Navegando por Palavras-chave "prematuro"
Agora exibindo 1 - 11 de 11
Resultados por página
Opções de Ordenação
- ItemAcesso aberto (Open Access)Avaliação neurológica pelo método Dubowitz em recém-nascidos prematuros com idade corrigida de termo comparada a de nascidos a termo(Sociedade de Pediatria de São Paulo, 2009-12-01) Golin, Marina Ortega; Souza, Fabíola Isabel S. de; Sarni, Roseli Oselka Saccardo [UNIFESP]; Universidade Nove de Julho cursos de Fisioterapia; FMABC; FMABC Departamento de Pediatria Serviço de Nutrologia; Universidade Federal de São Paulo (UNIFESP); FMABC Departamento de PediatriaOBJECTIVE: To compare neonatal neurological assessment of preterm newborn infants at term corrected age with term infants, and to identify the presence of association between neurologic abnormalities in preterm infants and demographic characteristics and neonatal clinical conditions. METHODS: This cross-sectional study enrolled 60 term and 30 preterm infants born at the Mario Covas State Hospital in Santo André, São Paulo, Brazil. The Dubowitz method was applied to assess neurobehavior. The total score cut-offs of 30.5 and 26 were used to compare respectively preterm and term infants and to analyze the variables related to performance in the preterm group. Preterm newborns were evaluated at 37 post-conceptual weeks and the control group was evaluated 48 hours after birth. All newborns were evaluated by the same neurologist, between feedings and at sleep-awake stages 4 or 5. Statistical analysis was performed by association tests. RESULTS: 90% of the preterm infants did not reach the expected score for term age. Underachievement was seen mainly in the domains of muscle tonus, type of muscle tonus and movements. Among the 30 preterm infants included in the study, 57% did not reach a total score > 26. Sepsis was the only complication significantly associated with neurological impairment (p=0.009). CONCLUSION: Preterm newborn infants at 37 weeks corrected age do not accomplish the neurologic performance of term infants. Sepsis was the only clinical variable associated with neurological disabilities.
- ItemSomente MetadadadosCusto-efetividade do corticoide antenatal para recém-nascidos com idade gestacional entre 26 e 32 semanas(Universidade Federal de São Paulo (UNIFESP), 2014-11-11) Ogata, Joice Fabiola Meneguel [UNIFESP]; Guinsburg, Ruth Guinsburg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To estimate the costs and perform a decision-analytic model of a Brazilian cohort of premature infants exposed or not to antenatal corticosteroids (ACS). Methods: Retrospective cohort analysis of premature infants with gestational age of 26-32 weeks without congenital malformations born between January/2006 and December/2009 in a tertiary, public university hospital. Maternal and neonatal demographic data, neonatal morbidities and hospital inpatient services during the hospitalization were collected. The costs were analyzed by the microcosting technique. After, a decision-analytic model was built to analyze the cost-effectiveness of ACS. Decisions trees were built for each group of gestational ages: 26-27, 28-29, 30-31 and 32 weeks, assuming that each patient exposed or not to ACS could experience the events in the model. The sensitivity analysis was performed to determine the stability of the model and to estimate the outcomes and costs from 1000 patients exposed or not to ACS. Results: Among 220 patients who met inclusion criteria, 211 (96%) charts were reviewed: 170 newborns received one antenatal corticosteroid dose at least six hours before delivery and 41 did not receive the antenatal medication. There was 14-37% reduction of the different cost components in infants exposed to ACS when the whole population was analyzed, without statistical significance. Regarding premature infants who were discharged home alive, there was a 24-47% reduction of the components of the hospital services costs for ACS group, with a significant decrease in the length of stay in the neonatal intensive care unit (NICU). The ACS very low birth weight infants, considering only the survivors, had a significant 30-50% reduction of all elements of the costs, with 36% decrease of total cost (p=0,008). The survivors with gestational age <30 weeks presented a decrease in the total cost of 38% (p=0,008) and a 49% reduction of NICU length of stay (p=0,011). In the cost-effectiveness analysis there was a R$ 7.677,00 reduction in hospital costs per patient exposed to ACS and 11% reduction in bronchopulmonary dysplasia (oxygen at 36 weeks postmenstrual age), 24% in advanced resuscitation in delivery room, 12% in severe intraventricular hemorrhage, 3,6% in surgical patent ductus arteriosus and 0,3% in surgical retinopathy, with a 2,5% increase in the incidence of late onset sepsis. The most important reduction in hospitalization costs was found in the 30-31 weeks group (R$ 5.734,00/ patient). The sensitivity analysis confirmed that ACS is a dominant therapy for almost all outcomes except sepsis (decreased the costs and the incidence). Conclusions: ACS reduces the costs of hospitalization of premature infants who are discharged alive after birth, especially those with very low birth weight and <30 weeks of gestational age. In the decision-analytic model, ACS was a dominant therapy, decreasing the costs of hospitalization and the outcomes of premature infants born in our country.
- ItemAcesso aberto (Open Access)Efeito do uso de protetores auriculares no sono de recém-nascidos prematuros na unidade neonatal: estudo clínico, randômico, controlado e cruzado(Universidade Federal de São Paulo (UNIFESP), 2015-11-26) Sato, Monica Hiromi [UNIFESP]; Pinheiro, Eliana Moreira Pinheiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: To compare the effect of using earmuffs on the sleep of preterm newborns during ?quiet time? in two neonatal intermediate care units. Method: This is a randomized controlled crossover clinical study conducted at two neonatal intermediate care units from different hospitals in São Paulo - SP. Sample comprised 24 clinically stable preterm newborns, whose weight ranged from 1,200 g to 2,000g, who were in an incubator and met the inclusion and exclusion criteria established for the study. We used a Polysomnography Alice 5 (Respironics®) and unstructured observation for data collection. The intervention consisted in the use of earmuffs during Quiet time, with a total of 96 periods analyzed: 48 in the experimental group, and the remainder 48 in the control group. Results: Of the total sample, half were male. The average gestational, corrected and chronological ages were 33.2 weeks, 34.9 weeks and 11 days, respectively. Current average weight of preterm newborns was 1,747g. There was no significant difference in total sleep time between the experimental and control groups, and their averages were 83.7 minutes and 87.1 minutes, respectively (p = 0.540). Comparisons of quiet and indeterminate sleep time showed a marginally significant difference between the two groups (p = 0.071). Younger preterm newborns and with lower weights had significantly reduced total sleep time and quiet sleep with the use of earmuffs (p <0.05). The increase of one week in gestational age resulted in a 3% increase in preterm newborn's total sleep time when variables such as ambient light, handling the newborn and current weight were controlled. Quiet sleep was the predominant sleep stage in most analyses. Ambient light and handling the preterm newborn did not influence total sleep time in both groups. Conclusion: We concluded that there was no significant difference in total sleep time of preterm newborns between the experimental and control groups during naptime in the units studied. Significant reductions in total sleep time of smaller preterm newborns in relation to the average gestational and corrected ages and current weight may be related to a possible discomfort they experience due to the use of earmuffs.
- ItemAcesso aberto (Open Access)Fatores perinatais associados ao óbito precoce em prematuros nascidos nos centros da Rede Brasileira de Pesquisas Neonatais(Sociedade Brasileira de Pediatria, 2008-08-01) Almeida, Maria Fernanda Branco de [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Martinez, Francisco Eulogio; Procianoy, Renato Soibelmann; Leone, Cléa Rodrigues; Marba, Sérgio Tadeu Martins; Rugolo, Lígia Maria Sousa Suppo; Luz, Jorge Hecker; Lopes, José Maria de Andrade; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP); Universidade de Federal do Rio Grande do Sul Faculdade de Medicina Departamento de Pediatria; Universidade Estadual de Campinas (UNICAMP); Universidade Estadual Paulista (UNESP)OBJECTIVE:To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.
- ItemAcesso aberto (Open Access)Fisioterapia em recém-nascidos com persistência do canal arterial e complicações pulmonares(Sociedade de Pediatria de São Paulo, 2008-03-01) Ribeiro, Ivete Furtado [UNIFESP]; Melo, Ana Paula L. De [UNIFESP]; Davidson, Josy [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To review the pulmonary complications and the available chest physical therapy interventions for neonates with patent ductus arteriosus (PDA). DATA SOURCES: Studies were retrieved from Medline and Lilacs and textbooks in Portuguese and in English, from 1992 to 2006. The following key-words were searched: ductus arteriosus, prematurity, respiratory distress syndrome, complications, lung. DATA SYNTHESIS: PDA is frequently observed among preterm infants and can be associated with pulmonary complications, such as atelectasis, infections, extubation failure, increased mechanical ventilation dependency and longer length of hospital stay. Studies show that chest physical therapy may improve pulmonary function, increase lung compliance, reduce airway resistance, optimize bronchial toilet and, as a result, decrease the work of breathing. CONCLUSIONS: Chest physical therapy contributes to improve clinical outcome of neonates with pulmonary complications due to patent ductus arteriosus, allowing them to optimize respiratory mechanics, blood oxygenation and ventilation/perfusion ratio.
- ItemAcesso aberto (Open Access)Fisioterapia motora no tratamento do prematuro com doença metabólica óssea(Sociedade de Pediatria de São Paulo, 2011-03-01) Moreno, Juliana; Fernandes, Luciana Volpiano [UNIFESP]; Guerra, Camila Campos; Universidade Federal de São Paulo (UNIFESP); Hospital das Clínicas Luzia de Pinho MeloOBJECTIVE: To review the role of motor physiotherapy in the treatment of preterm infants at risk of developing metabolic bone disease. DATA SOURCES: This is a review of articles published between 1986 and 2009, using the following key-words: premature infant physiologic calcification, physiotherapy techniques, metabolic bone diseases and the respective Portuguese-language descriptors. Twenty nine scientific articles were selected in the PubMed and ISI Web databases, along with one chapter of a Brazilian book. DATA SYNTHESIS: Metabolic bone diseases are a set of conditions related to abnormalities in the physiologic calcification process. They lead to problems going from structural frailness to fracture development. Routine application of passive joint mobilization exercises, massage and positioning exercises correlate with weight gain and increasing bone mineral content and density. CONCLUSIONS: Implementation of motor physiotherapy exercises could provide stability or stimulation for bone formation and may consequently avoid or minimize the complications resulting from metabolic bone disease of prematurity.
- ItemAcesso aberto (Open Access)Medida da freqüência respiratória e do volume corrente para prever a falha na extubação de recém-nascidos de muito baixo peso em ventilação mecânica(Sociedade de Pediatria de São Paulo, 2008-03-01) Davidson, Josy [UNIFESP]; Miyoshi, Milton Harumi [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Carvalho, Werther Brunow de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To verify if respiratory rate (RR), tidal volume (TV) and respiratory rate and tidal volume ratio (RR/TV) could predict extubation failure in very low birth weight infants submitted to mechanical ventilation. METHODS: This prospective observational study enrolled newborn infants with gestational age <37 weeks and birth weight <1,500g, mechanically ventilated from birth during 48 hours to 30 days and thought to be ready for extubation. As soon as the physicians decided for extubation, the neonates received endotracheal continuous positive airway pressure (CPAP) for 10 minutes while spontaneous RR, TV and RR/TV were measured using a fixed-orifice pneumotachograph positioned between the endotracheal tube and the ventilator circuit. Thereafter, the neonates were extubated to nasal CPAP. Extubation failure was defined as the need for reintubation within 48 hours. RESULTS: Of the 35 studied infants, 20 (57%) were successfully extubated and 15 (43%) required reintubation. RR and RR/TV before extubation had a trend to be higher in unsuccessfully extubated infants. TV was similar in both groups. Sensitivity and specificity of these parameters as predictors of extubation failure were 50 and 67% respectively for RR, 40 and 67% for TV and 40 and 73% for RR/TV. CONCLUSIONS: RR, TV and RR/TV showed low sensitivity and specificity to predict extubation failure in mechanically ventilated very low birth weight infants.
- ItemAcesso aberto (Open Access)Métodos de alimentação alternativos para recém-nascidos prematuros(Sociedade de Pediatria de São Paulo, 2012-06-01) Lopez, Claudia Peyres [UNIFESP]; Silva, Roberta Gonçalves Da; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual Paulista (UNESP)OBJECTIVE: To present a literature review about the use of glass/cup as an alternative method of feeding premature newborns and to identify if there is a consensus on its indication for this population. DATA SOURCE: A narrative review of the literature. Articles were selected from Medline, Lilacs, SciELO, and Cochrane databases, regardless of year, using the following specific key-words: feeding, premature newborn, breastfeeding, feeding methods. DATA SYNTHESIS: Although some studies showed that feeding premature and term newborns using the glass/cup is safe and efficient, most of them did not apply an objective evaluation of the swallowing to identify the effect of the method in this population. CONCLUSIONS: There is no consensus in the literature about feeding premature newborn infants by glass/cup. Controlled studies should be conducted in order to evaluate risks and benefits of alternative feeding methods in preterm newborn infants.
- ItemAcesso aberto (Open Access)Prevalence and factors associated with thoracic alterations in infants born prematurely(Associação Médica Brasileira, 2012-12-01) Davidson, Josy [UNIFESP]; Garcia, Kessey Maria Bini [UNIFESP]; Yi, Liu Chiao [UNIFESP]; Goulart, Ana Lucia [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To determine the prevalence of thoracic musculoskeletal alterations and associated factors in infants born prematurely. METHODS: This was a cross sectional study with infants in the first year of age, born prematurely with birth weight < 2,000 g, who were followed up at the Premature Clinic from February, 2007 to December, 2008. Exclusion criteria were: maj or congenital malformations as defined by the Centers for Disease Control and Prevention (CDC), grade III/IV intraventricular hemorrhage, or periventricular leucomalacia. Physical examinations performed independently by two physiotherapists were used to assess shoulder elevation and thoracic retractions. Comparisons between groups were performed using the chi-squared test or Fisher's exact test for categorical variables, and Mann-Whitney's test or Student's t-test were used for continuous variables. Interobserver reliability between the two physiotherapists was assessed by the kappa coefficient. Variables associated with these thoracic musculoskeletal alterations were studied by univariate and multiple logistic analyses. Statistical differences were considered significant when p < 0.05. This study was approved by the ethical committee of the institution, and parents/guardians signed an informed consent. RESULTS: 121 infants with a gestational age of 31.1 ± 2.8 weeks and birth weight of 1,400 ± 338 g were included. Thoracic alterations were detected by Physiotherapist 1 in 81 (66.9%) infants, and in 83 (68.6%) by Physiotherapist 2 (kappa coefficient = 0.77). By multivariate logistic regression analysis, factors associated with thoracic musculoskeletal alterations were: respiratory distress syndrome (odds ratio [OR] = 3.246, 95% confidence interval [CI]: 1.237-8.732), bronchopulmonary dysplasia (OR = 11.138, 95% CI: 1.339-92.621), and low length/age ratio (OR = 4.571, 95% CI: 1.371-15.242). CONCLUSION: The prevalence of thoracic alterations was high in infants born prematurely, and was associated with pulmonary disease and low length/age ratio.
- ItemAcesso aberto (Open Access)Reduction of exposure to blood donors in preterm infants submitted to red blood cell transfusions using pediatric satellite packs(Sociedade de Pediatria de São Paulo, 2013-09-01) Uezima, Cristina Lika; Barreto, Ariane Moreira; Guinsburg, Ruth [UNIFESP]; Chiba, Akemi Kuroda [UNIFESP]; Bordin, Jose Orlando [UNIFESP]; Barros, Melca Maria Oliveira [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE:In preterm newborn infants transfused with erythrocytes stored up to 28 days, to compare the reduction of blood donor exposure in two groups of infants classified according to birth weight.METHODS:A prospective study was conducted with preterm infants with birth weight <1000g (Group 1) and 1000-1499g (Group 2), born between April, 2008 and December, 2009. Neonates submitted to exchange transfusions, emergency erythrocyte transfusion, or those who died in the first 24 hours of life were excluded. Transfusions were indicated according to the local guideline using pediatric transfusion satellite bags. Demographic and clinical data, besides number of transfusions and donors were assessed. . Logistic regression analysis was performed to determine factors associated with multiple transfusions.RESULTS:30 and 48 neonates were included in Groups 1 and 2, respectively. The percentage of newborns with more than one erythrocyte transfusion (90 versus 11%), the median number of transfusions (3 versus 1) and the median of blood donors (2 versus 1) were higher in Group 1 (p<0.001), compared to Group 2. Among those with multiple transfusions, 14 (82%) and one (50%) presented 50% reduction in the number of blood donors, respectively in Groups 1 and 2. Factors associated with multiple transfusions were: birth weight <1000g (OR 11.91; 95%CI 2.14-66.27) and presence of arterial umbilical catheter (OR 8.59; 95%CI 1.94-38.13), adjusted for confounders.CONCLUSIONS:The efficacy of pediatrics satellites bags on blood donor reduction was higher in preterm infants with birth weight <1000g.
- ItemAcesso aberto (Open Access)Tratamento da persistência de canal arterial em recém-nascidos prematuros: análise clínica e cirúrgica(Sociedade Brasileira de Cardiologia - SBC, 2008-05-01) Locali, Rafael Fagionato [UNIFESP]; Matsuoka, Priscila Katsumi [UNIFESP]; Gabriel, Edmo Atique [UNIFESP]; Bertini Júnior, Ayrton [UNIFESP]; La Rotta, Carlos Arnulfo [UNIFESP]; Catani, Roberto [UNIFESP]; Carvalho, Antonio Carlos [UNIFESP]; Buffolo, Enio [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)BACKGROUND: The surgical treatment of patency ductus arteriosus is indicated when the clinical intervention fails. However, this treatment may have some complications. OBJECTIVE: To analyze clinical and surgical aspects involved on the treatment of patency ductus arteriosus in premature newborn. METHODS: Twenty two premature newborns, submitted to surgical treatment for patency ductus arteriosus from January, 2000 to June, 2006, were evaluated. There were 77,3% female patients, the mean birth weight was 952,5g and the mean gestational age was 27 weeks. The use of vasoactive drugs, indometacin, echocardiograph parameters and complications, in the pre and postoperative periods were evaluated. RESULTS: In this casuistic 59,1% patients needed intratracheal intubation at birth, 77,3% needed surfactants, 59,1% used vasoactive drugs preoperative. The mean doses of indometacin were 3,43, with dose range 0,1 to 0,25 mg/Kg/day. The mean caliber of arterial duct patent was 1,96 mm. The surgical procedure was carried out through extrapleural approach in 59.1% of the patients, the mean time of postoperative intubation was 30,9 days, and 50% of the patients used vasoactive drugs postoperative. There were 18,1% postoperative complications (postoperative non-fatal complications). CONCLUSION: More than the half of the patients needed intratracheal intubation at birth, surfactant use and vasoactive drugs in the preoperative period. There was greater prevalence of the extrapleural approach during the surgery. In the postoperative period, there was less demand of vasoactive use and there was not deaths related to the surgical procedure.