Dissertations / Theses on the topic 'Neonatal'

Bibliography: pages 47-49.
This dissertation is based largely on an original study performed by myself and Dr EB Hoffman on 34 neonates with bone and joint sepsis. Our experience of 19 septic hips is the largest in the literature. The study was performed at the Red Cross Children's Hospital in 1987 and 1988. The paper has been accepted for publication in the Journal of Bone and Joint Surgery (September 1990). The literature has been reviewed in depth and compared with our findings. In order to avoid repetition, I have not included a separate literature review in my dissertation. I have however incorporated the literature review in the introduction and especially in the discussion.

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A rotura prematura de membranas pré-termo (RPM-PT) é uma importante intercorrência obstétrica e a infecção da cavidade amniótica advinda do trato genital inferior é um dos principais fatores associados à sua fisiopatologia. As membranas corioamnióticas são barreiras mecânicas contra a ascensão de micro-organismos e possuem papel fundamental no sistema imune, pois são importantes fontes de mediadores inflamatórios como as citocinas e também de antimicrobianos naturais, como as defensinas. Em resposta à infecção, ocorrem recrutamento e ativação de leucócitos para as membranas fetais, o que caracteriza a corioamnionite histológica, que ativa a cascata inflamatória na interface materno-fetal e contribui com os mecanismos de enfraquecimento e rotura das membranas. Além acometer os tecidos gestacionais de gestações complicadas por RPM-PT, a corioamnionite histológica é um fator de risco para resultados adversos maternos e morbidades neonatais. 1) Quantificar a expressão de β defensinas (HBD1, 3 e 4) por membranas corioamnióticas de gestações complicadas por prematuridade associada à corioamnionite histológica; 2) Quantificar a expressão de RNA mensageiro (RNAm) e proteína de IL-18 em membranas corioamnióticas de mulheres com RPM-PT e correlacionar a expressão com a presença de corioamnionite histológica; 3) Avaliar os resultados neonatais adversos de gestações prétermo complicadas por corioamnionite histológica. Foram incluídas no estudo, gestantes com parto pré-termo e diagnóstico histológico de corioamnionite. Para o estudo da expressão de β defensinas, 40 fragmentos de membranas corioamnióticas, com diagnóstico histológico de corioamnionite, provenientes de gestações complicadas por rotura prematura de membranas pré-termo (RPM-PT) ou trabalho de parto prematuro com bolsa íntegra (TPP), que apresentaram parto...
The preterm premature rupture of membranes (PPROM) is an important obstetric issue, and infection in the amniotic cavity from the lower genital tract is one of the main factors associated with its physiology. Chorioamniotic membranes are mechanical barriers against the microorganism’s ascension, and they play a fundamental role in the immune system, since they are important sources of inflammatory mediators, such as cytokines, and of natural antimicrobials, like as defensins. In response to infection, leukocytes are recruited and activated in fetal membranes, which characterizes histological chorioamnionitis. This condition activates the inflammatory cascade on the maternal-fetal interface and contributes to weakening mechanisms and membrane rupture. In addition to affecting the gestational tissues of pregnancies complicated by PPROM, histological chorioamnionitis is a risk factor for adverse maternal outcomes and neonatal morbidities. 1) To quantify the expression of β defensins (HBD1, 3 and 4) by chorioamniotic membranes of pregnancies complicated by prematurity associated with histological chorioamnionitis; 2) To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis; 3) To evaluate adverse neonatal outcomes in preterm pregnancies complicated by histological chorioamnionitis. Pregnant women with preterm delivery and histological diagnosis of chorioamnionitis were included in the study. In order to study the expression of β defensins, 40 fragments of chorioamniotic membranes with histological diagnosis of chorioamnionitis from pregnancies complicated by PPROM or preterm labor with intact membranes (PTL), and with preterm labor as a gestational outcome, comprised the study group. As a control group, 40 chorioamniotic membranes without chorioamnionitis and paired... (Complete abstract click electronic access below)

Clinical symptoms of septic hepatitis are accompanied by jaundice, in most children hepatomegaly and hemorrhagic syndrome. The main laboratory criteria for septic hepatitis were: conjugated hyperbilirubinemia (100%), decreased prothrombin index (78%) and increased levels of ALT and AST (72%). The most unfavorable prognosis was observed as a result of penetration of the pathogen into the liver through the umbilical vein. In these cases, morphologically formed necrotic hepatitis with total damage to all parts of the hepatobiliary system. The clinical symptoms of the disease were characterized by severe hepatic insufficiency with impaired basic liver function and very high mortality.

Background: Disruption of the development of a stable and responsive system of respiratory control may be central to neonatal apnoea and Sudden Infant Death Syndrome. Aims: To test the hypotheses that sleeping position, maternal smoking and substance misuse will alter the ventilatory responses to hypercarbia and hypoxia in term infants; prematurely born infants with a lower ventilatory response to hypercarbia are at greater risk of developing apnoea, caffeine will increase this response; management of gastro-oesophageal reflux varies between NICUs, investigations that detect non-acid reflux will be more sensitive in diagnosing GORD, apnoea frequency will be greater following reflux events than before. Methods: The hypoxic and hypercarbic ventilatory responses were measured in term infants. The ventilatory response to hypercarbia was measured in preterm infants soon after birth and weekly until discharge. A survey was sent to UK NICUs. Infants on the NICU were investigated with pH/MII and polysomnography. Results of Upper gastro-intestinal contrast studies were compared with the results of pH/MII study. Results: Maternal substance misuse alters breathing characteristics and response to hypoxia in newborns. In these infants prone compared to supine sleeping is associated with a lower minute volume. In prematurely born infants, a lower ventilatory response to hypercarbia predicted those that would develop apnoea. Caffeine was associated with an increased ventilatory response to hypercarbia. Investigation and management of gastro-oesophageal reflux in NICUs varies widely. pH/MII increases the detection of reflux events compared to pH alone. The results of pH/MII and upper gastro-intestinal contrast study correlate poorly. Apnoea frequency is no greater following reflux than preceding, or during reflux free periods. Conclusion: Risks factors for SIDS alter respiratory control; apnoea of prematurity is associated with a reduced response to hypercarbia, which is increased by caffeine; there is little evidence for a role of gastro-oesophageal reflux in the pathogenesis of apnoea.

Orientador: Márcia Guimarães da Silva
Banca: Luciane Alarcão Dias-Melicio
Banca: Cilmery Suemi Kurokawa
Banca: Rosiane Mattar
Banca: Rodrigo Paupério Soares de Camargo
Resumo: A rotura prematura de membranas pré-termo (RPM-PT) é uma importante intercorrência obstétrica e a infecção da cavidade amniótica advinda do trato genital inferior é um dos principais fatores associados à sua fisiopatologia. As membranas corioamnióticas são barreiras mecânicas contra a ascensão de micro-organismos e possuem papel fundamental no sistema imune, pois são importantes fontes de mediadores inflamatórios como as citocinas e também de antimicrobianos naturais, como as defensinas. Em resposta à infecção, ocorrem recrutamento e ativação de leucócitos para as membranas fetais, o que caracteriza a corioamnionite histológica, que ativa a cascata inflamatória na interface materno-fetal e contribui com os mecanismos de enfraquecimento e rotura das membranas. Além acometer os tecidos gestacionais de gestações complicadas por RPM-PT, a corioamnionite histológica é um fator de risco para resultados adversos maternos e morbidades neonatais. 1) Quantificar a expressão de β defensinas (HBD1, 3 e 4) por membranas corioamnióticas de gestações complicadas por prematuridade associada à corioamnionite histológica; 2) Quantificar a expressão de RNA mensageiro (RNAm) e proteína de IL-18 em membranas corioamnióticas de mulheres com RPM-PT e correlacionar a expressão com a presença de corioamnionite histológica; 3) Avaliar os resultados neonatais adversos de gestações prétermo complicadas por corioamnionite histológica. Foram incluídas no estudo, gestantes com parto pré-termo e diagnóstico histológico de corioamnionite. Para o estudo da expressão de β defensinas, 40 fragmentos de membranas corioamnióticas, com diagnóstico histológico de corioamnionite, provenientes de gestações complicadas por rotura prematura de membranas pré-termo (RPM-PT) ou trabalho de parto prematuro com bolsa íntegra (TPP), que apresentaram parto... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: The preterm premature rupture of membranes (PPROM) is an important obstetric issue, and infection in the amniotic cavity from the lower genital tract is one of the main factors associated with its physiology. Chorioamniotic membranes are mechanical barriers against the microorganism's ascension, and they play a fundamental role in the immune system, since they are important sources of inflammatory mediators, such as cytokines, and of natural antimicrobials, like as defensins. In response to infection, leukocytes are recruited and activated in fetal membranes, which characterizes histological chorioamnionitis. This condition activates the inflammatory cascade on the maternal-fetal interface and contributes to weakening mechanisms and membrane rupture. In addition to affecting the gestational tissues of pregnancies complicated by PPROM, histological chorioamnionitis is a risk factor for adverse maternal outcomes and neonatal morbidities. 1) To quantify the expression of β defensins (HBD1, 3 and 4) by chorioamniotic membranes of pregnancies complicated by prematurity associated with histological chorioamnionitis; 2) To quantify the expression of IL-18 mRNA and protein in the chorioamniotic membranes of pregnant women with PPROM and correlate expression with histological chorioamnionitis; 3) To evaluate adverse neonatal outcomes in preterm pregnancies complicated by histological chorioamnionitis. Pregnant women with preterm delivery and histological diagnosis of chorioamnionitis were included in the study. In order to study the expression of β defensins, 40 fragments of chorioamniotic membranes with histological diagnosis of chorioamnionitis from pregnancies complicated by PPROM or preterm labor with intact membranes (PTL), and with preterm labor as a gestational outcome, comprised the study group. As a control group, 40 chorioamniotic membranes without chorioamnionitis and paired... (Complete abstract click electronic access below)
Doutor

Neonatal abstinence syndrome (NAS) is a public health concern that is increasing in the United States due to the use of illicit drugs by pregnant women, which exposes the fetus to these substances. NAS results in increased infant morbidity and prolonged stay in the hospital, which can lead to increased cost of care. The inability of the nurses to care for at-risk infants can lead to inconsistent NAS scores, which can affect the infant's care treatment. The project examined the effectiveness of educating the neonatal intensive care unit (NICU) nurses on the correct use of the modified Finnegan Neonatal Abstinence Tool (FNAST) and implementing a practice protocol in the management of infants experiencing NAS, thereby reducing inconsistencies in NAS scores. Implementing clinical guidelines and proper use of the modified FNAST can lead to early intervention and treatment of infants exhibiting withdrawal symptoms. An educational session was conducted, pretests and posttests were used to evaluate the NICU nurses' baseline knowledge of the correct use of the modified FNAST and their acquired knowledge after the educational intervention on the correct use of the modified FNAST. The goal of the project was met with the NICU nurses experiencing knowledge gain evidenced by a 30% increase between the pretests and posttests and obtaining consistent NAS scores by applying the correct technique of scoring. The mastery of the use of the modified FNAST brought about social change by impacting positive attitudes and behaviors among the NICU nurses and enhancing collaboration between the physicians and nurses.

Hospital treatment environments have become a major concern in recent years. Noise and illumination are potential stress sources in hospitals. The purpose ofthis study was to examine the effects of hospital noise levels and ambient illumination on newborn infants (neonates). Noise levels and lighting were varied and the effect upon neonatal heart rate, respiration rate, blood pressure, and oxygen consumption were measured. These measures are sensitive tosympathetic nervous system reactivity such as that brought about by stressful environments. In addition, noise and lighting levels were measured to determine if differences existed across conditions. Psychophysiological responses to various noise and lighting levels varied within and across neonates with some changes in the expected direction. Some unexpected results of Quiet Time were noted among neonatal intensive care staff and hospital personnel.

Background: Infants born prematurely or at term may unfortunately suffer morbidity from ventilator related complications. New ventilation techniques have been developed aimed at reducing that morbidity, but have yet to be fully evaluated. Aim: To optimise the delivery of new techniques using physiological outcome measures. Methods: A series of studies were undertaken. The objectives were: • In prematurely born infants with acute respiratory distress, to determine the optimal level of volume targeted ventilation. • In term and prematurely born infants, to assess the effect on work of breathing of the addition of pressure support (PSV) to synchronised intermittent mandatory ventilation (SIMV) during weaning and then compare the efficacy of PSV to assist control (ACV) in a randomised trial. • To perform in vitro and in vivo assessments of proportional assist ventilation (PAV). • The physiological outcome measures were the transdiaphragmatic pressure time product (PTPdi), respiratory muscle strength, thoracoabdominal asynchrony, tension time index of the diaphragm and assessment of asynchronous events. Results: A volume target of 4ml/kg in comparison to 6ml/kg or no volume targeting resulted in a higher PTPdi (p <0.001). In infants weaning from the ventilator, the PTPdi was 20% lower (p <0.001) during SIMV with PSV in comparison to SIMV alone. No significant difference in the duration of weaning was demonstrated between PSV and ACV. The in vitro PAV study highlighted abnormalities of airway pressure waveform and higher than excepted airway pressures during both elastic and resistive unloading. Conclusions: Low levels of volume targeting even within the ‘physiological’ range significantly increased the work of breathing. A triggered mode supporting all the infant breaths was superior to when a limited number of breaths were supported. When similar inflation times were used, triggered modes supporting all breaths were equally efficacious. Unloading levels affect the efficacy of PAV; these may be determined by using the ventilator calculated respiratory mechanics.

Background: Survival of neonates requiring respiratory support has improved over the last two decades, but unfortunately many suffer morbidity from ventilator related complications. Aim: To undertake a series of studies using physiological measurements as outcomes in infants with evolving or established bronchopulmonary dysplasia (BPD) to test the following hypotheses and carry out a national survey. Hypotheses: Proportional assist ventilation (PAV) compared to assist control ventilation (ACV) would improve oxygenation as assessed by the oxygenation index (OI). Neurally adjusted ventilatory assist (NAVA) compared to ACV would improve oxygenation. Use of heated, humidified, high flow nasal cannula (HHFNC) would not have increased given the results of recent randomised trials. Continuous positive airway pressure (CPAP) would reduce the work of breathing (WOB) and thoraco-abdominal asynchrony (TAA) and improve oxygen saturation (SaO2) compared to HHFNC. Methods: Four studies were undertaken. The OI was calculated from measurement of blood gases and the level of respiratory support. A survey was undertaken of lead practitioners in all UK neonatal units. The WOB was assessed by measurement of the pressure time product of the diaphragm (PTPdi) and TAA using respiratory inductance plethysmography (RIP).

Background: Survival of neonates requiring intensive care has improved, but many suffer ventilator-related complications. This thesis aims to optimise use of ventilation techniques, with a focus on infants born at term. Hypotheses: In infants with acute respiratory failure, volume-targeted ventilation (VTV) will be superior to pressure-limited ventilation (PLV). Proportional assist ventilation (PAV) will be effective in reducing elastic and resistive work of breathing (WOB) in an in vitro experiment. Methods: A series of studies were undertaken. National survey of practice in relation to respiratory support in term infants. Comparison of WOB at different levels of volume-targeting in term infants. Randomised comparison of VTV and PLV in preterm infants. Analysis of spontaneous respiratory activity in ventilated term infants. In vitro study of effect of elastic and resistive unloading on WOB during PAV. Results: Respiratory support practices for term-born infants differed between different levels of care. In term infants, WOB was higher at 4ml/kg compared to 5 and 6ml/kg. In preterm infants, there was no difference in time to achieve weaning criteria on VTV versus PLV. Fewer infants on VTV experienced hypocarbia. Patterns of patient-ventilator interaction were described for term-born infants. Active expiration was more common on SIMV versus CMV, and less common on triggered ventilation at 4ml/kg compared to 6ml/kg or no volume-targeting. Using PAV, elastic unloading was more effective than resistive unloading in reducing WOB.

INTRODUCCIÓN: La encefalopatía hipóxico-isquémica (EHI) es una de les causas más importantes de daño cerebral neonatal. La hipotermia terapéutica (HT) es el tratamiento establecido en la actualidad para los neonatos a término, afectos de una EHI. A pesar de ello, la HT no consigue una tratamiento neuroprotector completo. El alopurinol ha demostrado ser en diversos estudios animales un buen fármaco neuroprotector, pero nunca ha sido evaluado conjuntamente con la HT. En los últimos años los hallazgos clínicos han demostrado que los niños de sexo masculino afectos de EHI presentan peores resultados cuando se comparan con las de sexo femenino en resultados cognitivos. A pesar de ello, hay poco estudios que hayan evaluado el efecto de las terapias neuroprotectoras teniendo en cuenta el género en los resultados. El objetivo del presente estudio es evaluar el efecto aditivo potencial neuroprotector del alopurinol cuando se administra conjuntamente con la HT en un modelo roedor de EHI moderada. Las diferencias neuroprotectoras respecto el género fueron también evaluadas. MÉTODOS: Crías de rata de sexo masculine y sexo femenino de 10 días de vida (P10) fueron sometidas a un evento HI (modelo Rice-Vannucci) y randomizadas en cinco grupos: intervención shame (control), no tratamiento (HI), hipotermia (HIH), alopurinol (HIA) y tratamiento dual (hipotermia y alopurinol) (HIHA). Para evaluar la eficacia neuroprotectora, 24 horas después del evento HI los niveles de caspasa3 fueron medidos. El área dañada del hipocampo y del cerebro fue medida a las 72 horas del evento HI. El test geotaxis negativo fue realizado para evaluar los reflejos precoces motores. El aprendizaje de memoria temporo-espacial fue medido a través del Laberinto Acuático de Morris (LAM) a los 25 días de vida. RESULTADOS: El área cerebral dañada y el volumen preservado del hipocampo fue diferente entre los grupos ( p=0.001). La lesión de mayor tamaño fue observada en el grupo HI, seguido por el HIA. No se objetivaron diferencias entre grupo control, HIH y HIHA. Cuando el proceso de aprendizaje fue analizado, no se objetivaron diferencias. Las hembras del grupo HIA presentaron resultados similares a los del grupo HIH y HIHA. Al analizar los resultados de la caspasa3 se objetivó incrementada en ambos grupos HI y HIA. A pesar de ello, los niveles de caspasa3 en hembras sólo se encontraba elevada en el grupo HI. Todos los animales tratados presentaron una mejoría en los test funcionales tanto en los resultados a corto (test geotaxis negativo) como a largo plazo (LAM). A pesar de ellos, las hembras tratadas presentaron mejores resultados. En los resultados a corto plazo no se objetivaron diferencias de sexo. CONCLUSIONES: Nuestros resultados sugieren que la terapia dual confieren a una gran neuroprotección después de un evento HI. Hubo mejorías a nivel functional, histológico y molecular en todos los grupos tratados. Estas diferencias fueron más importantes en las hembras que en los machos. No se objetivaron diferencias estadísticamente significativas entre los grupos HIH y HIHA, ambos presentaron una gran mejoría. Nuestros resultados confirman la idea de diferentes mecanismos y vías de muerte celular, dependiendo del sexo.
BACKGROUND: Hypoxic-ischemic encephalopathy (HIE) is one of the most important causes of neonatal brain injury. Therapeutic hypothermia (TH) is the standard treatment for term newborns after perinatal hypoxic ischemic injury (HI). Despite this, TH does not provide complete neuroprotection. Allopurinol seems to be a good neuroprotector in several animal studies, but it has never been tested in combination with hypothermia. Clinical findings show that male infants with (HI) fare more poorly than matched females in cognitive outcomes. However, there are few studies about neuroprotection taking gender into account in the results. The aim of the present study was to evaluate the potential additive neuroprotective effect of allopurinol when administrated in association with TH in a rodent model of moderate HI. Gender differences in neuroprotection were also evaluated. METHODS: P10 male and female rat pups were subjected to HI (Vannucci model) and randomized into five groups: sham intervention (Control), no treatment (HI), hypothermia (HIH), allopurinol (HIA), and dual therapy (hypothermia and allopurinol) (HIHA). To evaluate a treatment's neuroprotective efficiency, 24 hours after the HI event caspase3 activation was measured. Damaged area and hippocampal volume were also measured 72 hours after the HI event. Negative geotaxis test was performed to evaluate early neurobehavioral reflexes. Learning and spatial memory were assessed via Morris Water Maze (MWM) test at 25 days of life. RESULTS: Damaged area and hippocampal volume were different among treatment groups (p = 0.001). The largest tissue lesion was observed in the HI group, followed by HIA. There were no differences between control, HIH, and HIHA. When learning process was analyzed, no differences were found. Females from the HIA group had similar results to the HIH and HIHA groups. Cleaved caspase 3 expression was increased in both HI and HIA. Despite this, in females cleaved caspase-3 was only differently increased in the HI group. All treated animals present an improvement in short-term (Negative geotaxis) and long-term (WMT) functional tests. Despite this, treated females present better long-term outcome. In short-term outcome no sex differences were observed. CONCLUSIONS: Our results suggest that dual therapy confers great neuroprotection after an HI event. There were functional, histological, and molecular improvements in all treated groups. These differences were more important in females than in males. No statistically significant differences were found between HIHA and HIH; both of them present a great improvement. Our results support the idea of different regulation mechanisms and pathways of cell death, depending on gender

La allopregnanolona es un neuroesteroide modulador alostérico positivo del receptor GABA A. Alteraciones de sus niveles neonatales afectan la maduración del sistema nervioso central, alterando así la conducta adolescente y adulta. Aunque se ha propuesto que la allopregnanolona puede ser un mecanismo que restaura la homeostasis fisiológica tras un estrés agudo en edad adulta, su papel en el estrés neonatal es menos claro. Por ello, con la finalidad de caracterizar su relación y sus posibles interacciones, en los presentes estudios evaluamos las consecuencias conductuales de: (1) la alteración neonatal de neuroesteroides mediante la administración de allopregnanolona o finasteride (inhibidor de la síntesis de allopregnanolona) entre los días postnatales 5 y 9 (PND5-PND9); y de (2) estrés neonatal inducido por 24h de separación materna temprana (EMS) en PND9. En el primer experimento estudiamos los efectos de la administración neonatal de allopregnanolona, de EMS y su interacción, en la exploración inducida por novedad en edad adolescente (test de exploración de Boissier), y en las conductas de ansiedad (prueba del laberinto elevado en cruz, EPM) y en el procesamiento atencional (prueba de inhibición prepulso de la respuesta de sobresalto acústica, PPI) en edad adulta. Los resultados muestran que la EMS aumentó la locomoción inducida por novedad y disminuyó el número de agujeros explorados en el test de Boissier. Estos efectos fueron neutralizados por la administración previa de allopregnanolona. En edad adulta, los animales que habían sufrido EMS presentaron un perfil ansiolítico en el EPM, y ambas intervenciones neonatales deterioraron el PPI. Dado que estudios previos muestran que la manipulación de los niveles neonatales de allopregnanolona provoca cambios en conductas emocionales que podrían relacionarse con la vulnerabilidad al abuso de drogas, en un segundo experimento estudiamos los efectos de la manipulación neonatal de allopregnanolona y del estrés neonatal en la vulnerabilidad al abuso de alcohol. Para ello evaluamos el consumo de alcohol en edad adulta (15 días con 1h diaria de acceso voluntario a dos disoluciones -etanol y glucosa-), y determinamos los niveles de monoaminas ventroestriatales. Los resultados muestran que la administración de finasteride aumentó el consumo de alcohol y glucosa durante la segunda semana del procedimiento. Por el contrario, cuando los animales sufrieron EMS no hubo efectos del finasteride sobre el consumo de alcohol. EMS aumentó tanto la dosis media de alcohol consumida durante el procedimiento como la glucosa consumida durante la primera semana. Estos efectos EMS fueron independientes del tratamiento neonatal previo. Por otro lado, la administración tanto de finasteride como de allopregnanolona disminuyó los niveles ventroestriatales de dopamina y serotonina, sin afectar sus correspondientes metabolitos y aumentando así sus turnover ratios. Este efecto solo estuvo presente en aquellos animales que no sufrieron EMS. En un estudio subsecuente evaluamos, mediante microdialysis in vivo, la actividad dopaminergica en estos animales. Los resultados revelan que los animales administrados con finasteride mostraron una disminución de la liberación de dopamina en el núcleo accumbens en respuesta tanto al alcohol como a la comida, sugiriendo que el elevado consumo de alcohol que muestran estos animales podría estar relacionado con una disminución de la liberación de dopamina en respuesta a la presentación de las disoluciones. En conclusión, los resultados de los presentes estudios remarcan la importancia de los neuroesteroides en etapas críticas del desarrollo cerebral e indican que la administración neonatal de allopregnanolona puede prevenir algunos de los efectos conductuales de la EMS en edad adolescente pero también inducir efectos negativos similares a la EMS en edad adulta. Además, este trabajo muestra por primera vez la posible implicación de las alteraciones neonatales de neuroesteroides en los trastornos por uso de alcohol en edad adulta.
Allopregnanolone (AlloP) is a neurosteroid (NS) that acts as a positive modulator of γ-aminobutyric acid (GABA) type A receptor (GABAAR). AlloP plays an important role in brain development since alterations of its neonatal levels affect the maturation of central nervous system altering posterior adolescent and adult behaviour. Although AlloP has been proposed to serve as a mechanism to restore physiological homeostasis after acute stress, its implications on neonatal stress are much less clear. Thus, in order to characterise their possible interactions and relationship, in the present studies we assessed the behavioural consequences of: (1) neonatal NS alterations by means of the administration of AlloP or finasteride (putative AlloP synthesis inhibitor, Finas) between postnatal days 5 and 9 (PND5-PND9); and of (2) neonatal stress induced by 24 h of early maternal separation (EMS) at PND9. In the first experiment we studied the effects of neonatal AlloP administration, EMS and their interaction on adolescent novelty-directed exploration (Boissier exploration test at PND40 and PND60), and on adult (PND85) anxiety-like behaviour (Elevated plus maze test, EPM) and sensory brain inputs processing (prepulse inhibition of the startle response, PPI). Main results showed that EMS increased novelty-induced motor activity and decreased head-dipping behaviour in the Boissier exploration test at PND40. These EMS effects were prevented by the neonatal administration of AlloP. In adulthood, EMS animals showed an anxiolityc-like profile in EPM test, and both neonatal interventions disrupted the PPI. Given that previous studies of our laboratory have shown that neonatal AlloP levels manipulations lead to changes in emotional behaviour that could relate to vulnerability to drug abuse, in a second set of experiments we studied the effects of neonatal physiological AlloP levels manipulation and neonatal stress on the vulnerability to alcohol abuse. For this, we evaluated the effects of both interventions on adult ethanol consumption (two-bottle free-choice procedure for 15 consecutive days starting on PND70) and ventrostriatal monoamine levels. Results showed that neonatal Finas administration increased alcohol and glucose consumption during the second week of the procedure. Instead, when animals suffered EMS, there were no effects of Finas on alcohol consumption. EMS increased both the mean of the ethanol doses consumed during the whole procedure and the glucose consumption during the first week of procedure. These EMS effects were independent of previous neonatal treatment. On the other hand, both neonatal Finas and AlloP administration decreased dopamine and serotonin levels in the ventral striatum, without affecting their corresponding metabolites and thus increasing their turnover ratios. This effect was only present in the animals that were not exposed to EMS. Given these results, in a subsequent experiment we evaluated the possible alterations of the rewarding dopaminergic pathways activity related to neonatal NS levels manipulation by means of in vivo microdialysis. Results showed that animals with neonatal Finas administration had a decreased dopamine release in the nucleus accumbens in response to both ethanol and food, thus suggesting that the higher ethanol consumption of these animals could be related to a blunted dopamine release in response to solutions presentation. Taken together, the results of the present studies point out the importance of NS on critical brain developmental periods and they indicate that neonatal AlloP administration prevents some of the behavioural EMS effects on adolescence, but also induces deleterious effects similar to those of EMS in adulthood. Moreover, this work shows for first time a possible implication of neonatal NS alterations in adult alcohol use disorders.

The aim of this study is to develop a pain assessment scale for use during neonatal transport. Underpinned by the rights of the child to have appropriate assessment and management of pain and the important deleterious effects pain can have on the physiological stability of the neonate, this study utilises a qualitative consensus paradigm of enquiry to inform the content and structure a pain assessment scale specific to the transport setting. The study was conducted in three Phases, the first Phase consisted of a nominal group meeting with transport clinicians to ascertain their views on items to include in a pain assessment scale for transport. Phase Two utilised the Delphi technique to gain consensus from a large cohort of clinicians experienced in the field of neonatal transport on the content, structure and design of a transport pain assessment scale. Results of the first two Phases of the study were then applied to the adaptation of an existing pain assessment scale. Face validity of the newly developed Neonatal Transport Pain Assessment Scale (NTPAS) was then tested in Phase Three by semi-structured interviews with transport clinicians. Results of initial face validity testing suggested positive results in relation to feasibility and clinical utility of the scale, however further testing is strongly recommended. Currently there are no pain assessment scales developed for use in the transport setting, and little evidence on the effects of transport on pain and pain assessment. This study offers a unique approach in adding to the body of knowledge on neonatal pain assessment and facilitated the development of a scale adapted to transport. Further research is suggested to undertake psychometric testing of the scale and establish validity and reliability in the clinical setting.

A dor pode causar prejuízos ao neonato a curto, médio e longo prazo. Nesse contexto, é preciso que os profissionais das unidades de terapia intensiva neonatal implementem ações para minimizar a dor e o sofrimento do neonato, dentre elas, o reconhecimento da dor por sua avaliação. Os objetivos do estudo foram conhecer a experiência da enfermeira na utilização de instrumentos de avaliação da dor do neonato e identificar as facilidades e dificuldades encontradas pela enfermeira no uso desses instrumentos. É uma pesquisa qualitativa, seus dados foram coletados por meio de entrevistas semiestruturadas, no total nove enfermeiras participantes. A orientação metodológica apoiou-se no Discurso do Sujeito Coletivo na organização dos dados, cujo agrupamento das Ideias Centrais similares originou os Discursos do Sujeito Coletivo que foram reunidos em dois temas: Dificuldades encontradas pela enfermeira na avaliação da dor em neonatos e Facilidades encontradas pela enfermeira na avaliação da dor em neonatos, que emergiram apoiados nas respostas da enfermeira que experienciou o uso do instrumento na avaliação de dor em neonatos. A impossibilidade do uso do instrumento é fato predominante na prática da enfermeira quando os neonatos estão sedados ou apresentam disfunções neurológicas. O acúmulo de atividades dispensadas à enfermeira somado ao déficit de recursos humanos, também, são razões verificadas como dificultadoras no uso do instrumento de avaliação. Nos relatos da enfermeira, observou-se que a falta de domínio nas situações em que o médico não prescreve o analgésico, apenas medidas não farmacológicas são insuficientes para o alívio da dor do neonato. O fato foi marcado por um sentimento de falta de autonomia da enfermeira bastante evidente. Notou-se, também, uma serie de dificuldades no uso do instrumento e na avaliação da dor do neonato, embora o instrumento facilite no sentido de alertar a equipe de saúde para a dor e possa gerar mudança no cuidado com o emprego de medidas não farmacológicas que busquem o conforto, diminuição da dor e do estresse do neonato
Pain is known to cause damage to neonates at short, middle and long term. In this context, it is mandatory that the health care professional that work at Neonatal Intensive Care Units implement suitable actions to minimize the neonates suffering. Among these actions, recognizing pain by means of its measurement is crucial. Therefore, the present study aimed to know the nurses experience while using tools to measure the neonates pain and to identity the nurses facilities and difficulties in using tools to measure the neonates pain. This is a qualitative research project whose data were collected by means of semi-structured interviews with nine nurses. The Discourse of the Collective Subject was used as the methodological framework to collect data. Grouping similar Main Ideas produced the themes of the Discourse of the Collective Subject. Thus, results are presented in two themes: Nurses difficulties to measure pain in neonates and nurses facilities to measure pain in neonates composed by the discourse of the collective subject which emerged from the answers provided by the nurses who used the tool to measure pain in neonates. The nurses reports show that the tool facilitates the care of neonates in pain. However, the impossibility to use the tool in certain situations, such as when the neonate is sedated or when he/she has neurological disorders seems to be regular occurrence in the nurses practice. Frequently, the nurses expectations to relieve the neonates pain are frustrated, because nurse applies the measurement tool, she detects the neonates pain but she depends on the doctors prescription for analgesic pharmacological drug. Its a result the nurse feels she doesnt have autonomy this producing frustration. Although the tool easier to alert the health care team for pain and can produce changes in care with the use of non pharmacological measures that seek comfort, reducing pain and stress of the newborn

This survey research explores neonatal intensive care unit speech-language pathologists’ perceptions of infants with neonatal abstinence syndrome; specifically, how NAS affects infants’ feeding skills, along with structural and oral-motor characteristics. The findings of this research will contribute to this population’s information base. The results are expected to inform the field and current evidence-based practice care for infants with NAS.Learner Outcome(s): Explain Neonatal Abstinence Syndrome (NAS) Describe infants with NAS and how NAS affects the infants’ feeding skills from the perspective of Neonatal Intensive Care Unit (NICU) Speech-Language Pathologists (SLPs) Identify how SLPs in the NICU participate in intervention for infants with NAS and their families

The incidence of neonatal infections caused by Enterobacteriaceae has been increasing in recent years, and they are now recognised as the predominant causative agents in neonatal intensive care unit (NICU) outbreaks. Klebsiella spp. and Serratia spp. are the most common causative pathogens, and E. coli is one of the leading causes of neonatal meningitis and sepsis. The infant intestinal flora is influenced by the feeding regime. This study focuses on assessing the risk to neonates from the ingestion of the Enterobacteriaceae such as; Enterobacter hormaechei, Enterobacter ludwigii, Enterobacter aerogenes, Enterobacter cloacae and Klebsiella oxytoca. The strains under study were isolated from two sources; human mastic breast milk (MBM) and neonatal nasogastric enteral feeding tubes (EFT). The overall aim was to evaluate the risk to neonates posed by the ingestion of these organisms either from contaminated breast milk or from infant formula. Due to the lack of adequate source information, it was necessary to first confirm the identity of the strains under investigation. This was achieved using standard biochemical profiles (phenotyping) and where necessary 16S rDNA sequence analysis. Secondly, it was necessary to determine whether all strains were unique or if any were multiple isolations of the same strain. This was achieved using Pulsed-Field Gel Electrophoresis (PFGE). To determine the potential exposure of neonates to these organisms, a range of physiological and virulence related assays were undertaken; heat tolerance to 55°C, biofilm formation, capsule formation and acidic pH survival (pH 3.5). The potential virulence of the strains was assessed using attachment-invasion assays of human Caco-2 intestinal cells, human brain microvascular endothelial cells (HBMEC) and rat brain capillary endothelial cell line (rBCEC4); and also persistence of bacteria in macrophages by using U937 cells. Patterns of adherence of Enterobacteriaceae to Caco-2 cells was investigated. The presence of the virulence factors of strains was determined by identifying haemolytic activity, serum resistance, siderophore production and antimicrobial susceptibility. The iron uptake genes were also investigated. The results by PFGE showed that neonatal enteral feeding tubes and mastic human breast milk were contaminated by twenty-one and three pulsotypes of Enterobacteriaceae, respectively. Furthermore, the same pulsotypes were spread among enteral feeding tubes of infants in the same NICUs; indicating the same origins, such as: environment, milk or carer. Similarly, the MBM strains were isolated from the same mother. The identification of strains by using 16S rDNA sequence analysis (genotyping) was more accurate than phenotyping (API technique) and the clustering of strains by PFGE is a suitable technique for strains relatedness. The physiological features of the strains in the current study were investigated. The ability of strains to survive at 55ºC was studied and most of the strains were able to survive at 55ºC for >30 minutes. Biofilm formation was investigated as this may be a factor of organism persistence in the neonatal intensive care unit (via milk, environment or workers) and attachment to enteral feeding tubes. All strains formed biofilms and this was, in general, enhanced at 37°C compared with room temperature (20ºC) in all types of formula. The highest levels of biofilm were in casein-based infant formula. Most strains produced capsular material at 37ºC on all types of formula. However, capsular material was produced by all strains in soya infant formula. All strains were able to survive at pH 3.5 for up to 2 hours. All strains were able to attach to Caco-2, HBMEC and rBCEC4 cells lines, while there was variation between strains ability to invade mammalian cells. In particular, most of Ent. hormaechei strains were able to invade the three types of cells lines and one Ent. ludwigii strain 1439 was only able to invade the rBCEC4 cell line. Ent. ludwigii strain 1439 was isolated from a case of neonatal meningitis. Three out of eight strains of Ent. hormaechei and two strains of Ent. cloacae strains survived within macrophages. Haemolysin production, serum resistance and siderophore production were also studied and all strains were positive. Genes encoding for iron uptake irp1, irp2 and fyuA were detected whereas irp1, irp2 genes were absent in all strains while fyuA was present in 4/6 of Ent. ludwigii strains, 1/8 of Ent. hormaechei, 2 of Ent. cloacae, 1 of Ent. aerogenes and 3/6 of K. oxytoca. Three out of eight strains of Ent. hormaechei showed resistance to even the 3rd generation cephalosporins, ceftazidime and cefotaxime and were ESBL-positive.

Neonatal abstinence syndrome (NAS) refers to the withdrawal infants exposed to opioids in utero may experience following birth. In recent years, the number of infants born who present with NAS has grown exponentially. This increase in the number of infants with NAS has led to a new population within the caseloads of speech-language pathologists (SLPs) who work in neonatal intensive care units (NICUs). SLPs’ knowledge base and skill set of assessment and treatment of swallowing and feeding disorders in infancy play a vital role in the treatment of infants with NAS in the NICU. A dearth of research exists regarding the specific nature of the feeding problems and skills of infants with NAS and whether SLP intervention for infants with NAS needs to differ from that of other infant NICU populations. Identifying how SLPs can best serve infants with NAS in the NICU is essential to their immediate well-being as well as the development of these infants. The purpose of this survey-based research study was to examine NICU SLPs’ perceptions of infants with NAS, and more specifically, how NAS affects the infants’ feeding skills, structural, and oral-motor characteristics. A questionnaire was developed based on an in-depth literature review to collect information on NAS, caseloads, treatment environment, and respondent demographics. The survey consisted of three sections: NAS (further divided into Assessment, Treatment, and Education), Environmental Description, and Respondent Demographics. The secure web-based questionnaire was distributed through SurveyMonkey™, an online survey platform. Survey research was conducted, and hospital-based speech-language pathologists within the USA acted as respondents. The findings will contribute to establishing a preliminary base of information on this topic. The results are expected to further inform the field as well as current practices in evidenced-based practice care for infants with NAS.

Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations. Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics. Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state. Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.

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O estudo pretendeu identificar os fatores de associação para morbimortalidade de neonatos egressos de Unidade de Terapia Intensiva Neonatal no município de Juiz de Fora e a frequência de morbidade e mortalidade comparadas com a da Vermont Oxford Network. Método: Estudo analítico-descritivo; coorte dos egressos das UTIN de Juiz de Fora. População do estudo: todos os pares de mães e recém-nascidos residentes em Juiz de Fora e que tiveram internação em UTIN em 2009 pelo Sistema Único de Saúde. Duzentos e cinquenta e oito recém-nascidos e mães participaram deste trabalho. A inclusão de participantes iniciou em 01 de janeiro de 2009 e terminou no dia 31 de dezembro de 2009. Os dados foram coletados utilizando os formulários da Vermont Oxford Network (VON) e, para avaliação do desempenho motor, foi feito o Teste da Performance Motora Infantil (TIMP). Para comparação de proporções e médias, foram utilizados o qui-quadrado (c2) e o teste t. Para verificar a associação dos fatores obstétricos, perinatais e neonatais com a morbidade TIMP alterado e óbito foram feitas análises bivariadas e análises de regressão logística para identificação de fatores independentes associados ao desfecho. A análise foi feita utilizando o SPSS versão14 e o Minitab para Windows versão 12. Foram analisados os grupos de RN da população geral, menores de 1501g e maiores de 1500g. Resultados: 64,0% dos participantes tinham baixo peso ao nascimento, 67,1% eram prematuros e 59,7% do sexo masculino. Na comparação entre Juiz de Fora e VON, existiram diferenças significativas quanto às intercorrências, às intervenções e às morbidades nos sobreviventes (p ≤ 0,05). A sobrevivência dos usuários de UTIN em Juiz de Fora foi 84,9% e a frequência de morbidades 22,4%. Na análise dos fatores de risco para mortalidade dos usuários de UTIN as variáveis que apresentaram associação significativa na regressão logística foram: assistência ventilatória com máscara facial ou tubo orotraqueal nos dez primeiros minutos de vida e alteração do sistema nervoso central. Mais de um terço dos participantes apresentaram alteração no desenvolvimento motor no TIMP considerando desvio padrão de -1 ou menos. Na análise dos fatores de risco para alteração no desenvolvimento motor, as variáveis que apresentaram associação significativa na regressão logística foram: idade gestacional, sexo e convulsão. Conclusão: A comparação entre os dados coletados dos usuários de UTIN, atendidos pelo SUS, no município de Juiz de Fora com os dados derivados do banco da VON mostra que a frequência das complicações associadas às intercorrências e intervenções no pré-natal, perinatal e na UTIN foi, na maioria dos casos, maior em Juiz de Fora. Espera-se que uma estratégia terapêutica menos agressiva, baseada principalmente na prevenção e na gestão global da assistência, possa estar associada a melhorias nos desfechos clínicos em recém-nascidos usuários de UTIN.
This study aims to identify the correlated aspects that contribute for the morbimortality of newborn that has left Neonatal Intensive Care (NICU) in Juiz de Fora. Another goal is to compare the morbidity and mortality rates with the rates indicated by Vermont Oxford Network. Method: Descriptive-analytical study, cohort of the NICU discharges in Juiz de Fora. Study population: all the mothers and their newborns that lives in Juiz de Fora and who were hospitalized in 2009 by Health Care (SUS). Two hundred fifty-eight newborns and their mothers took part of this work. The participants inclusion started on 01/01/2009 and finished on 12/31/2009. The data were collected by using Vermont Oxford Network (VON) forms. The children motor skill performance test (TIMP) was applied to evaluate the motor skills. Chi-square and the t-Test were used to compare proportions and averages. In order to verify the link among obstetrics, perinatal and neonatal data and the TIMP morbidity and death, bivariate and logistic regression analysis were done to identify the independent factors connect with the outcomes. The analysis were executed by SPSS version 14 and Minitab for windows version 12. It was analyzed newborns groups in general under 1501 grams and over 1500 grams. Results: 64,0% of the participants had low weight when they were born; 59,7% were male and 67,1% premature newborn. By comparing Juiz de Fora and VON, it was possible to realize that there were huge differences concerned to the intercurrences, interventions and the morbidity found in the survivals (p ≤ 0,05).The survival of NICU patients in Juiz de Fora was 84,9% and 22,4%the numbers of morbidity. By analyzing of the mortality risk factor for NICU patients, it was concluded that the variables that have shown a substantial connection with the logistic regression were: ventilatory assistance with facial mask within ten life minutes and the variation of the central nervous system. More than one third of the participants had some modification of the motor development at TIMP, considering the pattern deviation of -1 and -2. The analysis of risk factors that contributes for the alteration of the motor development concluded that the variables that have shown a substantial connection with the logistic regression were: gestational age, gender and seizures. Conclusion: The comparison of the data collected from NICU patients treated by Health Care (SUS) in Juiz de Fora with the data from VON bank shows that the frequency of the complications connected to the intercurrences and prenatal interventions, perinatal and at NICU were, in most cases, bigger in Juiz de Fora. It is expected that a suitable therapeutic strategy, based mainly on prevention and global assistance management, could bring some improvement of the clinical discharges of newborns treated at NICU.

Preterm births are becoming more common worldwide, leading to an increase in the complications of prematurity. Preterm babies are specifically at risk of infection, defined as late onset sepsis after the third day of life. Ideally, infection should be prevented but if this is not possible rapid and accurate detection is necessary so that treatment can be started early_ Symptoms of infection in term and preterm infants are non-specific. Current methods of diagnosis are dependent on culturing organisms in blood, but this can be problematic and diagnostic performance in neonates is not good. Alternative methods may prove to be more efficient. The aim of this study was to determine if molecular methods can improve the diagnosis of infection in neonates. Success of the molecular assay was judged based on comparison with blood culture and CRP. ability to quantify bacterial copy number and to specifically identify pathogens. Infants whom clinicians thought were infected had additional blood sampled at the time of routine investigations for infection. Clinical and routine laboratory data were also recorded. Molecular analysis of the samples was performed using a reverse transcriptase real~ time PCR 16S rRNA assay. 16S rRNA is a universal sequence present in all bacteria. Infants were judged to be infected based on a previously validated culture~ independent clinical scoring system. Eighty four infants were included in the analysis. 16S reran proved to be more sensitive and specific than blood culture and CRP. The assay could quantify the number of bacteria present in the infection ("bacterial load"). A number of less common bacteria and Human Parechovirus were identified and further correlation is required to determine the pathogenicity of these organisms . In summary. molecular methods can enhance the diagnosis of late onset neonatal sepsis, provide quantitative information, on bacterial load and provide insights into the nature of bacteria causing the disease process.

Bacterial sepsis is a frequently occurring disease in the first weeks of life, posing a significant threat particularly to those born prematurely. The incidence of sepsis is determined by laboratory surveillance, only taking into account culture positive episodes of sepsis. However, in up to 80% of neonates treated for sepsis, blood cultures fail to grow an organism. Therefore a variety of molecular techniques have been trialled to overcome these diagnostic difficulties. To describe the current incidence and causal pathogens of neonatal sepsis in Europe in this thesis, systematic literature reviews on neonatal bacterial and fungal infections were conducted. The review highlighted in particular the discrepancy between incidences of culture positive and clinical sepsis. A further literature review assessed molecular diagnostic techniques that have been employed to determine pathogens of neonatal sepsis. Based on the results obtained from the systematic reviews, a series of molecular tests, including quantitative multiplex PCRs, a 16S rDNA broad range PCR and a Candida multiplex PCR were developed. These tests were applied to two sets of samples obtained from neonates with suspected and confirmed early and late onset sepsis in Europe, collected in two separate clinical trials. Results identified a large amount of bacteria (74% in EOS and 50% in LOS), however failed to detect all cultured pathogens. A large number of samples were positive for CoNS and Enterobacteriacae in both sample sets. In particular, in EOS, S. pneumoniae was shown to be more predominant than anticipated from the literature, and in LOS Enterococci were more prevalent. Of concern is a high number of polymicrobial infections detected by PCR. Universal definitions for clinical sepsis need to be established to enable surveillance and comparison across countries. Molecular diagnostics have the potential to become an important additional tool to describe the epidemiology of neonatal sepsis.

O objetivo da tese é descrever uma coorte de nascidos vivos e os óbitos neonatais dela derivados e estimar as probabilidades de morte segundo características do recém-nascido, da gestação, do parto e da mãe, bem como das causas de morte. Utilizou-se como fonte de obtenção de dados as Declarações de Nascido Vivo (DN) e de Óbito (DO),documentos básicos dos Sistemas Oficiais de Informação do país. A coorte foi formada por 3225 nascimentos vivos de mães residentes e ocorridos no Munícipio de Santo André, no 1º semestre de 1992. Para a identificação dos óbitos neonatais foi empregada a técnica de \"linkage\", pareando-se as DO com as respectivas DN, obtendo-se 55 óbitos neonatais. A proporção de nascidos vivos de baixo peso ao nascer foi de 6,8 por cento . Obteve-se associação estatisticamente significativa para os nascidos vivos de baixo peso e a presença de gestações de pré-termo, parto normal e cujo nascimento havia ocorrido no hospital público do SUS. Este hospital é referência para as gestações de risco do municipio. Essa associação estava presente também nos recém-nascidos de mães adolescentes e idosas e nos de mães prímiparas ou grandes multíparas. Não se encontrou associação entre o baixo peso ao nascer e sexo, bem como com a variável anotação do nome do pai na DN. Os óbitos concentraram-se no 10 dia de vida (54,5 por cento ).Verificou-se que 94,6 por cento das crianças morreram sem que estas tivessem deixado o hospital após o nascimento. Com relação às causas básicas de morte, as mais frequentes foram as afecções perinatais. A análise das causas múltiplas permitiu uma melhor avaliação da participação da imaturidade/prematuridade e das infecções perinatais no processo que levou a morte. Estas causas estiveram presentes como causa básica ou associada em 63,6 por cento e 25,5 por cento dos óbitos, respectivamente. Os fatores de risco para os óbitos neonatais foram baixo peso ao nascer, gestações de pré-termo e a ausência do registro do nome do pai. Os partos cesareanos foram considerados como fator de confusão para o risco de morte neonatal, o efeito protetor destes partos desapareceu ao se controlar o peso ao nascer. O maior risco de morte encontrado nos nascimentos no hospital público do SUS também deixou de existir ao se controlar a variável peso. Observou-se um risco de morte significativamente maior para os nascidos vivos de baixo peso do sexo masculino que nos do sexo feminino. A categoria de recém-nascidos de baixo peso e de pré-termo apresentou risco de morte 82 vezes maior que os de termo com peso igual ou superior a 2500 gramas. Não se encontrou um risco de morte significativo para os nascidos vivos de mães primíparas ou grandes multíparas e de mães adolescentes ou idosas em relação aos recém-nascidos de mães multíparas e com idade entre 20 e 34 anos. Foram considerados como nascidos vivos de risco os nascimentos de baixo peso. Observou-se um risco de morte significativamente maior por anomalias congênitas e afecções perinatais nos nascimentos de baixo peso que entre aqueles que tinham peso igual ou acima de 2500 gramas. O risco de morte por infecções perinatais foi 94,0 vezes maior nesse grupo de recém-nascidos. Os nascidos vivos de baixo peso do sexo masculino apresentaram uma chance 3,6 vezes mais elevada de morrer por afecções respiratórias que os do sexo feminino deste grupo. Os dados obtidos sugerem que muitos destes óbitos poderiam ter sido evitados se houvesse uma melhor identificação das gestações de risco no pré-natal e fosse assegurada uma adequada atenção ao parto e aos recém-nascidos, bem como indicam que nem todos recém-nascidos de risco receberam os cuidados nescessários após o parto.
A cohort of live births was analysed and the risk of death according to some variables was estimated. The data was obtained from the birth and death certificates. The records were linked, and each death was matched with the birth certificate, in order to identify the neonatal deaths and the survivals of the cohort. It was studied 3,225 live borns of resident mothers of the Santo André Municipality. The births occurred in this area from 01/101/1992 to 06/30/1992. The incidence of low birthweight was 6.8 per cent and the proportion of preterm infants was 5.3 per cent . The low birthweight was associated to the preterm gestation, vaginal deliveries, and to the births which occurred on the SUS public hospital. There was also an association between the low birthweight and the live borns from adolescent and older mothers. The low and high parity were risk factors to the low birthweight. The abscence of notation of the father\'s name on the birth certificate was not associated to the low birthweight. The deaths occurred mainly in the first day of the life (54.5 per cent ) . The data showed that 94.6 per cent of the infant deaths occurred before hospital discharge . The perinatal afections were the leading cause of death. The prematurity/imaturity was assigned as underlying or associated cause in 63.6 per cent of the deaths and the perinatal infections in 25.5 per cent of these deaths. It was found a higher risk of death in low birthweight and preterm newborns and in infants with abscence of the father\'s name on the birth certificate. The cesarean section deliveries showed to be a confounding factor to the neonatal deaths, as well as, the type of the hospital in which the infants were deliveried. The male low birthweight infants presented higher risk of death than the female infants. The low birthweight and preterm babies showed a 82 times higher risk of dying than the normal weight and term infants. The low birthweight newborn showed a higher risk of death from congenital anommalies and perinatal afections. This group of live births, also presented a risk of death from perinatal infections 94.0 times higher than the normal weight babies. The male low birthweigth infants presented 3.6 times higher chance of dying from perinatal respiratory afections than the female newborns of this group. These results suggest that some deaths could be avoided by adequate prenatal, delivery and neonatal care in the maternity wards. The high risk death found in the preterm and very low birth weight infants also suggest that some of these high risk newborns did not had access to neonatal intensive care.

O vírus citomegálico humano (CMV) é o principal agente de infeção congénita. Em Portugal, os estudos publicados apontam para uma prevalência desta infeção entre 0,7% e 1,1%. A importância do rastreio desta infeção é reconhecida desde há vários anos, mas as condições para a sua realização, de forma que seja técnica e economicamente viável, ainda não estão reunidas. A metodologia de pools de urina descrita por uma equipa portuguesa, revelou uma correlação total com os resultados obtidos pelo método de referência, a cultura celular, e permite uma redução bastante significativa, quer nos tempos de execução quer nos custos em reagentes, abrindo assim a possibilidade efetiva de utilizar esta técnica para o rastreio da infeção congénita. Este estudo tem como primeiro objetivo rastrear recém-nascidos do Hospital da Luz e Maternidade Alfredo da Costa num determinado período de tempo, no sentido de determinar a prevalência da infeção congénita por CMV nessa população. O rastreio tem como base a utilização de pools (20 urinas) e a deteção de DNA viral por PCR em tempo real. As 20 urinas de cada pool positiva são posteriormente testadas individualmente. O segundo objetivo deste trabalho foi a deteção de carga viral de CMV, por PCR em tempo real, a partir de uma fralda com urina CMV positiva. Como resultados, obtiveram-se 45 pools, 4 delas positivas com uma urina positiva em cada pool, sendo a prevalência deste rastreio 0,44%. Esta metodologia confirmou a sua utilidade para um rastreio universal de infeção congénita por CMV, no entanto verificaram-se dificuldades na aplicação da mesma, o que deverá ser tomado em consideração na implementação de um eventual programa de rastreio. Os resultados obtidos na extração de urina CMV positiva através de fraldas de recém-nascidos foram muito promissores, o que abre a possibilidade da sua utilização para o diagnóstico da infeção congénita.
The human cytomegalovirus (CMV) is the main agent of congenital infection. In Portugal, this infection has shown a prevalence of 0.7 to 1.1%. The importance of the screening of this infection is well recognized for several years now, but the economic viability of its usage is not yet assured. The urine pool technique, described by a Portuguese team, revealed a total correlation with the results obtained by the gold standard method (cell culture) and allows a very significant reduction of the time and cost of the procedure. Therefore, this technique could be used for congenital CMV screening. The main purpose of this study was the screening of congenital CMV infection in newborns from Hospital da Luz and Maternidade Alfredo da Costa in a specific period of time and the determination of its prevalence. The screening is based on the analysis of pools made of 20 urines and viral DNA detection by real time PCR. In the positive pools, the 20 samples were then individually tested to determine which one was positive. The second purpose of this study was the detection and quantification of viral CMV DNA by real time PCR from a diaper with positive urine for CMV. In our screening, we analysed 45 pools of which 4 were positive with one positive urine each and we concluded that the prevalence of congenital CMV infection was 0,44%. With these results, we were able to show that this technique can be used for universal screening but we also verified some difficulties in its application which should be considered in future studies. The results obtained from the extraction of the urines collected from the diapers were very promising, showing that this technique could be used for congenital CMV infection diagnosis.

Identifica la prevalencia y características de la hipoacusia neurosensorial en recién nacidos a término con hiperbilirrubinemia neonatal. El estudio es descriptivo, retrospectivo de corte transversal, se incluyen todos los recién nacidos a término con hiperbilirrubinemia sin otro factor de riesgo conocido para hipoacusia nacidos en el Servicio de Neonatología del Hospital Santa Rosa durante el período 2004-2011 con evaluación audiológica mediante Potenciales evocados auditivos de tallo cerebral (PEATC). Se estudiaron 36 pacientes. Hubo un predominio del sexo femenino (61.1%), el peso promedio al nacer fue 3149.4 ± 558 gramos, la edad promedio al alta fue 2.186 ± 1.99 días, la edad promedio al momento del reingreso fue 6.46 ± 3.46, el valor promedio de bilirrubina total fue de 23.6 ± 5.25. Se encontraron 5 pacientes (13,9%) con hiperbilirrubinemia moderada, 15 pacientes (41.7%) con hiperbilirrubinemia severa, 9 casos (25%) con hiperbilirrubinemia extrema y 5 casos (13.9%) con hiperbilirrubinemia fulminante. En 16 (44.4%) se reportó incompatibilidad sanguínea. El tipo más común de incompatibilidad fue ABO, con 8 casos de tipo OA (22.2%) y 8 casos OB (22.2%). Se utilizó fototerapia en 34 (94.4%) y fenobarbital en 19 (52.8%) pacientes En 7 (19.4%) pacientes se practicó exanguinotransfusión. A ningún paciente se le administró albúmina. La tasa de prevalencia de hipoacusia en recién nacidos hiperbilirrubinémicos fue de 72.2% en el primer control de PEATC y de 29% en el segundo control. Se concluye que la tasa de prevalencia de hipoacusia en recién nacidos hiperbilirrubinémicos fue de 72.2% en el primer control de PEATC, y de 29% en el segundo control.
Trabajo de investigación

Exames radiográficos do tórax são frequentemente solicitados para pacientes recém-nascidos internados na Unidade de Terapia Intensiva (UTI) Neonatal. Entretanto, as crianças são mais radiossensíveis quanto menor a idade que possuem e devido ao maior número de células em processo de replicação. Essa característica acaba despertando uma maior preocupação da comunidade científica em conhecer a dose de radiação a que são expostos esses pacientes pediátricos. Este trabalho descreve a metodologia aplicada para a execução de uma análise dosimétrica em pediatria neonatal no Hospital Infantil Pequeno Príncipe, em Curitiba. Inicialmente, o trabalho propõe a construção de um objeto simulador de um recém-nascido para consequentes medidas de dose de radiação recebida pelo paciente neonato, através do uso de TLDs (Dosímetros Termoluminescentes) para medidas de ESAK (Kerma-ar na Superfície de Entrada) sob a região torácica e medida de kerma-ar na profundidade do pulmão, na água, com o uso de uma câmara de ionização. Também foi avaliada a dose de radiação espalhada recebida pelo paciente internado próximo ao paciente examinado. Os resultados da pesquisa mostraram, em geral, níveis de dose abaixo dos valores de referência para as medidas de ESAK. Para as medidas de kerma-ar na profundidade do pulmão, os valores encontrados e comparados com cálculos de dose-órgão por meio de um software mostraram-se abaixo dos valores obtidos com os TLDs. As medidas de radiação espalhada mostraram que os pacientes próximos ao paciente examinado recebem uma pequena faixa de contribuição de dose durante os exames.
Chest radiographic examinations are frequently requested for newborn patients hospitalized in a Intensive Care Unit (ICU) Neonatal. However, children are more radiosensitive the younger they are and due to the higher number of cells in replication process. This feature arises greater concern in the scientific community to know the dose of radiation that these pediatric patients are exposed. This paper describes the methodology used for the implementation of a dosimetric analysis in neonatal pediatrics at the Children's Hospital Pequeno Príncipe, in Curitiba. Initially, the work proposes the construction of a phantom of a newborn to subsequent measurement of the radiation dose received by the neonate patient, through the use of TLDs (Thermoluminescent Dosimeters) for measures ESAK (Entrance Surface Air-Kerma) in the thoracic region and measure kerma-air in the deep lung, in water, with the use of an ionization chamber. The scattered radiation dose received by another patient near the patient under examination was also evaluated. The results showed, in general, dose levels below the reference values for the measures ESAK. For the kerma- air in the deep lung, and the values obtained compared to organ dose calculations through software is shown to be below the values obtained with TLDs. The measurements showed that the scattered radiation near the patient examined receive a small contribution of dose during examinations.

Neonatal screening is a program, which aims at early identification of conditions for which early and timely intervention can prevent or reduce associated mortality and morbidity. The most modern screening technology is the tandem mass spectrometry (tandem MS; MS/MS). MS/MS-newborn screening requires confirmatory testing and clinical evaluation before a diagnosis can be made. When you are citing the document, use the following link http://essuir.sumdu.edu.ua/handle/123456789/32305

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.
Objectives: Interpregnancy interval (IPI), the time period between the end of one pregnancy and the conception of the next, can have a significant impact on maternal and infant outcomes. This study examines the relationship between interpregnancy interval and neonatal outcomes of low birth weight, preterm birth, and specific neonatal morbidities. Study Design: Retrospective cohort study comparing neonatal outcomes across 6 categories of IPI using data on 202,600 cases identified from Arizona birth certificates and the Newborn Intensive Care Program data. Comparisons between groups were made using odds ratios and 95% confidence intervals, and multivariable logisitic regression analysis. Results: Interpregnancy intervals of < 12 months and ≥ 60 months were associated with low birth weight, preterm birth, and small for gestational age births. The shortest and longest IPI categories were also associated with specific neonatal morbidities, including periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, apnea bradycardia, respiratory distress syndrome, transient tachypnea of the newborn, and suspected sepsis. Relationships between interpregnancy interval and specific neonatal morbidities did not remain significant when adjusted for birth weight and gestational age. Conclusions: Significant differences in neonatal outcomes (preterm birth, low birth weight, and small for gestational age) were observed between IPI categories. Consistent with previous research, interpregnancy intervals < 12 months and ≥ 60 months appear to be associated with increased risk of poor neonatal outcomes. Any difference in specific neonatal morbidities between IPI groups appears to be mediated through increased risk of low birth weight and preterm birth by IPI.

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O per?odo neonatal, que compreende os primeiros 27 dias p?s-parto, ? uma fase considerada de vulnerabilidade ? sa?de infantil, fazendo-se necess?rio uma maior vigil?ncia pelo profissional de sa?de atrav?s de a??es que valorizam o bin?mio m?e/filho e o atendimento integral ao rec?m-nascido. Para tanto, esse trabalho objetivou avaliar as a??es de aten??o, a partir das estrat?gias preconizadas pelo Minist?rio da Sa?de. Trata-se de um estudo de corte transversal realizado a partir do banco de dados da pesquisa nacional de base populacional intitulada ?Chamada Neonatal: avalia??o da aten??o ao pr?-natal e aos menores de um ano nas regi?es Norte e Nordeste?. Utilizou-se como unidade amostral as m?es e as crian?as menores de 1 ano que compareceram a campanha de vacina??o do dia 12 de junho de 2010 nos nove munic?pios potiguares priorit?rios para o Pacto de Redu??o da Mortalidade Infantil e Neonatal. Para compor as vari?veis de estudo foram selecionadas as quest?es/a??es referentes ao per?odo neonatal e aos fatores sociodemogr?ficos, seguidas de uma an?lise descritiva e inferencial. Obteve-se uma amostra de 837 pares m?e/filho, sendo 57,6% na capital e 42,4% no conjunto dos interiores, que foi ponderada para representar os munic?pios do Estado. Predominaram as m?es com idade entre 20-29 anos, ensino m?dio completo, n?o benefici?rio de programa de transfer?ncia de renda; e crian?as do sexo masculino (51,2%). A freq??ncia das a??es de ?mbito hospitalar variou de 35% a 96% e as realizadas na Unidade B?sica de Sa?de (UBS) de 57% a 91,2%. A maioria das a??es teve associa??o com os hospitais de natureza p?blica e com a capital do estado (p<0,05). Os resultados para a maioria das a??es est?o abaixo do preconizado nos programas e pol?ticas de aten??o ? crian?a, e revelam as iniq?idades regionais em sa?de e a necessidade de envolvimento dos servi?os e dos profissionais na busca da integralidade do cuidado para possibilitarem melhor assist?ncia atrav?s de pr?ticas humanizadas nesse per?odo de maior vulnerabilidade.
The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality?s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.

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A mortalidade neonatal precoce é o componente da mortalidade infantil responsável por mais de 50 por cento dos óbitos ocorridos no primeiro ano de vida, e se relaciona com assistência pré-natal, parto e recém-nascido (RN). O estudo objetivou analisar os eventos adversos (EA) presentes nas unidades de terapia intensiva neonatal (UTIN) mediante revisão da literatura nacional e internacional, e análise dos dados do sistema de notificação brasileiro de eventos adversos, bem como estudar a influência dos EA no óbito neonatal precoce, em uma maternidade pública do município do Rio de Janeiro. A tese foi escrita sob a forma de três artigos. No primeiro, mediante revisão sistemática, apresentaram-se os incidentes medicamentosos como os mais frequentes e as infecções de origem hospitalar como precursoras de danos de maior gravidade. No segundo artigo um estudo quantitativo, descritivo, retrospectivo, com análise de dados secundários fornecidos pelo Sistema de Notificação em Vigilância Sanitária (NOTIVISA), desde sua implantação em 2007 a setembro de 2013 , a análise dos EA relacionados aos RN e às UTIN notificados revelou problemas na qualidade e no manejo do cateter central de inserção periférica (PICC), e no uso de antibióticos e nitrato de prata. No terceiro artigo, um estudo do tipo caso-controle pareado com relação 1:2, de revisão retrospectiva de prontuários com o uso de rastreadores (triggers), avaliaram-se os EA ocorridos no período neonatal precoce em uma UTIN no município do Rio de Janeiro e sua associação com o óbito neonatal precoce. Identificou-se o EA Extubação não planejada com comprometimento respiratório e necessidade de reintubação associado ao óbito neonatal precoce. Ressalta-se a ocorrência de EA de maior gravidade nos RN que evoluíram para o óbito quando comparados aos sobreviventes. Recomenda-se o uso do rastreador hipotermia, devido à identificação de sua alta frequência e associação com a bradicardia.
Entende-se que muitos EA podem não estar descritos nos prontuários, sendo recomendado o investimento também em estudos observacionais para maior aproximação da realidade vivenciada nas UTIN. Os RN mais acometidos por EA também são os mais vulneráveis, como os prematuros e os de menor peso ao nascimento. É pertinente enfatizar medidas preventivas no âmbito dos serviços: treinamento contínuo da equipe multiprofissional, implementação de sistema informatizado no processo de prescrição e diagnóstico, discussão das falhas ocorridas e padronização dos cuidados de saúde e incentivo à cultura de segurança do paciente. Acredita-se que tais medidas possam melhorar o cuidado dos RN, sobretudo no momento mais crítico, os primeiros seis dias vida. Sugere-se o aprimoramento do sistema de notificação de eventos adversos.
Early neonatal mortality is the infant mortality component that accounts for over 50 percent of deaths in the first year of life, being related to prenatal care, childbirth and newborn (NB). The study aimed to analyze adverse events (AE) in neonatal intensive care units (NICU) by reviewing national and international literature, and analyzing data from Brazil's adverse event reporting system, as well as studying the influence of AE s in early neonatal death, in a public maternity hospital in Rio de Janeiro city. The thesis was written in the form of three articles. In the first, through systematic review, medical incidents were presented as most frequent, and hospital infections as precursors of most serious damage. In the second article - a quantitative, descriptive, retrospective study, with analysis of secondary data provided by the Sanitary Surveillance Reporting System (NOTIVISA), since its creation in 2007 to September 2013 - the analysis of AE related to NB s and notified NICU revealed problems in the quality and management of peripheral insertion central catheter (PICC), and the use of antibiotics and silver nitrate. In the third article, a case-control study paired with 1:2 ratio, retrospective review of medical records with use of trackers (triggers), evaluated AE s in early neonatal period in a NICU in Rio de January, and its association with early neonatal death. It identified the AE "unplanned extubation with respiratory compromise and need for reintubation" associated with early neonatal death. It is noteworthy the occurrence of more severe AE s in infants who had a fatal outcome compared to survivors. It is recommended to use the tracker "Hypothermia", due to the identification of its high frequency and association with bradycardia. It is understood that many AE s may not be described in the medical records, and it is also recommended investment in observational studies to further approximation of reality experienced in the NICU.^ien
The infants most affected by AE s are also the most vulnerable, such as premature and low birth weight. It should be emphasized preventive measures within services: ongoing training of the multidisciplinary team, computerized system in the prescription and diagnostic process, discussing faults and standardization of health care and encouraging tehe culture of the patient s safety. It is believed that these measures may improve the care of newborns, especially at the most critical moment, the first six days of life. Improvement of the adverse event reporting system is suggested. (AU)^ien

Neonatal immune responses are typically deficient against a wide variety of antigens, including alloantigens, vaccine antigens, and infectious agents. These responses are characterized by Th2-skewed cytokine production, and deficient Th1 and cytotoxic responses. However, these deficient responses can be boosted to adult levels by the use of strong, Th1 promoting agents. This demonstrates that neonates are capable of developing mature immune responses under specific conditions. Using two different murine models, we have found that neonates develop robust Th and cytotoxic responses, which under some antigenic conditions significantly exceed those of adults. First, using a model of early life exposure to noninherited maternal antigens (NIMA), we found that murine neonates develop robust in vivo cytotoxic responses to low doses of alloantigens. Importantly, primary in vivo cytotoxic responses to alloantigen developed during the neonatal period, and persisted into adulthood. Neonates developed similar memory cytotoxic responses to donor spleen cells, bone marrow, and stem cell-enriched (Lin-) bone marrow cells, suggesting that the exposure dose is more important than the type of transplanted donor cell for the development of cytotoxicity. NIMA-exposed neonates also developed vigorous primary and memory allospecific Th1/Th2 responses which exceeded the responses of adults. These findings suggest that early exposure to low levels of NIMA may lead to long term immunological priming of all arms of T cell adaptive immunity. Second, we characterized the phenotype and function of neonatal recent thymic emigrants (RTE). RTE are the predominant cell type in murine neonates, and are present at higher frequencies within the neonatal CD4+ compartment than in adults. Our data demonstrate that RTE from murine neonates and adults are phenotypically and functionally distinct. In particular, although the magnitude of RTE cytokine responses from both age groups is dependent on the conditions of activation, neonatal RTE consistently exhibited higher levels of effector cytokine production than adult RTE. In particular, activation of neonatal RTE in the presence of IL-7 lead to greatly increased IFNgamma production, while adult responses were not altered. Overall, neonatal RTE responses were more plastic than those of adult RTE, as both Th1 and Th2 responses were altered in neonates using various activation conditions, while only Th2 responses were consistently changed in adults. Finally, in contrast to adult RTE, neonatal RTE proliferated in response to IL-7 stimulation at very early timepoints. This was associated with faster kinetics of IL-7Ralpha downregulation and higher levels of pSTAT5 in neonatal RTE. These quantitative and qualitative differences in neonatal RTE populations may largely explain the diverse responses that are elicited in neonates in response to different antigens, especially under those conditions in which Th1 responses are enhanced (i.e., exposure to NIMA alloantigens). Taken together, these data demonstrate that neonatal T cell responses are actually highly plastic, instead of intrinsically deficient. Furthermore, if given optimal stimulation conditions, neonatal responses can actually exceed those produced by adults.

Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to  deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.

Magister Scientiae (Physiotherapy) - MSc(Physio)
Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.

Dissertação(mestrado) - Universidade Federal do Rio Grande, Programa de Pós-Graduação em Enfermagem, Escola de Enfermagem, 2005.
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Este estudo descritivo, exploratório com abordagem quantitativa foi desenvolvido com 61 recém-nascidos(RN) de risco internados na Unidade de Tratamento Intensivo Neonatal do Hospital Universitário Dr. Miguel Riet Corrêa Jr. - cujas famílias eram residentes no município do Rio Grande/RS. Os dados foram colhidos no período de abril a setembro de 2005, utilizando-se uma entrevista semiestruturada aplicada às mães durante o período de internação de seus filhos. O estudo buscou identificar os fatores pré e perinatais que influenciaram as condições de nascimento levando à necessidade de internação do RN. Dentre estes foram investigadas as características socioeconômicas, demográficas e biológicas maternas, a história gestacional e reprodutiva da mãe e as condições de nascimento da criança, propriamente ditas. Após a análise dos dados verificou-se que 60,7% dos RN que fizeram parte do estudo apresentaram baixo peso ao nascimento (BPN) e 49,2% eram pré-termos. Dos RNs avaliados 62,3% nasceram por cesariana, sendo que destas 14,8% foram referidas como eletivas pelas mães. Quanto à situação socioeconômica 85,2% das mães relatou renda familiar per capta inferior a dois salários mínimos, sendo que 75,4% delas não exercia atividade remunerada. Das entrevistadas 83,6% vivia com companheiro e 47,5% possuía mais de oito anos de estudo. A maioria das mulheres era de cor branca (68,9%) e tinha entre 20 e 34 anos (59%). Salienta-se que 26,2% das mães tinha idade inferior a 19 anos. Das mulheres que souberam informar seu peso pré-gestacional (56), 84,4% relatou peso superior a 50 Kg. Entre as mães entrevistadas 41% eram primíparas e 23% referiram já ter tido três ou mais gestações. Das mulheres com história de gestação anterior (36), 38,9% já havia tido no mínimo uma gestação finalizada em aborto e 25% referiu ter tido natimortos. História de BPN e pré-termos prévios foi referida por 27,8% e 38,9% dessas mães, respectivamente. A maioria das mulheres (93,4%) realizou o pré-natal, sendo que 59,6% referiu seis ou mais consultas. Das mulheres assistidas 66,7% iniciaram o pré-natal no 1º trimestre de gestação. Entre as patologias mais prevalentes na gestação destacam-se a infecção urinária, a anemia e a hipertensão arterial relatadas por 49,2%, 44,3% e 23% das mulheres. Sem desconsiderar o aspecto socioeconômico das famílias dos RNs que fizeram parte do estudo, os resultados mostram que apesar da cobertura ser elevada, a assistência pré-natal no município necessita ser revista em sua qualidade para reduzir sobretudo a ocorrência de patologias maternas durante a gestação e o nascimento de RNs prétermos e/ou com BPN, devendo ser redrobada a atenção durante o pré-natal às mulheres com história de desfechos gestacionais desfavoráveis. Outro aspecto a ser ressaltado é o índice elevado de cesarianas. Estes resultados servem de alerta aos enfermeiros e demais profissionais de saúde e autoridades responsáveis pela saúde do município do Rio Grande, ressaltando a importância da adoção de medidas para prevenir os principais fatores que levam aos desfechos indesejáveis.
This descriptive and exploratory study with quantitative boarding it was developed with 61 newborn children of risk interned in the neonatal intensive care unit of the University Hospital Dr. Miguel Riet Corrêa Jr. located at Rio Grande City - whose families were resident in the city of Rio Grande/RS. The data had been harvested in the period of April the September of 2005, using a semi-structured interview applied to the mothers during the period of internment of its children. The study it searched to identify the factors pre and perinatais that had influenced the birth conditions leading to the necessity of internment of the newborns. Amongst these they had been investigated the mothers social economic characteristics, demographic and biological, and the gestational and reproductive history of the mother and the conditions of birth of the child had been investigated, properly said. After the analysis of the data was verified that 60.7% of the newborn children that had been part of the study they had presented low weight to the birth and 49.2% were pre-terms. Of the newborns evaluated 62.3% they had been born for cesarean, being that of these 14.8% had been related as elective by the mothers. How much to social economic situation 85.2% of the mothers told familiar income to per catches inferior the two minimum wages, being that 75.4% of them did not exert remunerated activity. Of interviewed 83.6% told that lived with a partner and 47.5% had eight years of study. The majority of the women was of white color (68.9%) and had between 20 and 34 years (59%). Salient that 26.2% of the mothers had inferior age of 19 years. Of the women whom they had known to inform its weight before gestational period (56), 84.4% told to superior weight the 50 kg between interviewed mothers 41% were first pregnancy and 23% had related that already had three or more gestations. Of the women with history of previous pregnancy(36), 38.9% already had at least a pregnancy finished in abortion and 25% related to had an infant borned dead. History of BPN and previous pre-terms was related by 27, 8% and 38, 9% of these mothers, respectively. The majority of the women (93.4%) carried through the prenatal medical care, being that 59.6% related six or more consultations. Of attended women 66.7% they had initiated prenatal medical care in 1º the trimester of pregnancy. Between the pathologies most prevalent in the pregnancy is distinguished: Urinary Infection, anemia and the arterial hypertension for 49, 2%, 44.3% and 23% of the women. Without disrespecting the socio and economic aspect of the families of the newborns who had been part of the study, the results show that although the covering to be raised, the prenatal medical assistance in the city need to be reviewed in its quality to reduce over all the occurrence of the maternal pathologies during the gestation and the birth of pre-terms newborn children and/or with BPN, having to be redoubled the attention during the prenatal care to the women with history of favorable pregnancies outcomes. Another aspect to be salient is the high index of cesareans. These results serves as an alert to the nurses and of health and responsible authorities for the health of the city of Rio Grande, standing out the importance of the adoption of measures to prevent the main factors that lead to the outcomes undesirable.
Este estudio descriptivo, exploratorio con abordaje cuantitativo se desarrolló con 61 recién nacidos (RN) de riesgo internados en la Unidad de Tratamiento Intensivo Neonatal del Hospital Académico Dr. Miguel Riet Corrêa Jr.–cuyas familias eran residentes en el distrito municipal de Río Grande/RS. Los datos se escogieron en el período de abril a septiembre de 2005, usándose una entrevista segmentada aplicada a las madres durante el período de la internación de sus niños. El estudio buscó identificar los factores de antes y alrededor del nacimiento que influyeron en las condiciones del parto que arrebatan en la necesidad de internación del RN. Entre estos se investigó las características socioeconómica, demográfica y biológica maternas, el periodo de gestación y reproductivo de la madre y las condiciones del nacimiento del niño, bien marcadas. Después del análisis de los datos se verificó que 60,7% de RN que eran parte del estudio presentaron el peso bajo al nacimiento (BPN) y 49,2% eran los prematuros. De RNs estimados 62,3% nacieron por cesárea, y de estos 14,8% fueron electivas por las madres. En lo que pese a la situación socioeconómica 85,2% de las madres dijeron recibir sueldo familiar per capta inferior a dos sueldos mínimos, y 75,4% de ellas no ejercían actividades que generasen dinero. De las entrevistadas 83,6% de ellas residían con compañero y 47,5% tenían más de ocho años de estudio. La mayoría de las mujeres eran de color blanco (68,9%) y tenían entre 20 y 34 años (59%). Está puntiagudo fuera eso 26,2% de las madres tenían la edad inferior a 19 años. De las mujeres que conocieron informar su peso antes de la gestación (56), 84,4% decían obtener el peso superior a 50 Kg. Entre las madres entrevistadas 41% eran primíparas y 23% refirieron haber tenido tres o más gestaciones. De las mujeres con la historia de gestación anterior (36), 38,9% ya habían tenido por lo menos una gestación terminada en aborto y 25% referirán haber tenido nacido muerto. La historia de BPN y prematuros previos fue referida por 27,8% y 38,9% de esas madres, respectivamente. La mayoría de las mujeres (93,4%) realizó el prenatal, y 59,6% refirieron seis o más consultas. De las mujeres asistidas 66,7% empezaron el prenatal en el 1° trimestre de gestación. Entre las patologías más frecuentes en la gestación se destacan la infección urinaria, la anemia y la hipertensión arterial dicen 49,2%, 44,3% y 23% de las mujeres. Sin desconsiderar el aspecto socioeconómico de las familias de RNs que eran parte del estudio, los resultados muestran que además de la cobertura ser elevada, la asistencia prenatal en el municipio necesita de revisión en su cualidad para disminuir la ocurrencia de patologías maternas durante la gestación y el nacimiento de RNs prematuros y/o con BPN, siendo de demasiada atención durante el prenatal a las mujeres con resultados de gestaciones desfavorables. Otro aspecto a ser destacado es el índice alto de cesáreas. Estos resultados sirven como alarma a los enfermeros y otros profesionales de salud y a las autoridades responsables para la salud del distrito municipal de Río Grande, dando énfasis a la importancia de la adopción de medidas para prevenir los factores principales que resultan a los fines indeseables.

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Este estudo descritivo, exploratório com abordagem quantitativa foi desenvolvido com 61 recém-nascidos (RN) de risco internados na Unidade de Tratamento Intensivo Neonatal do Hospital Universitário Dr. Miguel Riet Corrêa Jr. - cujas famílias eram residentes no município do Rio Grande/RS. Os dados foram colhidos no período de abril a setembro de 2005, utilizando-se uma entrevista semiestruturada aplicada às mães durante o período de internação de seus filhos. O estudo buscou identificar os fatores pré e perinatais que influenciaram as condições de nascimento levando à necessidade de internação do RN. Dentre estes foram investigadas as características socioeconômicas, demográficas e biológicas maternas, a história gestacional e reprodutiva da mãe e as condições de nascimento da criança, propriamente ditas. Após a análise dos dados verificou-se que 60,7% dos RN que fizeram parte do estudo apresentaram baixo peso ao nascimento (BPN) e 49,2% eram pré-termos. Dos RNs avaliados 62,3% nasceram por cesariana, sendo que destas 14,8% foram referidas como eletivas pelas mães. Quanto à situação socioeconômica 85,2% das mães relatou renda familiar per capta inferior a dois salários mínimos, sendo que 75,4% delas não exercia atividade remunerada. Das entrevistadas 83,6% vivia com companheiro e 47,5% possuía mais de oito anos de estudo. A maioria das mulheres era de cor branca (68,9%) e tinha entre 20 e 34 anos (59%). Salienta-se que 26,2% das mães tinha idade inferior a 19 anos. Das mulheres que souberam informar seu peso pré-gestacional (56), 84,4% relatou peso superior a 50 Kg. Entre as mães entrevistadas 41% eram primíparas e 23% referiram já ter tido três ou mais gestações. Das mulheres com história de gestação anterior (36), 38,9% já havia tido no mínimo uma gestação finalizada em aborto e 25% referiu ter tido natimortos. História de BPN e pré-termos prévios foi referida por 27,8% e 38,9% dessas mães, respectivamente. A maioria das mulheres (93,4%) realizou o pré-natal, sendo que 59,6% referiu seis ou mais consultas. Das mulheres assistidas 66,7% iniciaram o pré-natal no 1º trimestre de gestação. Entre as patologias mais prevalentes na gestação destacam-se a infecção urinária, a anemia e a hipertensão arterial relatadas por 49,2%, 44,3% e 23% das mulheres. Sem desconsiderar o aspecto socioeconômico das famílias dos RNs que fizeram parte do estudo, os resultados mostram que apesar da cobertura ser elevada, a assistência pré-natal no município necessita ser revista em sua qualidade para reduzir sobretudo a ocorrência de patologias maternas durante a gestação e o nascimento de RNs pré- termos e/ou com BPN, devendo ser redrobada a atenção durante o pré-natal às mulheres com história de desfechos gestacionais desfavoráveis. Outro aspecto a ser ressaltado é o índice elevado de cesarianas. Estes resultados servem de alerta aos enfermeiros e demais profissionais de saúde e autoridades responsáveis pela saúde do município do Rio Grande, ressaltando a importância da adoção de medidas para prevenir os principais fatores que levam aos desfechos indesejáveis.
This descriptive and exploratory study with quantitative boarding it was developed with 61 newborn children of risk interned in the neonatal intensive care unit of the University Hospital Dr. Miguel Riet Corrêa Jr. located at Rio Grande City - whose families were resident in the city of Rio Grande/RS. The data had been harvested in the period of April the September of 2005, using a semi-structured interview applied to the mothers during the period of internment of its children. The study it searched to identify the factors pre and perinatais that had influenced the birth conditions leading to the necessity of internment of the newborns. Amongst these they had been investigated the mothers social economic characteristics, demographic and biological, and the gestational and reproductive history of the mother and the conditions of birth of the child had been investigated, properly said. After the analysis of the data was verified that 60.7% of the newborn children that had been part of the study they had presented low weight to the birth and 49.2% were pre-terms. Of the newborns evaluated 62.3% they had been born for cesarean, being that of these 14.8% had been related as elective by the mothers. How much to social economic situation 85.2% of the mothers told familiar income to per catches inferior the two minimum wages, being that 75.4% of them did not exert remunerated activity. Of interviewed 83.6% told that lived with a partner and 47.5% had eight years of study. The majority of the women was of white color (68.9%) and had between 20 and 34 years (59%). Salient that 26.2% of the mothers had inferior age of 19 years. Of the women whom they had known to inform its weight before gestational period (56), 84.4% told to superior weight the 50 kg between interviewed mothers 41% were first pregnancy and 23% had related that already had three or more gestations. Of the women with history of previous pregnancy(36), 38.9% already had at least a pregnancy finished in abortion and 25% related to had an infant borned dead. History of BPN and previous pre-terms was related by 27, 8% and 38, 9% of these mothers, respectively. The majority of the women (93.4%) carried through the prenatal medical care, being that 59.6% related six or more consultations. Of attended women 66.7% they had initiated prenatal medical care in 1º the trimester of pregnancy. Between the pathologies most prevalent in the pregnancy is distinguished: Urinary Infection, anemia and the arterial hypertension for 49, 2%, 44.3% and 23% of the women. Without disrespecting the socio and economic aspect of the families of the newborns who had been part of the study, the results show that although the covering to be raised, the prenatal medical assistance in the city need to be reviewed in its quality to reduce over all the occurrence of the maternal pathologies during the gestation and the birth of pre-terms newborn children and/or with BPN, having to be redoubled the attention during the prenatal care to the women with history of favorable pregnancies outcomes. Another aspect to be salient is the high index of cesareans. These results serves as an alert to the nurses and of health and responsible authorities for the health of the city of Rio Grande, standing out the importance of the adoption of measures to prevent the main factors that lead to the outcomes undesirable.
Este estudio descriptivo, exploratorio con abordaje cuantitativo se desarrolló con 61 recién nacidos (RN) de riesgo internados en la Unidad de Tratamiento Intensivo Neonatal del Hospital Académico Dr. Miguel Riet Corrêa Jr. – cuyas familias eran residentes en el distrito municipal de Río Grande/RS. Los datos se escogieron en el período de abril a septiembre de 2005, usándose una entrevista segmentada aplicada a las madres durante el período de la internación de sus niños. El estudio buscó identificar los factores de antes y alrededor del nacimiento que influyeron en las condiciones del parto que arrebatan en la necesidad de internación del RN. Entre estos se investigó las características socioeconómica, demográfica y biológica maternas, el periodo de gestación y reproductivo de la madre y las condiciones del nacimiento del niño, bien marcadas. Después del análisis de los datos se verificó que 60,7% de RN que eran parte del estudio presentaron el peso bajo al nacimiento (BPN) y 49,2% eran los prematuros. De RNs estimados 62,3% nacieron por cesárea, y de estos 14,8% fueron electivas por las madres. En lo que pese a la situación socioeconómica 85,2% de las madres dijeron recibir sueldo familiar per capta inferior a dos sueldos mínimos, y 75,4% de ellas no ejercían actividades que generasen dinero. De las entrevistadas 83,6% de ellas residían con compañero y 47,5% tenían más de ocho años de estudio. La mayoría de las mujeres eran de color blanco (68,9%) y tenían entre 20 y 34 años (59%). Está puntiagudo fuera eso 26,2% de las madres tenían la edad inferior a 19 años. De las mujeres que conocieron informar su peso antes de la gestación (56), 84,4% decían obtener el peso superior a 50 Kg. Entre las madres entrevistadas 41% eran primíparas y 23% refirieron haber tenido tres o más gestaciones. De las mujeres con la historia de gestación anterior (36), 38,9% ya habían tenido por lo menos una gestación terminada en aborto y 25% referirán haber tenido nacido muerto. La historia de BPN y prematuros previos fue referida por 27,8% y 38,9% de esas madres, respectivamente. La mayoría de las mujeres (93,4%) realizó el prenatal, y 59,6% refirieron seis o más consultas. De las mujeres asistidas 66,7% empezaron el prenatal en el 1° trimestre de gestación. Entre las patologías más frecuentes en la gestación se destacan la infección urinaria, la anemia y la hipertensión arterial dicen 49,2%, 44,3% y 23% de las mujeres. Sin desconsiderar el aspecto socioeconómico de las familias de RNs que eran parte del estudio, los resultados muestran que además de la cobertura ser elevada, la asistencia prenatal en el municipio necesita de revisión en su cualidad para disminuir la ocurrencia de patologías maternas durante la gestación y el nacimiento de RNs prematuros y/o con BPN, siendo de demasiada atención durante el prenatal a las mujeres con resultados de gestaciones desfavorables. Otro aspecto a ser destacado es el índice alto de cesáreas. Estos resultados sirven como alarma a los enfermeros y otros profesionales de salud y a las autoridades responsables para la salud del distrito municipal de Río Grande, dando énfasis a la importancia de la adopción de medidas para prevenir los factores principales que resultan a los fines indeseables.

Magister Curationis - MCur
Background: The neonatal period starts at birth and ends 28 days after birth, and is the most defence less period in the newborn's life. Improving newborn health is a priority for the Ministry of Health and Social Services (MoHSS) in Namibia. The national neonatal mortality rate stood at 21.80 per 1000 live births in the country, and Namibia was unable to attain Millennium Development Goal 4 which focused on reduction of the child mortality rate by two-thirds between 1990 and 2015. Aim: This study investigated the factors contributing to neonatal deaths at a national hospital in the Khomas region of Namibia, with the following objectives: (i) to identify causes of early neonatal deaths; (ii) to identify the causes of late neonatal deaths; and (iii) to identify avoidable and unavoidable factors contributing to neonatal deaths. Methodology: The study used a quantitative research approach with a retrospective descriptive design to investigate factors contributing to neonatal deaths. The primary data were collected from a population of 231 record files of all neonates who died during the period 1 January to 31 December 2013 while admitted to the national hospital before 28 completed days of life. Results: The study identified that of the neonates who died, 67.1% (n=155) were early neonatal deaths (during the first 0–7 days of life), while 32.9% (n=76) died during the late neonatal period (from 8–28 days of life). Of the neonates who died, 50.6% (n=117) were male and 48.48% (n=112) were female. The causes of early and late neonatal deaths were similar, although they happened at different stages. The causes of early neonatal deaths have been identified as respiratory distress syndrome (RDS) – 24.2% (n=56); neonatal sepsis – 12.1% (n=28); birth asphyxia – 11.7 % (n=27); congenital abnormalities – 14.7 % (n=34); hemorrhagic diseases of newborns – 3.9% (n=9); and unknown – 0.6% (n=1). Neonatal sepsis caused the highest number of late neonatal deaths 17.7 %,( n=41); followed by RDS – 7.4% (n=17); congenital abnormalities – 3.9% (n=9); birth asphyxia – 3.1% (n=7); birth trauma – 0.4% (n=1); and unknown factors – 0.4 % (n=1). The study revealed that avoidable factors related to healthcare providers had a severe impact on neonatal deaths, while congenital abnormalities were unavoidable factors. Conclusion: The study concluded that most neonatal deaths are related to actions or inactions of the healthcare providers and could be avoided. Recommendations: Based on the results of the study, further research is required to assess the knowledge, skills, and behaviors of the healthcare providers. Training and education about neonatal resuscitation needs to be carried out on a regular basis.

The hearing loss (HL) causes significant disturbance to the personal development and it is of high prevalence among the congenital deficiencies. The early detection and intervention are basic to minimize the damages caused for the HL. The newborn hearing screening (NHS) is an important alternative for the early detection of the HL. The objective of this work was promote the implantation of a program of optional newborn hearing screening , evaluating the auditory function of the newborn children, identifying the auditory alterations, the pointers of more frequent auditory risk and analyzing the factors that had intervened with the development of the considered program of NHS. The sample was composed in 225 newborn of a city hospital, evaluated in maternity and Neonatal Intensive Care Unit (NICU) by means of transient evoked otoacoustic emissions (TEOAE). The first auditory selection occurred before leaving the hospital. The 100 children who had failed in the first hearing screening would have to return in 15 days for a re-test. The children had been directed for the stage of diagnosis 10 that had remained with fail in the second hearing screening. Of four children that they had appeared for braistem evoked response audiometry (BERA) the auditory alteration was confirmed in all they. It does not have significant statistics difference between the groups with and without risk pointers in the first auditory selection, being this significant difference in the second selection. The children of the NICU had gotten, significantly, more resulted fail of what of the maternity. The result passes prevailed for the feminine sex and the right ear. It did not have significant difference between the results gotten after and before 24 hours of life. It was gotten the end of the stages proposals 14,22% of evasion with predominance for the group with risk pointers. It is concluded that one-third of the evaluated children had risk pointers to HL, being the permanence in NICU the most frequent. The occurrence of auditory alterations in the sample was superior to the related literature. Was gotten high fail results in the first hearing screening, which significantly had been reduced in the second hearing screening. Some factors, as environment of accomplishment, experience of the appraiser, participation of the team of the hospital and time of permanence of the newborn child in the joint lodging, had intervened with the results of the first hearing screening. The evasion in the second hearing screening and the stage of the diagnosis was the main difficulty found during the development of the program.
A deficiência auditiva (DA) acarreta transtornos significativos ao desenvolvimento pessoal e é de alta prevalência dentre as deficiências congênitas. A detecção e intervenção precoce são fundamentais para minimizar os prejuízos ocasionados pela DA. A triagem auditiva neonatal (TAN) é uma importante alternativa para a detecção precoce da DA. O objetivo deste trabalho foi promover a implantação de um programa de triagem auditiva neonatal opcional (TANO), avaliando a função auditiva dos recém-nascidos, identificando as alterações auditivas, os indicadores de risco auditivo mais freqüentes e analisando os fatores que interferiram no desenvolvimento do programa de TAN proposto. A amostra compôs-se de 225 recémnascidos de um hospital municipal, avaliados na maternidade e UTI Neonatal por meio de emissões otoacústicas evocadas transientes (EOAET). A primeira triagem auditiva ocorreu antes da alta hospitalar. As 100 crianças que falharam na primeira triagem auditiva deveriam retornar em 15 dias para reteste. Foram encaminhadas para a etapa de diagnóstico as 10 crianças que permaneceram com falha na segunda triagem auditiva. Das quatro crianças que compareceram para avaliação de Potencial Evocado Auditivo de Tronco Encefálico (PEATE) a alteração auditiva foi confirmada em todas elas. Não houve diferença estatisticamente significativa entre os grupos com e sem indicadores de risco na primeira triagem auditiva, sendo esta diferença significativa na segunda triagem. As crianças da UTI Neonatal obtiveram, significativamente, mais resultados falha do que as da maternidade. O resultado passa prevaleceu para o sexo feminino e para a orelha direita. Não houve diferença significativa entre os resultados obtidos antes e após 24 horas de vida. Obteve-se ao final das etapas propostas 14,22% de evasão, com predomínio para o grupo com indicadores de risco. Concluiu-se que um terço das crianças avaliadas tinham indicadores de risco para DA, sendo a permanência em UTI Neonatal o mais freqüente. A ocorrência de alterações auditivas na amostra foi superior à referida pela literatura. Obteve-se elevado número de resultados falha na primeira triagem auditiva, os quais foram significativamente reduzidos na segunda triagem. Alguns fatores como o ambiente de realização, a experiência do avaliador, a participação da equipe do hospital e o tempo de permanência do neonato no alojamento conjunto podem ter influenciado os resultados da primeira triagem auditiva. A evasão na segunda triagem auditiva e na etapa do diagnóstico foi a principal dificuldade encontrada durante o desenvolvimento do programa.