) and a higher number of orientations for the stimulus, for both natural (3.2±0.8) and distorted faces (2.5±0.9). CONCLUSION: Preterm newborns recognize facial stimuli and disclose no preference for natural faces, different from full-term newborns.

Thyroid abnormalities in term infants with fungal sepsis / Alterações tireoidianas no recém-nascido de termo com sepse fúngica

Summary Objective: To describe thyroid alterations in term newborns (TNB) with fungal sepsis during NICU hospitalization. Method: The study included six TNB that during the clinical and laboratory manifestations of sepsis with positive cultures for fungus showed changes in thyroid hormones, called low T3 syndrome and low T3-T4 syndrome. TNB that could present hormonal changes caused by disease as those born to mothers with thyroid disease, or who had perinatal asphyxia and major surgeries were excluded. Results: Of six TNB with fungal sepsis, five had positive culture for Candida albicans and one had positive culture for Candida tropicalis. Low T3 syndrome was observed in two TNB (50%), while T3-T4 syndrome was observed in other two (100%). The four children progressed to septic shock. Conclusion: Fungal sepsis is becoming more common among newborns admitted to NICU. Thyroid insufficiency could be a marker of disease severity with possible need for hormone supplementation.

Resumo Objetivo: descrever as alterações tireoidianas em recém-nascidos de termo (RNT) que apresentaram sepse fúngica durante internação na UTI neonatal. Método: foram incluídos seis RNT que, durante as manifestações clínicas e laboratoriais de sepse, com culturas positivas para fungo, apresentaram alterações dos hormônios tireoidianos, denominadas síndrome do T3 baixo e síndrome do T3 e T4 baixo. Foram excluídos RNT que apresentaram alteração hormonal por doença, como RNT filhos de mães com doença tireoidiana, asfixia perinatal e cirurgias de grande porte. Resultados: dos seis RNT com sepse fúngica, cinco apresentavam cultura positiva para Candida albicans e um para C. tropicalis. A síndrome do T3 baixo foi observada em duas crianças (50%) e a do T3 e T4 baixo em dois RN (100%). As quatro crianças evoluíram com choque séptico. Conclusão: a sepse fúngica é cada vez mais frequente nos recém-nascidos internados em UTI neonatal. A insuficiência tireoidiana pode vir a ser marcadora de gravidade da doença, e a suplementação hormonal pode ser necessária.

Pharmacokinetics of ranitidine in preterm and term neonates with gastroesophageal reflux.

BACKGROUND: The aim of this study was to determine the effect of gestational age on pharmacokinetics of ranitidine in newborns with gastroesophageal reflux. METHODS: A prospective, descriptive and pharmacokinetic study was carried out in 30 pre-term and 20 full-term babies. 3 mg/kg of ranitidine was administered intravenously to all the babies and at 0.25, 0.5, 1, 2, 4, and 8 h following the administration, samples of blood were drawn to assess ranitidine levels using high performance liquid chromatographic technique. RESULTS: Pharmacokinetics of ranitidine had a bi-exponential behavior with a half-life elimination of (t1/2el) 2.79 h, area under curve (AUC) of 1688 ng/mL, volume of distribution (Vd) of 1.44 L/kg, and clearance (Cl) of 5.9 L/kg/h. The median plasmatic concentration in pre-terms was 1113 ng/mL and 280 ng/mL in full-terms. Vd, t1/2 and Cl presented high values in preterm although the correlation of Cl with glomerular filtration in term newborns was better. CONCLUSIONS: Plasma levels of ranitidine depend on the gestational age of the newborns. However, the possible relationship between after-birth age and pharmacokinetics of the neonates as their internal organs get matured without minding their gestational background.

Total zinc quantification by inductively coupled plasma-mass spectrometry and its speciation by size exclusion chromatography-inductively coupled plasma-mass spectrometry in human milk and commercial formulas: Importance in infant nutrition.

This paper summarises results of zinc content and its speciation in human milk from mothers of preterm and full-term infants at different stages of lactation and from synthetic formula milks. Human milk samples (colostrum, 7th, 14th, and 28th day after delivery) from Spanish and Brazilian mothers of preterm and full-term infants (and also formula milks) were collected. After adequate treatment of the sample, total Zn was determined, while speciation analysis of the Zn was accomplished by size exclusion chromatography coupled online with the ICP-MS. It is observed that total zinc content in human milk decreases continuously during the first month of lactation, both for preterm and full term gestations. All infant formulas analysed for total Zn were within the currently legislated levels. For Zn speciation analysis, there were no differences between preterm and full term human milk samples. Moreover Zn species elute mainly associated with immunoglobulins and citrate in human milk whey. Interestingly the speciation in formula milk whey turned out to be completely different as the observed Zn(2+) was bound almost exclusively to low molecular weight ligands (citrate) and only comparatively very low amounts of the metal appeared to be associated with higher mass biomolecules (e.g. proteins).

Nonthyroidal illnesses syndrome in full-term newborns with sepsis

ABSTRACT Objective To assess hormonal changes in nonthyroidal illness syndrome (NTIS) in full-term newborns (NT) with sepsis. Materials and methods We included 28 NT with sepsis divided into 2 groups according to the time of normalization of serum and clinical indicators of infection: group A(A), 16 NT with improvement in up to 8 days; and group B(B), 12 NT improvement after 8 days. Among the 28 NT, 15 NT progressed to septic shock, with 5 NT group A and 10 NT in group B. NT were excluded when they showed severe sepsis and asphyxia, and congenital malformations, as well as those whose mothers had thyroid disease and IUGR. Results 17 NT (60.7%) presented NTIS. Low T3 was observed in NTIS in 10 NT (58.8%), and low T4 and T3 in 5 NT (29.5%), all of them with septic shock. Two NT showed mixed changes (11.7%). After sepsis was cured, there was no hormonal change, except in 3 NT. Administration of dopamine, furosemide, and corticosteroids did not affect the results. Conclusions This study indicates that nonthyroidal illness syndrome may be transiently present during sepsis in full-term newborns, especially in cases of prolonged sepsis. Low T3 can occur without changes in reverse T3 (different from adults), and low T4 and T3 occur mainly in patients with septic shock. Arch Endocrinol Metab. 2015;59(6):528-34.