Dissertations / Theses on the topic 'Premature'

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Introdução: O choque séptico é uma importante causa de morbimortalidade em recém-nascidos prematuros. O lactato vem sendo estudado como marcador diagnóstico e prognóstico do choque, mas os estudos no período neonatal são escassos. Objetivo: Investigar se os níveis séricos de lactato podem predizer o risco de morte em prematuros com choque séptico. Métodos: Estudo retrospectivo, longitudinal, realizado na UTI Neonatal do Hospital das Clinicas da Faculdade de Medicina de Botucatu no período de janeiro de 2014 a dezembro de 2016, após aprovação do CEP. Foram incluídos todos os prematuros menores que 37 semanas, internados na UTI, com mais de 72 horas de vida, que apresentaram diagnóstico de choque séptico e dosagem do lactato sérico nas primeiras 48 horas do choque. Foram excluídos aqueles com malformações múltiplas, infecções congênitas e erros inatos do metabolismo. Variáveis estudadas: maternas, gestacionais, neonatais, agente etiológico e dosagem do lactato. Os prematuros foram comparados em dois grupos: sobrevida e óbito. Desfecho: óbito. Análise estatística: testes paramétricos e não paramétricos com significância estatística se p<0.05. Acurácia do lactato: sensibilidade, especificidade, valor preditivo positivo e negativo. Resultados: Dentre os 456 prematuros sobreviventes por mais de 72 horas, 130 apresentaram sepse tardia (28,5%) e destes, 36 choque séptico (28%). A mortalidade no choque foi de 42%. A positividade em hemocultura foi de 36% com predomínio de Gram-positivos no grupo sobrevida e de Gram-negativos no grupo óbito. A comparação entre os grupos sobrevida e óbito, respectivamente mostrou: idade gestacional 29,5sem vs 27,5sem (p=0.05); peso de nascimento 950g vs 900g (p=0.386), idade no diagnóstico do choque 11 dias vs 7 dias (p=0.071), uso de drogas vasoativas 52% vs 93% (p=0.011). Os níveis de lactato foram maiores no grupo óbito (1,2mmol/L vs 1,7 mmol/L; p=0.043). O lactato  4mmol/L apresentou boa acurácia na predição de morte diretamente relacionada ao choque (89%) com baixa sensibilidade, 33%, mas com especificidade e valor preditivo positivo de 100% e valor preditivo negativo de 88%. Conclusão: A incidência e mortalidade do choque séptico em prematuros foram altas, sendo os muito prematuros e os de extremo baixo peso os mais acometidos. Valores de lactato  4 mmol/L apresentaram boa acurácia na predição de morte, alta especificidade e alto valor preditivo positivo.
Introduction: Septic shock is an important cause of morbidity and mortality in premature infants. Lactate has been studied as a diagnostic and prognostic marker of shock, but studies in the neonatal period are scarce. Objective: To investigate if serum lactate levels can predict the risk of death in preterm infants with septic shock. Methods: Retrospective, longitudinal study performed at the Neonatal Intensive Care Unit (NICU) of the Clinics Hospital – Botucatu School of Medicine, from January 2014 to December 2016, after approval of the Ethics Committee. All preterm infants less than 37 weeks gestational age, with more than 72 hours of life, admitted at the NICU with diagnosis of septic shock and serum lactate dosage in the first 48 hours of shock were included. Those with multiple malformations, congenital infections and inborn errors of metabolism were excluded. Variables studied: maternal, gestational, neonatal, etiologic agent and lactate dosage. The preterm infants were compared in two groups: survival and death. Outcome: death. Statistical analysis: parametric and non-parametric tests with statistical significance if p<0.05. Lactate accuracy: sensitivity, specificity, positive and negative predictive value. Results: Among the 456 preterm infants who survived for more than 72 hours, 130 had late onset sepsis (28.5%) and of these 36 septic shock (28%). The shock mortality was 42%. The positivity in blood cultures was 36%, with a predominance of Gram-positive in the survival group and Gram-negative in the death group. The comparison between survival and death groups, respectively, showed: gestational age 29.5weeks vs 27.5 weeks (p=0.05); birth weight 950g vs 900g (p=0.386), age at shock diagnosis 11 days vs 7 days (p=0.071), vasoactive drugs 52% vs 93% (p=0.011). Lactate levels were higher in the death group (1.2mmol/L vs 1.7 mmol/L, p=0.043). Lactate ≥4 mmol/L showed good accuracy in predicting death directly related to shock (89%) with low sensitivity 33%, but with specificity and a positive predictive value of 100% and a negative predictive value of 88%. Conclusion: The incidence and mortality of septic shock in premature infants were high, and very premature and extremely low birth weight were the most affected. Values of lactate  4 9 mmol/L showed good accuracy in predicting death, high specificity and high positive predictive value.

O nascimento de crianças antes de completar as 37 semanas de idade gestacional, ou seja, o nascimento prematuro, constitui-se em um evento de preocupação global. Os prematuros tardios, aqueles nascidos entre 34 semanas e 36 semanas e seis dias de gestação, representam uma parcela significativa na prematuridade. Entretanto, os recém-nascidos pré-termo tardios não podem ser considerados como recém-nascidos próximos ao termo, pois fisiologicamente são imaturos e em razão disso geram maiores ocorrências de internações hospitalares e morbidades. Essas consequências da prematuridade tardia geram impacto na saúde pública. Sendo assim, o objetivo do presente estudo foi conhecer as condições ao nascimento de recém-nascidos pré-termo tardios. Trata-se de um estudo qualitativo, do tipo exploratório, cuja coleta de dados realizou-se em três unidades de Estratégia de Saúde da Família, no período de novembro de 2011 a dezembro de 2012, na cidade de Porto Alegre/RS, com 13 informantes, mães desses recém-nascidos prematuros tardios. Os dados utilizados neste estudo foram obtidos do banco de dados da pesquisa “O cuidado leigo e profissional na prematuridade: fatores culturais relacionados ao período gestacional e pós-natal”, a qual teve registro na Comissão de Pesquisa da Escola de Enfermagem da Universidade Federal do Rio Grande do Sul e aprovação do Comitê de Ética em Pesquisa da Prefeitura Municipal de Porto Alegre, com Parecer registrado sob número 001.039956.11.3. A análise de dados foi fundamentada no referencial da Análise Temática e de Padrões, compondo dois temas: complicações decorrentes da prematuridade tardia; e repercussões no crescimento e desenvolvimento. O primeiro tema mostrou que as complicações decorrentes da prematuridade tardia foram relacionadas à sífilis congênita, ao baixo peso, à icterícia, à anemia, à hipoglicemia e à gemelaridade. Essa condição de nascimento exigiu cuidados específicos, desse modo reafirmando que os pré-termo tardios não podem ser considerados bebês a termo. O segundo tema apresentou a prematuridade tardia como um fator que pode comprometer o crescimento e desenvolvimento da criança. A partir do conhecimento das condições de nascimento desses recém-nascidos, ressalta-se a importância de desenvolver protocolos de atenção à saúde do pré-termo tardio, bem como a capacitação dos profissionais que atuam neste contexto para promover um cuidado diferenciado e de qualidade a esses bebês e suas famílias.
Childbirth before achieving 37 weeks of pregnancy, which is known as premature birth, consists in an occurrence of global concern. The late-premature babies, those who are born between 34 weeks and 36 weeks and 6 days of pregnancy, represent a significant portion of prematurity. Nevertheless, the late-preterm newborns cannot be considered close to term newborns as physiologically they are immature and as a result of this, it has a higher incidence of hospital stays and deaths. These consequences of late prematurity give impact on the public health system. Thus, the aim of the present study was to get to know the birth conditions of late-preterm newborns. It refers to an explorative, qualitative study, which data was collected in three Family Health clinics in the period from November, 2011 until December 2012, in the city of Porto Alegre, RS, from 13 participants, mothers of the late-preterm newborns. The data used in this study were obtained from the databank of the investigation, ‘Lay and professional care in prematurity: cultural factors related to pregnancy and the post-natal period’, which was registered in the Investigation Committee of the Nursing School of the Federal University of Rio Grande do Sul and approved by the Investigations Ethical Committee of the Municipal Authority of Porto Alegre, appearing under the registration number 001.039956.11.3. The data analysis was founded in reference to Thematic Analysis and Patterns, composing of two topics: complications resulting from late prematurity and repercussions on growth and development. The first topic showed that the resulting complications of late prematurity were related to congenital syphilis, low weight, jaundice, anemia, hypoglycemia and multiple births. This birth condition demanded specific care, reaffirming those late-preterm babies cannot be considered as full-term babies. The second topic, presented late prematurity as a factor that can compromise the growth and development of the child. From the knowledge of the birth conditions of these newborns the importance of developing protocols to draw attention to the health of late pre-term babies is highlighted, as well as the abilities of these professionals perform in this area to promote differentiated good quality of care for these babies and their families.
El nacimiento de niños antes de completar las 37 semanas de edad gestacional, o sea, el nacimiento prematuro, constituye un evento de preocupación global. Los prematuros tardíos, aquellos nacidos entre 34 semanas y 36 semanas y seis días de gestación, representan un grupo significativo de prematuridad. Entre tanto, los recién nacidos pre-término tardíos no pueden ser considerados como recién nacidos cercanos al término, pues filosóficamente son inmaduros y debido a eso generan mayores problemas de internaciones hospitalarias y morbilidades. Esas consecuencias de prematuridad tardía generan un impacto en la salud pública. Debido a esto, el objetivo del presente estudio fue conocer las condiciones del nacimiento del recién nacido pre-término tardío. Se trata de un estudio cualitativo, de tipo exploratorio, cuya recolección de datos se realizó en tres unidades de Estrategia de Salud de la familia en el periodo de noviembre 2011 hasta diciembre 2012, en la ciudad de Porto Alegre, Rio Grande del Sur, con 13 informantes, madres de esos recién nacidos prematuros tardíos. Los datos utilizados en este estudio fueron obtenidos del Banco de datos de la investigación ‘El cuidado lego y profesional en la prematuridad: factores culturales relacionados al periodo gestacional y postnatal’, la cual tuvo registro en la comisión de investigación de la Escuela de Enfermería de la Universidad Federal de Rio Grande del Sur y aprobación del comité de ética en investigaciones de la Prefectura Municipal de Porto Alegre con opinión registrada bajo el número 001.039956.11.3. El análisis de datos fue fundamentado en el referencial del Análisis Temático y de Patrones, compuesto de dos temas: complicaciones decurrentes de la prematuridad tardía y repercusiones en el crecimiento y desenvolvimiento. El primer tema mostró que las repercusiones decurrentes de la prematuridad tardía fueron relacionadas con la sífilis congénita, el bajo peso, la ictericia, la anemia, la hipoglicemia y los partos múltiples. Esa condición de nacimiento exigió cuidados específicos, de esa forma reafirmó que los pre-término tardíos no pueden ser considerados bebés de término. El segundo tema presentó la prematuridad tardía como un factor que puede comprometer el crecimiento y el desenvolvimiento del niño. A partir del conocimiento de las condiciones de parto de esos recién nacidos, se resalta la importancia de desenvolver protocolos de atención a la salud del pre-término tardío, al igual que la capacitación de profesionales que actúan en este contexto para promover un cuidado diferenciado y de cualidad a esos bebés y a sus familias.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Fundação para o Desenvolvimento da UNESP (FUNDUNESP)
O Trabalho de Parto Prematuro (TPP) é uma grave intercorrência obstétrica que acomete de 5-10% das gestações. Embora sua etiologia seja multifatorial, a infecção da cavidade amniótica (CA) é um importante fator associado ao seu desencadeamento. Objetivo: Comparar a freqüência de infecção na cavidade amniótica de gestantes em TPP em relação a gestantes fora de trabalho de parto e correlacionar com os níveis de citocinas pró-inflamatórias no líquido amniótico (LA). Material e Métodos: Foram incluídas neste estudo 20 gestantes em TPP e 20 gestantes fora de trabalho de parto, com idades gestacionais pareadas. No grupo TPP, amostras de LA foram obtidas no momento da resolução da gestação ou durante amniocentese transabdominal. O grupo de gestantes fora de trabalho de parto foi constituído de pacientes com indicação de amniocentese transabdominal. Para avaliação da infecção na CA foram realizadas reações em cadeia da polimerase (PCR) para a detecção de Mycoplasma hominis, Ureaplasma urealyticum e do gene bacteriano RNAr 16S. Os produtos de RNAr 16S foram seqüenciados para a identificação da espécie bacteriana. Os níveis das citocinas inflamatórias, interleucina (IL)-1β, IL-6, IL-8 e fator de necrose tumoral (TNF-α) no LA foram quantificados por ensaio imunoenzimático (ELISA). Resultados: A incidência de TPP no período do estudo foi de 5,8%. No grupo TPP, a pesquisa de invasão microbiana da CA foi positiva para M. hominis (35,0%), U. urealyticym (10,0%) e gene RNAr 16S (30,0%), sendo todas as freqüências superiores às encontradas no grupo fora de trabalho de parto (p<0,05). Quanto às citocinas, níveis aumentados de IL-1β (p=0,03), IL-6 (p<0,001) e IL-8 (p<0,001) foram detectados no LA das pacientes em TPP em relação às gestantes fora de trabalho de parto. Além disso, amostras de LA, com presença de infecção, apresentaram níveis...
Preterm labor (PL) represents a serious obstetric complication whose rate is 5-10%. Although the PL etiology is multifactorial, intraamniotic infection is strongly associated to its occurrence. Objective: To compare the frequency of intraamniotic infection in women presenting PL with women not in labor and to correlate with inflammatory cytokines levels in amniotic fluid (AF). Material and Methods: Twenty women with PL and 20 women with same gestational age, but not in labor, were included in this study. AF samples of women in PL were collected at delivery or by amniocentesis. The control group was composed by women with indication for amniocentesis. The evaluation of intraamniotic infection was performed detecting Mycoplasma hominis, Ureaplasma urealyticum and the bacterial rRNA 16S gene using polymerase chain reaction (PCR). The PCR rRNA 16S products were sequenced for bacterial species identification. The IL-1β, IL-6, IL-8 and TNF-α levels in AF were measured by enzyme-linked immunoabsorbent assay (ELISA). Results: During the study period, PL rate was 5,8%. Intraamniotic infection in women with PL was positive for M. hominis (35,0%), U. urealyticum (10,0%) and bacterial rRNA 16S (30,0%). AF infection rates for all tested microorganism were superior in PL when compared to women not in labor (p<0,05). Regarding to the cytokine measurement, AF of PL women showed increased IL-1β (p=0,03), IL-6 (p<0,001) and IL-8 (p<0,001) levels in comparison to AF samples from women not in labor. Additionally, AF with infection presented increased levels of IL-1β e IL-6 (p=0,03). Conclusion: Women with PL present high frequency of intraamniotic infection when compared with women not in labor and such infection correlates with increased IL-1β e IL-6 AF levels.

Com este projeto pretendeu-se contribuir para o desenvolvimento e aperfeiçoamento da intervenção do Enfermeiro Especialista em Saúde Materna e Obstetrícia, no processo de cuidar da mulher/família aquando do nascimento prematuro. Tornar-se mãe e pai gera uma fase de transição no ciclo familiar e o casal ambiciona a vinda de um filho perfeito. Porém, a prematuridade vem dissolver as fantasias e os desejos. Assim, o momento de transição para a parentalidade de um casal com um filho prematuro exige um cuidar específico e personalizado. Com o estudo qualitativo aqui realizado concluiu-se que os enfermeiros têm o dever de conhecer, na sua singularidade, a família de quem cuidam, atuando em parceria de forma a responder eficazmente às necessidades da mesma, conferindo-lhes informações e conhecimentos de modo a facilitar e a capacitá-los para o processo de transição para a parentalidade, começando a estimulação das competências parentais ainda durante a gravidez; ABSTRACT This project aimed to contribute to the development and improvement of the midwife intervention, in the process of caring for the woman / family at the time of premature birth. Becoming a mother and father creates a transition phase in the family cycle and the couple aspires to have a perfect child. However, prematurity comes to dissolve fantasies and desires. Thus, the moment of transition to the parenting of a couple with a premature child requires specific and personalized care. With the qualitative study conducted here, it was concluded that midwives have a duty to know, in their singularity, the family they care for, acting in partnership in order to respond effectively to their needs, providing them with information and knowledge in order to facilitate and qualify them for the transition to parenting, beginning the stimulation of parenting skills even during pregnancy.

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Há evidências na literatura de que a permanência dos prematuros em incubadora, com o propósito de garantir sua sobrevida, pode gerar um impacto negativo para o vínculo mãe/filho. Na maioria das vezes a criança está sedada e as mães impossibilitadas do contato tátil e de oferecer cuidados. Há vários estudos de como as mães vivenciam essa situação, mas poucos centram-se no papel da voz materna que, nessas condições, é uma via disponível para o estabelecimento do vínculo com o bebê, fundamental para sua constituição subjetiva. Este estudo teve por objetivo analisar o conteúdo da fala e a voz das mães frente a seu parto e a seu filho prematuro, pacientes de incubadora. Os médicos responsáveis pelo pelos leitos das crianças da pesquisa também foram entrevistados com o intuito de avaliar seu papel na forma como a mãe subjetiva a criança neste contexto. Em até sete dias após a internação da criança na Unidade de Terapia Intensiva neonatal (UTIN), foi realizada uma primeira entrevista, aberta, com mães de prematuros que permaneciam na incubadora. Uma segunda entrevista ocorreu após a alta da incubadora. Os médicos responsáveis pelo leito da criança também foram entrevistados, afim de encontrar possíveis relações do discurso médico com o discurso materno. Observou-se, também, como e o que as mães diziam aos bebês e seus comportamentos quando elas falavam com eles. Os dados foram analisados qualitativamente, à luz da teoria psicanalítica. A característica mais presente nos relatos foi a necessidade de reconstruir a história do nascimento prematuro, de forma minuciosa. Frente à perplexidade da situação, as mães tentavam encadear os acontecimentos, recordando detalhes, organizando sua história e tentando preencher com palavras e números o vazio e a angústia do não-saber. Ao “falar a criança”, as características físicas se sobrepunham a outras peculiaridades subjetivas, denotando dificuldade de simbolização diante do real do corpo da criança. Foi frequente recorrer a termos técnicos e ao uso de significantes que evidenciavam sua condição de fragilidade. Todas as mães relataram “falar com a criança” desde a gestação. Apesar do contato ser mediado por aparelhos e do toque estar praticamente excluído, as mães permaneciam próximas à incubadora, apostavam na importância de sua presença, falando em manhês com seus filhos, falas carregadas de afeto. Para elas, os comportamentos das crianças, assim como as mudanças cardíacas e respiratórias observadas nos aparelhos de monitoração, tinham um propósito e eram interpretados como reação à sua presença e à sua voz. As respostas as alimentavam narcisicamente, retroalimentando um diálogo e devolvendo o lugar roubado pelo nascimento prematuro. Na segunda entrevista, na Unidade de Cuidados Especiais (UCE), a voz e o discurso denotavam que as mães estavam mais tranquilas; as crianças eram incluídas nas entrevistas e nos planos de um futuro próximo. Estar mais longe dos riscos, possivelmente, permitiu algumas elaborações e enunciações caladas pelo trauma da prematuridade. Ter a criança nos braços foi apontado como mágico, apesar de algumas referirem insegurança, sem a proteção da incubadora. Os médicos, sempre presentes na cena de cuidado do recém-nascido prematuro, tinham a preocupação em transmitir o maior número de informações possível, contudo observou-se grande empenho em informar e dificuldade para lidar com questões subjetivas, que a condição da UTIN exigia. Na UCE a equipe incentivava as mães a assumir os cuidados, contudo cuidar não era fácil, apesar de trazer a sensação de ser mais mãe. Os dados apontam para a importância que as mães dão à sua voz no estabelecimento e manutenção do vínculo da díade, mesmo quando separadas da criança pela incubadora, durante um período fundamental da constituição do sujeito. Apesar do ambiente da UTIN não ter sido projetado para favorecer a maternagem, tanto pela formação de pessoal como organização do serviço e isso possa trazer consequências para constituição da subjetividade dos bebês, observou-se um esforço das mães de pressupor ali um sujeito, para além da prematuridade e manter o vínculo com os filhos prematuros, quando ainda permaneciam na incubadora.
There is evidence in the literature of the negative impact that keeping premature babies in incubators - to ensure they will survive - can cause to mother-child bonding. Most of the times, the child is sedated and the mother cannot offer tactile contact or care. There are many studies on how mothers manage this situation, but only a few focus on the mother’s voice, that is, in these conditions, an available way to bonding with the baby, which is essential to their subjective constitution. The present study’s aim was to understand mothers’ perception of premature delivery, their role during the child’s stay in the incubator and their interaction with the babies. In up to seven days after the internment in the Neonatal Intensive Care Unit (NICU), an open interview with mothers of newborns in incubators was held. A second interview took place after the discharge from the incubator. The doctors responsible for each crib were also interviewed in an attempt to find possible correlations between the medical and the maternal speech. It was also observed what mothers told their babies, how they did it and their behavior while talking to them. A qualitative analysis of data was done according to the psychoanalysis theory. The need to rebuild minutely the premature newborn story was the most common feature in the mothers’ report. Facing the perplexity of the situation, mothers tried to connect moments by recalling details, organizing their story and trying to fill up the emptiness and the not-knowing anguish with words and numbers. When talking about the child, physical characteristics superposed other subjective peculiarities, making it difficult to symbolize before the child’s real body. Searching for technical terms and significants that made their fragile condition evident was recurrent. All mothers said that they talked to the child since pregnancy. Although contact is mediated by equipment and touch is basically inexistent, moms kept close to the incubator once they believed their presence was important, talking to their children in mommy talks full of care. For them, the child’s behavior, as well as cardiac or respiratory changes seen in the monitoring, had a purpose and was interpreted as reaction to her presence and her voice. Answers fed them in a narcissist way, empowering some dialogues and giving back the place that was stolen by the premature birth. In the second interview, at the Special Care Unit (SCU), voice and speech showed mothers were more at ease; children were part of the interviews and of near future plans. Being further away from the risks possibly allowed elaboration and enunciation concealed by the trauma of prematurity. Having their children in their arms was pointed out as something magical, although some mothers referred to insecurity without the incubator’s protection. Doctors, always around in the premature newborn scenario, worried about offering as much information as possible, but, despite of the engagement in informing, there was difficulty in dealing with subjective matters, which was an NICU condition. At the SCU, the team encouraged mothers to take over, but taking care was not easy, despite the feeling of being more mom. Data suggest mothers value their voice in stablishing and maintaining the dyad bonding, even when they are apart from the child in the incubator during a critical period for the subject constitution. Although the environment at the NICU was not designed to favor maternity, both because of staff educational background and lack of service organization - and this can pose consequences to the constitution of babies’ subjectivity, the mothers’ effort to presuppose a subject, beyond prematurity was noted, and an effort to keep the bonding to the premature children when they were kept in the incubator.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
Este trabalho teve como objetivo mensurar a produção de hidroperóxidos e a capacidade antioxidante do plasma de cabras e seus cabritos, por meio do teste d-ROMs (Reactive Oxygen Metabolites) e BAP (Biological Antioxidant Potential), após as cabras serem submetidas a diferentes protocolos de corticoterapia antenatal, os animais foram aleatoriamente alocados em quatro grupos experimentais: grupo I - constituído por quatro cabras e sete cabritos, com uma única dosagem de 20 mg de dexametasona, por via IM/SID, dois dias antes da cirurgia eletiva (139 dias); grupo II - composto por quatro cabras e seis cabritos utilizando a dosagem de 2 mg de dexametasona, dos 133 aos 136 dias; 4 mg dos 137 aos 138; e 20 mg aos 139 dias de prenhes, por via IM/SID; grupo III - constituído por quatro cabras e sete cabritos, com dosagem de 16 mg de dexametasona aos 139, com doses repetidas a cada 12 horas até a cirurgia eletiva, por via IM/BID, e grupo IV - composto por quatro cabras e seis cabritos utilizando a dose de 4, 8, 16 e 20 mg de dexametasona, por via IM/SID, aos 137, 138, 139, 140 dias de gestação, respectivamente. Para analisar d-ROMs e BAP foram feitas coletas de sangue nas cabras por punção da veia jugular aos 15 minutos (M15) após o parto, e nos cabritos foram realizadas as coletas de sangue por punção da veia jugular nos respectivos momentos com referência ao nascimento de cada neonato: 15 minutos (M15), 24 horas (M24) e 48 horas (M48).
The objective of this work was to measure the production of hydroperoxides and the antioxidant capacity of goats and their goats by means of the d-ROMs test (Reactive Oxygen Metabolites) and BAP (Biological Antioxidant Potential), after the goats were submitted to different protocols of antenatal corticosteroid therapy, the animals were randomly assigned to four experimental groups: group I - consisting of four goats and seven goats, with a single dose of 20 mg of dexamethasone, IM / SID, two days before elective surgery (139 days); group II - composed of four goats and six goats using the dosage of 2 mg dexamethasone, from 133 to 136 days; 4 mg of 137 to 138; and 20 mg at 139 days of pregnancy, by IM/SID; group III - consisting of four goats and seven goats, with a dose of 16 mg of dexamethasone at 139, with repeated doses every 12 hours until elective surgery, by IM/BID, e group IV - composed of four goats and six goats using the dose of 4, 8, 16 and 20 mg dexamethasone, by IM / SID route, to the 137, 138, 139, 140 days of gestation, respectively. Blood samples were taken from the goats by puncture of the jugular vein at 15 minutes (M15) after calving and the kidneys were collected by puncturing the jugular vein at the respective moments with reference to the birth of each neonate: 15 minutes (M15), 24 hours (M24) and 48 hours (M48).
FAPESP: 16/00808-6

Projeto de Graduação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Licenciada em Enfermagem
O presente projeto aborda o tema da prematuridade e a experiência das mães perante a dificuldade de ter um filho que vem “antes de tempo”. A duração normal de uma gravidez é de 37 a 42 semanas, mas em algumas situações e devido a vários fatores existem bebés que nascem antes das 37 semanas de idade gestacional, sendo estes bebés designados de bebé prematuro ou pré-termo. O bebé prematuro nasce com uma imaturidade dos seus órgãos e sistemas (respiração, controlo da temperatura, digestão, metabolismo, etc.), o que o torna mais vulnerável a determinadas doenças, mais sensível a determinados fatores externos, como sejam a luz, a temperatura e o ruído, e com risco de vir a ter problemas de crescimento e desenvolvimento. Os bebés prematuros, principalmente os que nascem antes das 35 semanas de gestação ou que são de muito baixo peso, necessitam de uma atenção especial e de cuidados extraordinários para conseguirem amadurecer biologicamente e sobreviver fora do ambiente protetor que é o útero da mãe. Com este estudo pretende-se perceber como vivenciaram as mães a experiência do nascimento de um filho prematuro, o que na maioria das vezes é um acontecimento inesperado que envolve um misto de sentimentos por um lado uma enorme alegria, mas também, uma enorme insegurança e medo de perder o bebé. Para este estudo delineou-se o seguinte objetivo geral: “Saber qual é a experiência de ser mãe de um bebé prematuro” A metodologia utilizada neste estudo foi de carater exploratório e descritivo com abordagem qualitativa. A população são as mães de bebés prematuros e a amostra foi constituída por 11 mães que acederam em responder às nossas questões colocadas através de uma entrevista semi-estruturada. Os resultados mostram que ser mãe de um bebé prematuro é um acontecimento que surge muitas vezes de forma inesperada, suscitando sentimentos de alegria e júbilo mas também muita insegurança e medo de perder o filho. Apesar de ser um acontecimento sofrido e vivido com sentimentos ambivalentes, as mães olham para o futuro destas crianças com preocupação mas também com muita esperança no seu desenvolvimento harmonioso e feliz.
The current project approaches the subject of prematurity and the experience of mothers placed before the difficulties of having a child that is born “before time”. The length of a normal pregnancy is between 37 to 42 weeks, however, in some situations and due to several factors, there are babies that are born before 37 weeks of gestational age, being therefore referred as premature or pre-term babies. A premature baby is born with immaturity of organs and systems (respiration, temperature control, digestion, metabolism, among others), which makes it more vulnerable to certain diseases and, also more sensitive to certain external factors such as light, temperature and noise, and being prone to having growth and development problems. Premature babies, especially those who are born before 35 weeks of gestation or those who have very low weight, need special attention and extraordinary care in order to mature biologically and survive outside the protecting environment that is the mother’s uterus. The aim of this study is to understand how the mothers have lived through the experience of having a premature baby, which is, most of the time, an unexpected event, with a mixture of feelings, on one hand, a great joy but, also, a great insecurity and fear of losing the baby. Therefore, for this study, the following general objective was set: “To know what is the experience of being the mother of a premature baby”. The methodology used in this study has an exploratory and descriptive character with a qualitative approach. The population is composed of premature babies’ mothers and the sample is comprised of 11 women who accepted to answer our questions placed through a semi-structured interview. The results show that being the mother of a premature baby is an event which comes, quite often, in an unexpected way, bringing both feelings of joy and rejoicing but also feelings of insecurity and fear of losing the baby. Although it is a harsh situation lived with ambivalent feelings, the mothers look at the future of these children with preoccupation but also hope in their happy and complete development.
N/A

Due to advances in prenatal and neonatal medicine, there has been an improved survival rate of premature children over the past decades. Unfortunately, the most premature children have poor neurological and cognitive prognoses. The aetiology for the high proportion of learning disabilities in very premature children, is however often unknown (Grunau, Whitfield, & Davis, 2002; Litt, Taylor, Klein, & Hack, 2005). There has been increased awareness of visual problems in premature children, and of visual problems related to learning and reading. The studies reported in this thesis address the development of visual function as well as reading ability in premature children. A series of visual functions, cognitive- and reading ability were evaluated in a group of typical Norwegian children (n= 87) in order to provide developmental trajectories for these functions. This group acted as the control group for a group of premature children (n= 37), of whom the majority (n= 25) came from an established cohort of extremely premature children from the National Hospital in Oslo. Finally, an intervention study for treatment of binocular visual problems for a subgroup of premature and typical children (n= 27) was executed. Even when controlling for age, gender and cognitive ability, visual functions were generally weaker in the premature group. Deficiencies found in this group showed patterns that can be related to close work in one plane; a Planar component, and to focusing and binocular abilities; a Depth component. We have shown that convergence and fusion at close distances, which might interfere with near work, can be trained. There is also a possible improvement in ability to detect coherent motion as a result of this training. This ability might relate to learning and reading (Sigmundsson, Anholt, & Talcott, 2010; Stein, 2001). Thus more comprehensive visual examinations and treatment of deficiencies could lead to improved learning abilities in premature children.

Hormone replacement therapy (HRT) and the combined oral contraceptive pill (COCP) are both commonly used for oestrogen replacement in premature ovarian failure but there is a lack of evidence of their effects. We compared the effects of combined HRT (Nuvelle) and the COCP (Microgynon 30) in 30 women with premature ovarian failure in a two year open-label randomised trial. 29 women who declined to take treatment were also followed using the same protocol. 36 women (61%) completed the trial (15 in the no treatment group; 12 in the HRT group; 9 in the COCP group). In comparison with the COCP, treatment with HRT increased bone mineral density at the lumbar spine at 2 years, which was the primary outcome measure (+0.038 g/cm2; 95% CI 0.002 to 0.073; p 0.040; linear regression using adjustment for baseline values). Bone turnover markers (P1NP and CTX) showed similar reductions in the two treatment groups. There were trends in favour of HRT in lipid profile, high sensitivity C-reactive protein, blood pressure and sexual function. The HRT group had a significantly greater reduction in menopausal symptoms at 24 months. Improvements in most symptom scores took longer in the COCP group. In the no treatment group, bone density dropped at all sites over the course of the trial. The no treatment group also performed poorly in comparison with the treatment groups in bone turnover, depression score and menopausal symptoms score. These findings will have important implications for counselling young women with premature ovarian failure on their choice of oestrogen replacement. We have shown that in many respects HRT performed superiorly to the COCP. However, further research is required to confirm these effects. The results from the no treatment group will enable women who choose to decline treatment to be counselled on the effects of this choice of management.

Objetivo: Avaliar as lesões placentárias encontradas em gestantes com SAF e correlacionar com as intercorrências na gestação e repercussões perinatais. Casuística e Método: Foram acompanhadas 72 gestantes com diagnóstico confirmado de SAF, excluídas gestações gemelares e fetos mal-formados. Colhida placenta para análise histológica. O grupo SAF foi distribuído em três subgrupos baseando-se na história clíncia prévia e títulos de aCL e aL, e o risco de desenvolver trombose e insuficiência placentária na gestação, a saber: moderado, A(n=20), alto risco, B(n=37) e alto risco C(n=15). As pacientes foram tratadas com AAS 100mg/dia, suspensa com 36 semanas, e heparina, cuja dose era modificada de acordo com alterações na dopplervelocimetria obstétrica. Anotadas as intercorrências materno-perinatais e os achados no estudo anátomo-patológico das placentas com a aplicação de protocolo terapêutico. Um grupo de 32 gestantes normais serviu de controle. No subgrupo A, as pacientes não apresentavam colagenoses, outras trombofilias nem trombose prévia. No subgrupo B, 17 (46%) tinham LES;15(40%) fenômeno de Raynaud; 13(35%) toxemia; 12(32%) trombose prévia; nove (24,3%) outras trombofilias associadas e sete (19%) HAC. No subgrupo C, 14(93%) tinham tido trombose anterior, 4 (26,6%) LES e 2 (13,3%) outras trombofilias. As perdas fetais prévias eram 86,8%, 83% e 82,7% para subgrupos A, B e C, respectivamente. A média de início pré-natal foi de 11,8 semanas sem predominância entre os grupos. O início de AAS e heparina foi em média de 12,3 e 14,5 semanas de gestação respectivamente, igual nos subgrupos. Resultados: 1. As principais complicações maternas na média geral, foram: TPP (49,3%) e toxemia (25%). 2. Os resultados perinatais apresentaram: partos prematuros 44%; ILA diminuído 41%; SFA 40%; RCF 34%; oligoâmnio 31%.(1) e (2) semelhantes entre os subgrupos e com significância estatística com o grupo-controle. 3. A idade gestacional no parto foi em média de 35,8 semanas, e peso fetal 2493g, sem diferença estatística entre os subgrupos e grupo-controle. 4. Na análise microscópica predominou infartos com 60% das placentas afetadas, correlacionadas com alta incidência de resultados adversos nas gestações, assim como hiperplasia da camada média de ATV, 44,6%, com predomínio de RCF (60%) e prematuros (80%) no subgrupo C, necrose fibrinóide do trofoblasto com predomínio de ILA diminuído (60%) no subgrupo B, deposição maciça de fibrina perivilosa com predomínio de SFA (100%) no subgrupo A, vasculopatia trombótica fetal com predomínio de SFA (100%) e prematuros (75%) no subgrupo A e RCF (77%) no subgrupo B. Todas as lesões com significativa estatística em relação ao grupo-controle. Entre os subgrupos, a deposição maciça de fibrina perivilosa apresentou estatística significativa no subgrupo C em relação aos demais. 5. Conclusões: O protocolo terapêutico foi eficaz, porém ainda é elevado o índice de morbidades na gestação.A alta incidência de infartos e outras complicações trombóticas na placenta confirmam a agressão placentária e a necessidade de adequação nos protocolos de anticoagulação
Objective: Evaluate the placental injuries found in pregnant women with SAF and correlate with the morbidity in pregnancy and fetal repercussions. Methods: 72 pregnant women with SAF diagnosis were followed, except the twin pregnancies and inadequate formed fetus. Gathered placenta to histological examination. The SAF group was distributed in three subgroups based on the previous clinic history, aCL and aL titles, risk of thrombosis development and the placentary insuffiency in pregnancy to know: moderated, A (n=20); high risk, B (n=37) and even higher risk, C (n=15). The patients were treated with AAS 100mg/day, suspended within 36 weeks and enoxaparin which portion was modified according to the fetal placental circulation alteration on obstetric dopplervelocimetria. The outcome of pregnancy and placental pathological findings studies with the application of the therapeutic protocol were noted down.32 normal pregnant women were the control group. In subgroup A the patients did not presented any disease colagen or heritable thrombophilia.In subgroup B,17(46%) pacients presented LES; 15(40%) Raynaud phenomena; 13(35%) preeclampsia; 12(32%) had previous thrombosis; nine(24.3%) had other thrombophilia and seven(19%) HAC. In subgroup C, 14 (93%) pacients presented previous thrombosis; 4(26%) LES; 4(26%) HAC; 3(20%) preeclampsia; 3(20%) Raynaud phenomena and 2(13.3%) others thrombophilia. The previous fetus losses were 85%, 80% and 79% to subgroups A, B and C respectively. Prenatal started around 12 weeks with no advantage among the groups. Introduction of AAS and enoxaparin was 12 and 14 weeks respectively the same in subgroups. Results: 1. The main maternal complications in general were: TPP (49%) and toxemia (25%). 2. The fetal results presented: 44% early childbirth; 41% reduced ILA; 40% SFA; 34% RCF; 31% oligohydramnios. (1) e (2) similar between the subgroups and expressive statistic with the control group. 3. The pregnant age was in avarage 35,8 weeks with fetus weigh 2493g with no statistic differences between the subgroups and the control group. 4. In the microscopy analysis predominated infarcts with 60% of the placentas affected, correlated with the high incidence of adverse results in pregnancies, so as 44,6% reduction or obliteration of fetal stem vessels by mural hyperplasia; 60% RCF predominance and 80% early childbirth in subgroup C, fibrinoid necrosis trophoblast with reduced ILA predominance (60%) in subgroup B, massive perivillous fibrin deposition with SFA predominance (100%) in subgroup A, fetal thrombotic vasculopathy with SFA predominance (100%) and early birth (75%) in subgroup A and RCF (77%) in subgroup B. All the placental injuries with statistics significance related to the group control. Among the subgroups the massive perivillous fibrin deposition presented statistic significance in the subgroup C related to the others. Conclusions: The therapeutic protocol was effective, but is still high the morbidity indices among the pregnancies. The high incidences of infarcts and other thrombotic complications in the placenta confirm the placental aggression and the necessity of the adequation in the anticoagulation protocols

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Universidade Federal Fluminense. Hospital Universitário Antonio Pedro
Corpo de Bombeiros Militar do Estado do Rio de Janeiro
Atualmente, pode-se perceber um crescente aprimoramento na atenção prestada aos recém-nascidos de maneira geral e, de modo particular, aos recém-nascidos prematuros. É nítido o aumento da sobrevida de recém-nascidos, cada vez mais prematuros, em diversos lugares do mundo, incluindo o Brasil, o qual leva a diminuição dos limites de viabilidade. Diante de um cenário incerto, da possibilidade de graves sequelas e de sofrimento para o recém-nascido e sua família, a reanimação na sala de parto de um recém-nascido no limite de viabilidade envolve inúmeras questões bioéticas. Este estudo consistiu numa pesquisa qualitativa, na qual foram realizadas entrevistas semiestruturadas (em anexo) com os médicos da UTI neonatal de um Hospital de Ensino na Região Metropolitana do Rio de Janeiro que realizam salas de parto. Foram analisados aspectos relacionados à prática da assistência neonatal em sala de parto aos recém-nascidos extremamente prematuros, objetivando compreender os fatores associados à conduta médica diante destes recém-nascidos sob a ótica da bioética. O propósito deste trabalho é o de conhecer e analisar os valores éticos e/ou argumentos morais que embasavam a conduta médica ante ao nascimento de um recém-nascido no limite de viabilidade
Currently, it can be seen a growing improvement in the care provided to newborns in general and, particularly, to premature infants. It is clearly increased newborn survival of increasingly premature, in various parts of the world, including Brazil, which leads to decreased viability limit. Faced of an uncertain scenario, the possibility of serious consequences and suffering for the newborn and his/ her family, resuscitation in the delivery room of a newborn in the limit of viability involves numerous ethical issues. This study was a qualitative research in which semi-structured interviews with the doctors at the neonatal ICU of the University Hospital in a Metropolitan Region of Rio de Janeiro, who perform delivery rooms, were realized. There were analyzed practices related to aspects of neonatal care in the delivery room to extremely premature newborn, aiming at understanding the factors associated to medical management before these newborns from a bioethics perspective. The purpose of this work is to understand and analyze the ethical values and / or moral arguments which were based on a medical management before the birth of a newborn in the limit of viability

Approximately 1% of women will experience menopause before the age of 40, a condition known as premature ovarian failure (POF). The goal of this thesis was to identify genetic causes of POF by examining a number of candidate factors in POF patients and control women. Carriers of FMR1 premutations (55-200 CGG repeats) are known to be at increased risk of POF. A higher prevalence of alleles between 35-54 repeats was found among POF patients (p=0.01), suggesting that risk for POF may extend outside the classic premutation range. There was no evidence for any difference in FMRI promoter methylation or gene expression between cases and controls. Allele distributions of gene polymorphisms in the androgen receptor (AR), estrogen receptor (ß, sex hormone binding globulin, and FSH receptor genes did not differ between POF patients and controls. However, haplotype at the estrogen receptor a gene, ESRI, was found to be associated with POF in a simple dominant manner (RR=9.7; 95% CI=2.6-35.6). Although the functional effect of this haplotype could not be confirmed, it may confer a more active promoter that influences risk by increasing the rate of follicular atresia. X-chromosome inactivation (XCI) skewing can indicate an abnormal X chromosome and may therefore be increased in POF patients. There was no increase in skewed XCI >90% in patients with secondary amenorrhea, however, there was a significant increase in 4 POF patients with primary amenorrhea (p=0.001). No X-chromosome abnormalities were detectable by high resolution DNA microarray, and skewed XCI may be explained by a trisomic rescue event causing reduced follicular pool. Age-related chromosome factors were assessed to determine if POF patients demonstrate an increased rate of cellular aging. With age, XCI skewing and AR methylation increase and telomere length decreases. There was no difference in skewing or methylation between patients and controls. Surprisingly telomere length was increased in POF patients (p=0.04), a finding that may be explained by abnormal estrogen exposure. Genotype at the longevity-associated APOE gene was not associated with POF. In conclusion, these findings have illuminated several new areas of research in this field and provide background for future research into POF pathogenesis.

Premature infants represent 7% of all births in the UK and have higher rates of vaccine preventable infections. National recommendations for vaccine schedules focus predominantly on term infants. We aimed to assess the immunogenicity of the UK immunisation schedule in preterm infants randomising infants to 3 different PCV13 primary schedules and using data from the randomized controlled trial and a pooled data metaanalysis of preterm vaccine studies to identify factors affecting vaccine responses. Methods 210 infants «35 weeks gestation) received DTaP-IPV-Hib vaccine at 2, 3 and 4 months of age and meningococcal C conjugate vaccine at 2 and 3 months alongside 3 different PCV13 vaccine schedules (Group1: 2 and 4 months, Group 2: 2, 3 and 4 months, Group 3: 2,4 and 6 months). At 12 months of age participants received MMR, PCV13 and Hib-MenC-TI vaccines. Antibody concentrations and Iymphocyte subpopulations were measured before and one month after primary and booster vaccinations. Results The median birth gestation was 29+6 weeks (range 23+2-34+6). Younger gestation was associated with lower antibody concentrations at baseline but had limited effect on vaccine responses. For PCV13, group 3 had the highest antibody concentrations post-primary and prior to booster vaccination but the lowest antibody concentrations after the booster. There was no consistent effect of chronic lung disease, growth restriction or the receipt of blood products, antenatal or postnatal steroids on vaccine responses. For all antibodies a longer duration of vaccine course or an older age at final immunisation was associated with improved immunogenicity. Increased CD19+was associated with improved PCV13 immunogenicity Conclusion Premature infants can mount satisfactory responses to all routine vaccines but the schedule followed for PCV13 vaccine will significantly influence when optimal protection occurs. Disease epidemiology must be considered when deciding which schedule to follow.

Glioblastoma is the most common and fatal adult primary brain tumour. Despite maximum therapy, median survival time is 14 months after diagnosis. Senescence is a cellular stress response that results in irreversible growth arrest with continued metabolic activity. It has been shown to be a novel mechanism to inhibit tumorigenesis and tumor progression. However, the role of senescence in glioblastoma is poorly understood. Furthermore, resistance to therapy is believed to be in large part due to extensive heterogeneity in glioblastoma at the molecular level. While this has shed light on the biological understanding of glioblastoma, the impact of such heterogeneity in glioblastoma with respect to therapeutic mechanisms such as senescence induction is largely unknown and warrants further investigation. Primary glioblastoma cells constitute an important model of study as they are a closer representation of the parent disease. In the present study, previously isolated primary glioblastoma cells from human patients were characterized according to their molecular subtype by microarray expression analysis. PriGO7A, PriGO8A and PriGO9A cells were predominantly of the classical subtype whereas PriGO17A were predominantly mesenchymal. I investigated the response of these PriGO cells towards various stress inducing agents to determine their capability to undergo senescence. PriGO8A and PriGO9A cells underwent senescence in response to serum characterized by increased SAβGal activity, PML bodies, p21 and morphological changes characteristic of senescence. This occurred in the absence of a detectable DNA damage response as seen without an increase in γH2AX foci. There was also a lack of a senescence-associated secretory phenotype. Ionizing radiation, known to induce senescence in fibroblasts by inducing double stranded DNA damage, caused cell death but not senescence in PriGO8A and PriGO9A cells. Similarly, exposure of PriGO8A and PriGO9A cells to Triapine (an agent known to cause single stranded DNA damage) induced cell death without senescence. PriGO17A cells did not show evidence of cell death or senescence upon exposure to any of the above agents. In subsequent studies, I investigated the molecular mechanism responsible for induction of senescence in PriGO cells. Microarray expression analysis revealed that serum exposure in PriGO8A cells increased the expression of genes associated with the Transforming growth factor-β (TGFβ) pathway. The response of PriGO8A cells to serum was attributed at least in part to TGFβ that was dependent on basal expression of the TGFβ activator protein thrombospondin. PriGO7A cells lacked basal thrombospondin expression and did not undergo senescence in response to serum, but exhibited senescence in response to TGFβ. PriGO17A cells, on the other hand, exhibited senescence in response to TGFβ only when Ras activity was blocked. In conclusion, primary glioblastoma cells retain a functional senescence program capable of undergoing senescence in response to TGFβ, which suggests senescence can potentially be exploited therapeutically in glioblastoma. In addition, the response to therapeutic agents in glioblastoma is influenced by the molecular heterogeneity present in primary glioblastoma cells not only of different subtypes but also within the same subtype.

A soft, light-weight, beige, stuffed toy was placed in direct body contact with stable, 30-34 wk gestation infants. Length of hospitalization, l activity level, length of time to return to birth weight, and parent visiting rate were recorded for the randomly assigned 10 experimental and 10 control infants. Contrary to predictions, significant differences were found in the length of hospitalization and weight gain, with the control group being discharged sooner and returning to birth weight faster. No significant differences occurred in the parent visiting rate, and only minimal positive results were seen in the activity level for the experimental group. The disproportionate number of younger, smaller, sicker infants in the experimental group was believed to be a reason for these unexpected results.

Background. Improvements in postnatal care provided in neonatal intensive care units have resulted in increasing survive percentage of children born at the limits of viability. A large number of premature infants experienced major impairment and/or minor neurodevelopmental disabilities, such as cognitive, psychiatric and motor disorders. The etiology of these developmental deficits still remains not completely understood, but they may be the result of neonatal brain injury as well of interruption of the normal process of brain maturation that occurs during the last trimester of pregnancy, a critical period of prenatal ontogenesis. Prediction of the outcome of individual preterm infants is difficult. Although a premature infant may be asymptomatic for abnormal clinical signs, he may exhibit subtle alterations in brain activity which often remain unrecognized. A neurophysiologic evaluation of brain activity in the third trimester of gestation would probably be of great benefit for early detection of pathological processes or subclinical alterations. Electroencephalogram and cortical auditory evoked potentials turned out to be simple and useful techniques in evaluation of brain maturation. Aims. We conducted cross-sectional and longitudinal investigations at early crucial phases of development (35 and 40 weeks post-conception) in order to identify differences in cerebral activity between premature infants born at different gestational ages and full-term neonates, using electroencephalogram (EEG) at rest and cortical auditory evoked potentials (CAEP). We further aimed to correlate the neonatal data with later neurodevelopment. Methods. The research is divided into three studies: Study 1: EEG spectral activity was recorded at 35 post-conception weeks in 40 premature infants and compared between groups of infants born at different gestational age (“extremely low gestational age”, ELGA: 23–27+6, ‘‘very low gestational age’’, VLGA: 28–31+6 and “low gestational age”, LGA: 34-35). The results were correlated with behavioral developmental scores obtained at 12 months corrected age from 20 infants. Study 2: a subgroup of 10 infants of Study 1 repeated the EEG recording at 40 post-conception age. EEG spectral activity of this subgroup was compared longitudinally and further the activity recorded at 40 GA were compared with those of a group of 10 full-term infants. Study 3: CAEP were recorded in active sleep at 35 post-conception weeks in response to an auditory stimulation in 36 premature infants and compared between groups of infants born at different gestational age (ELGA, VLGA, LGA). The results were correlated with behavioral developmental scores obtained at 12 months corrected age from 20 infants. Methodology Study 1 and 2. Electrical brain activity was recorded for 40 minutes on 5 bipolar channels. Data were transformed into the frequency domain using a Fast Fourier Transform algorithm. Frequency spectrum was divided into the following bands: δ (0.5-4 Hz, comprising δ1 0.5-1 Hz and δ2 1-4 Hz), θ (4-8 Hz), α (8-13 Hz) and β (13-20 Hz). Statistical analysis were performed on absolute and relative power values only on central sites (C3-C4, C3-T3, C4-T4). Methodology Study 3. 1000 Hz (paradigm 1) and 500 Hz (paradigm 2) auditory stimulations were performed on continuous EEG recording. Design consisted of 300 tones for each paradigm. Inter-stimulus interval randomly varied between 600 and 900 ms; 12 monopolar channels were recorded, referenced to the bilateral linked ear lobes. 600 ms epochs were divided for statistical analysis in time windows of 100 ms. Statistical analysis were performed only on central sites (Fz, Cz). Results. Study 1. On C3-C4, relative spectral power values differed significantly between ELGA and LGA groups. Infants born at lower gestational ages had a higher amount of power in the δ and a lower amount of α and β spectral power. The preliminary data on those infants attaining 12 months of corrected age showed that higher amount of δ and a lower amount of β and α resulted associated with poor relational skills and personal self autonomies. Study 2. At 40 post-conception age, premature infants showed on C3-C4 a decrease in δ activity and a mild, not significant, increase in higher frequencies; no significant differences in spectral power values were found with full-term neonates. Study 3. In response to 1000 Hz tones no waveforms became evident on Fz in ELGA infants, while LGA presented a wide and slow positive response; the groups differed significantly. VLGA’s grand average waveform resembled that of LGA group, but characterized by a high variability. Responses to 500 Hz resulted highly variable and not reliable. Conclusions. We found early subtle brain electrical alterations in premature infants experiencing different developmental pathways, suggesting a different cortical organization; these differences seem to be associated with later development. The potential of neurophysiological methodologies is to provide a useful indicator of good prognosis or poor developmental outcomes.
Premesse. Gli avanzamenti tecnologici che negli ultimi decenni hanno caratterizzato le cure perinatali e le tecniche di terapia intensiva neonatale hanno permesso la sopravvivenza di una percentuale sempre maggiore di neonati prematuri nati ad età gestazionali sempre più basse, ai limiti della sopravvivenza. Eppure, studi sullo sviluppo a breve e lungo termine hanno dimostrato che molti neonati prematuri riportano esiti maggiori e/o disordini evolutivi minori, come deficit cognitivi e neuropsicologici, disturbi psichiatrici/comportamentali e motori. La causa di tali disordini dello sviluppo rimane poco chiara, ma può essere il risultato di sofferenza cerebrale in epoca neonatale come anche dell’interruzione del normale processo di sviluppo che avviene nel terzo trimestre di gravidanza, un periodo estremamente critico per la maturazione cerebrale. Predire come sarà lo sviluppo di un neonato prematuro rimane attualmente molto difficile. Infatti, sebbene un neonato possa essere asintomatico per segni clinici indicativi di una condizione patologica in atto, possono essere presenti alterazioni subcliniche del funzionamento cerebrale che spesso non vengono riconosciute. Una valutazione neurofisiologica dell’attività cerebrale nel neonato prematuro può probabilmente essere di grande utilità nel precoce riconoscimento di processi patologici o di alterazioni subcliniche. L’elettroencefalogramma (EEG) e i potenziali evocati uditivi corticali (CAEP) si sono dimostrati tecniche semplici e valide nel valutare la maturazione cerebrale. Obiettivi dello studio. Abbiamo condotto delle valutazioni neurofisiologiche trasversali e longitudinali in due fasi precoci e cruciali dello sviluppo (35 e 40 settimane postconcezionali) allo scopo di identificare differenze nell’attività elettrica cerebrale fra prematuri nati ad età gestazionali diverse e neonati a termine, usando EEG a riposo e i CAEP. Tali indagini in epoca neonatale sono state poi correlate con lo sviluppo comportamentale a distanza. Metodi. La ricerca è stata articolata in tre studi: Studio 1: è stata eseguita l’analisi spettrale dell’EEG registrato a 35 settimane postconcezionali in 40 neonati prematuri; tale attività è stata comparata fra gruppi di neonati nati ad età gestazionali diverse (estremi prematuri, ELGA: 23–27+6, veri prematuri, VLGA: 28–31+6 e prematuri, LGA: 34-35). I risultati ottenuti in epoca neonatale sono stati correlati con l’indice di sviluppo comportamentale ottenuto ai 12 mesi di età corretta nei primi 20 bambini che hanno raggiunto tale età. Studio 2: un sottogruppo di 10 neonati dello Studio 1 ha ripetuto la registrazione EEG a 40 settimane postconcezionali; la potenza spettrale ottenuta dalle registrazioni EEG a 35 e 40 settimane postconcezionali è stata cofrontata longitudinalmente; successivamente l’attività spettrale ottenuta alle 40 settimane postconcezionali è stata confrontata con quella di 10 neonati a termine alla nascita. Studio 3: i CAEP sono stati registrati in sonno attivo a 35 settimane postconcezionali in 36 prematuri e comparati fra gruppi di neonati nati ad età gestazionali diverse (ELGA, VLGA, LGA). I risultati sono stati correlati con l’indice di sviluppo comportamentale ottenuto ai 12 mesi di età corretta nei primi 20 bambini che hanno raggiunto quest’età. Metodologia Studio 1 e 2. L’attività elettrica cerebrale è stata registrata per 40 minuti su 5 canali bipolari. I dati ottenuti sono stati trasformati nel dominio delle frequenze utilizzando una trasformazione Fast Fourier. Lo spettro di frequenza è stato diviso nelle seguenti bande: δ (0.5-4 Hz, composto da δ1 0.5-1 Hz e δ2 1-4 Hz), θ (4-8 Hz), α (8-13 Hz) e β (13-20 Hz). Le analisi statistiche sono state eseguite sui valori di potenza assoluti e relativi ottenute solo dai siti centrali (C3-C4, C3-T3, C4-T4). Metodologia Studio 3. Durante la registrazione continua dell’EEG i neonati sono stati stimolati con treni di toni a 1000 Hz (paradigma 1) e a 500 Hz (paradigma 2). Il disegno sperimentale prevedeva 300 toni per ciascun paradigma. L’intervallo inter-stimolo variava in maniera casuale fra 600 e 900 ms; sono stati registrati 12 canali monopolari, riferiti bilateralmente ai lobi degli orecchi. Le epoche di 600 ms sono state divise per l’analisi statistica in finestre temporali di 100 ms. Le analisi statistiche sono state eseguite solo sui siti centrali (Fz, Cz). Risultati. Studio 1. In C3-C4, i valori di potenza spettrale relativa differivano significativamente fra i gruppi di ELGA e LGA. I neonati nati alle età gestazionali più basse avevano una maggiore potenza relativa in δ e una minore in α e β. La correlazione di questi dati con lo sviluppo comportamentale dei primi bambini che hanno raggiunto i 12 mesi di età corretta ha mostrato come alte percentuali di potenza in δ e basse in β e α fossero associate ad abilità relazionali più povere ed autonomie personali meno mature. Studio 2. A 40 settimane postconcezionali i prematuri hanno mostrato in C3-C4 una riduzione di potenza δ relativa e un lieve, non significativo, aumento di potenza nelle alte frequenze; non sono state trovate differenze significative rispetto i neonati a termine. Studio 3. Nel paradigma a 1000 Hz non è stato possibile rilevare nessuna risposta ai suoni nei neonati ELGA, mentre nei LGA in Fz era evidente una lenta ed ampia onda positiva; la grande media dei due gruppi differiva significativamente in Fz. La grande media dei neonati VLGA assomigliava a quella dei LGA, ma era caratterizzata da un’alta variabilità. Le risposte a toni di 500 Hz sono risultate troppo variabili e non riproducibili. Conclusioni. Confrontando neonati prematuri che hanno sperimentato linee di sviluppo differenti, abbiamo trovato delle differenze sottili nell’attività elettrica cerebrale che suggeriscono un’alterazione dell’organizzazione corticale. Tali differenze sembrano inoltre associate allo sviluppo comportamentale nel primo anno di vita. Questi risultati suggeriscono che le tecniche neurofisiologiche possano essere molto utili nella prognosi dei neonati prematuri.

Orientadores: Maria Francisca Colella dos Santos, Andrea Trevas Maciel Guerra
Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas
Made available in DSpace on 2018-08-15T10:05:40Z (GMT). No. of bitstreams: 1 Casali_RaquelLeme_M.pdf: 1957097 bytes, checksum: 0478a353098aaec7ddb8d41b65685008 (MD5) Previous issue date: 2010
Resumo: Introdução: O Potencial Evocado Auditivo de Tronco Encefálico (PEATE) é um exame objetivo de extrema importância no diagnóstico precoce de alterações auditivas em neonatos e lactentes, devido à dificuldade de se obter respostas audiológicas subjetivas fidedignas nessa população. Os dados normativos das respostas da população adulta para esse teste já estão bem estabelecidos na literatura. No entanto, os dados obtidos na população pediátrica, em especial referente aos prematuros, precisam ser mais estudados. O uso de critérios de normalidade para adultos na análise do PEATE de crianças pode levar a interpretação equivocada dos resultados devido à influência do processo de maturação do sistema auditivo. Nos últimos anos com o avanço da triagem auditiva neonatal e seguindo a preconização da detecção precoce de alterações auditivas houve um aumento da demanda de crianças muito novas para a conclusão do diagnóstico audiológico. Dessa forma, faz-se necessária a obtenção de dados normativos de neonatos e lactentes termos e prematuros para esse teste, os quais poderão ser utilizados como referência na interpretação dos resultados e, portanto, possibilitarão o aumento da precisão diagnóstica. Objetivos: Analisar o padrão de respostas de recém nascidos termos e prematuros para o PEATE, considerando os fatores gênero e orelha, e analisar a influência da maturação do sistema auditivo nas respostas eletrofisiológicas dessa população. Material e Métodos: Estudo de corte transversal e prospectivo. Foram avaliados 36 lactentes termos e 30 prematuros que permaneceram no alojamento conjunto, passaram no teste Emissões Otoacústicas Transientes, apresentaram curva timpanométrica tipo A e, com exceção da prematuridade, não apresentaram nenhum outro indicador de risco para perda auditiva. As avaliações ocorreram entre a alta hospitalar e o terceiro mês de vida, sendo constituídas por anamnese, medidas de imitância acústica e avaliação eletrofisiológica por meio do PEATE. Resultados: Na comparação das latências absolutas e interpicos das ondas I, III e V quanto às orelhas direita e esquerda foi observada diferença estatisticamente significante para o interpico I-III. Ao considerarmos o gênero masculino e feminino, não houve diferença significante para as latências absolutas e interpicos, tanto para os termos quanto para os prematuros. Na comparação das latências absolutas e interpicos entre prematuros e termos observou-se diferenças estatisticamente significantes para as latências absolutas das ondas I, III e V em 80 dB e da onda V em 60 e 20 dB. Verificou-se correlação inversa entre idade gestacional e latências absolutas. Foi observado que com o aumento da idade gestacional e consequentemente da maturação do sistema auditivo central ao nível do tronco encefálico ocorre uma diminuição contínua das latências absolutas de todas as ondas nos lactentes termos e prematuros. Essa diminuição está relacionada à progressiva mielinização das estruturas do sistema nervoso central. Conclusão: A maturação do sistema auditivo influencia as respostas do PEATE de neonatos e lactentes. Para evitar a interpretação equivocada dos resultados deve-se considerar a idade gestacional na análise do PEATE na população pediátrica
Abstract: Introduction: The Auditory Brainstem Response (ABR) is a very important objective test in early diagnosis of hearing impairment in newborns and infants due to the difficulty of obtaining reliable subjective auditory responses in this population. Normative data of the adult population's responses for this test are well established in the literature. However, the data for pediatric population, in particular concerning premature need to be further studied. The use of normality criteria for adults in the analysis of ABR in children can lead to misinterpretation of the results due to the influence of the auditory system's maturation. Nowadays, with the advance of newborn hearing screening and following the proposal of early detection of hearing impairment, there is an increased demand of very young children to complete the audiological diagnosis. Therefore, it is necessary to obtain normative data for term and premature newborns and infants for this test. These data can be used as a reference when interpreting the results and thus enable to increase the diagnostic accuracy. Objectives: To compare the ABR responses between full-term and premature children, considering gender and ear factors, and to analyze the influence of the auditory system maturation in the electrophysiological responses of this population. Methods: Transversal and prospective cohort study. We evaluated 36 full-term and 30 premature infants, who remained in the nursery, passed the Transient Otoacoustic Emissions test, presented tympanometric curve type A and, besides prematurity, did not have any other risk factors for hearing loss. The evaluations occurred between the discharge from the hospital and the third month of life, and consisted of history, acoustic immittance measures and evaluation of ABR. Results: Comparison of absolute and interpeak latencies of waves I, III and V on the right and left ears showed statistically significant difference in interpeak I-III, for which the values in the right ear were lower than in the left ear. In the comparison of absolute and interpeak latencies in relation to gender, there was no significant difference for the absolute and interpeak latencies for both full-term and premature infants, at all intensities evaluated. In the comparison of absolute and interpeak latencies between full-term and premature infants we observed statistically significant differences for absolute latencies of waves I, III and V at 80 dB and of wave V at 60 and 20 dB; for all intensities we observed longer latencies in premature. Inverse correlation was found between age and absolute latencies. It was observed that with gestational age increase, and hence of central auditory system's maturation at the brain stem, there is a continuous decrease of absolute latencies of all waves in terms and preterm infants. This decrease is related to the progressive myelination of the structures of central nervous system. Conclusions: Maturation of the auditory system influences the responses of the ABR of neonates and infants. To avoid misinterpretation of results, gestational age must be considered in the analysis of ABR in the pediatric population
Mestrado
Saude da Criança e do Adolescente
Mestre em Saude da Criança e do Adolescente

Este estudo teve como foco a vivência da família no método canguru (MC) com os seguintes objetivos: identificar o significado para mãe e família dessa experiência, compreender o funcionamento da dinâmica familiar decorrente da permanência da mãe e do filho no MC, apreender as transformações familiares provenientes da permanência no método e construir um modelo teórico sobre a experiência. A coleta de dados foi realizada por meio de entrevista e observação. Entrevistou-se 26 pessoas, membros de 18 famílias assistidas na enfermaria canguru no Hospital das Clínicas – UFMG. Utilizou-se como referencial teórico o Interacionismo Simbólico e como método a Grounded Teory. Dos dados emergiram os fenômenos; TENDO EVOLUÇÃO E DESFECHO NÃO ESPERADOS NA GESTAÇÃO, que é uma fase em que os pais se deparam com a gravidez e sofrem diante da gestação interrompida; DEPARANDO COM A PREMATURIDADE DO FILHO, em que os pais entram no mundo da prematuridade, constatando a necessidade de agir pela sobrevivência do filho, e VIVENDO A DECISÃO E A EXPERIÊNCIA JUNTO DO FILHO, que revela a possibilidade ou não de entrar e permanecer no MC hospitalar. A partir desses fenômenos, foi possível chegar à categoria central Pesando riscos e benefícios entre estar com o filho no canguru ou com a família.
This study focuses on the family way of life in the kangaroo method (KM) with the following objectives: to identify the meaning of this experience for mother and family, to understand the functioning of the family dynamics resulting from the mother and child’s permanence in this method, to capture family transformations in view of the permanence in the method, and to construct a theoretical model about the experience. Data were collected by means of interviews and observation. 26 persons were interviewed, who are part of 18 families who attend kangaroo nursing care at the Hospital das Clínicas of the Federal University of Minas Gerais (UFMG), Brazil. The study used Symbolic Interactionism as a theoretical reference base and Grounded Theory as a method. The following phenomena arose from these data: HAVING UNEXPECTED EVOLUTION AND OUTCOME IN PREGNANCY, which is a phase in which the parents suddenly confront the pregnancy and have to deal with a premature birth; CONFRONTING THE PREMATURITY OF THE CHILD, in which the parents enter the world of prematurity and confirm the need to act in favor of the child’s survival; and LIVING WITH THE DECISION AND THE EXPERIENCE TOGETHER WITH THE CHILD, which reveals whether or not the parents will decide to enter and stay at the hospital’s KM. From these phenomena, we arrived at the central category: Weighing the risks and benefits between staying with the child in kangaroo method or with the family.

A trajetória de desenvolvimento do neonato pré-termo se inicia no contexto da Unidade de Terapia Intensiva Neonatal, permeado pela presença contínua de diversos estímulos dolorosos. As experiências iniciais e repetidas de dor podem ter efeito em longo prazo para os neonatos vulneráveis. A Academia Americana de Pediatria e a Sociedade Pediátrica Canadense recomendam o uso da solução de sacarose como intervenção não-farmacológica para alívio de dor em neonatos, entretanto, a eficácia e segurança do uso continuado da sacarose necessitam de investigação. O presente estudo randomizado controlado duplo-cego teve por objetivos avaliar a eficácia da administração via oral da solução de sacarose a 25%, em esquema de doses repetidas no alívio da dor em neonatos pré-termo e avaliar os possíveis efeitos colaterais advindos do uso continuado da sacarose para os neonatos. Trinta e três neonatos pré-termo com muito baixo peso ao nascer foram distribuídos em dois grupos: Grupo Sacarose (n = 17) e Grupo Água (n = 16). Os neonatos foram avaliados durante quatro dias consecutivos, durante procedimento de punção para coleta de sangue. Cada avaliação foi dividida em cinco fases: Linha de Base, Preparação para Punção (antissepsia), Punção, Recuperação com Manuseio (curativo) e Recuperação sem Manuseio. O indicador de dor foi avaliado pela atividade facial, mensurada pelo Neonatal Facial Coding System (NFCS). O nível de ativação dos neonatos foi mensurado pelo estado de vigília e sono e pela frequência cardíaca. Na primeira avaliação, os neonatos de ambos os grupos não receberam nenhuma substância antes do procedimento doloroso. Nos três dias seguintes, o Grupo Sacarose recebeu 0,5ml/kg de sacarose oral e o Grupo Água recebeu água estéril, dois minutos antes de cada procedimento doloroso. Foram obtidos dados de evolução clínica dos neonatos nos prontuários médicos. Os resultados encontrados revelaram que no primeiro dia de avaliação os neonatos de ambos os grupos anteciparam a reação ao estímulo doloroso de punção, apresentando elevação significativa do escore do NFCS, do estado de vigília e sono e da frequência cardíaca, já na antissepsia, sendo que durante a recuperação a frequência cardíaca continuou elevada em comparação à fase de Linha de Base. A partir do segundo dia de avaliação, o Grupo Sacarose apresentou menores escores do NFCS e do estado de vigília e sono, durante o procedimento, em comparação ao Grupo Água. O indicador fisiológico de frequência cardíaca não apresentou diferença significativa entre os grupos, entretanto, a sacarose reduziu o tempo necessário para o neonato se recuperar e atingir a estabilidade fisiológica após passar pelo procedimento doloroso de punção. Não houve diferença significativa na evolução clinica dos neonatos de ambos os grupos, o que demonstra que a sacarose não causou efeitos colaterais em curto prazo aos neonatos. Conclui-se que a dose de 0,5ml/kg de solução de sacarose a 25% administrada em esquema de doses repetidas foi eficaz para o alívio da dor em neonatos pré-termo e não trouxe efeitos colaterais imediatos para o estado de saúde dos neonatos.
The development pathway of the preterm neonate begins in the context of the Neonatal Intensive Care Unit, permeated by the presence of several painful stimuli. Initial and repetitive pain may have long-term effect for vulnerable newborns. The American Academy of Pediatrics and Canadian Pediatric Society recommends the use of sucrose solution as non-pharmacological intervention for pain relief in neonates, however, the efficacy and safety of continued use of sucrose needs investigation. The present randomized controlled double-blind study aimed to assess the efficacy of oral administration of sucrose solution to 25% in repeated doses to relief pain in preterm neonates and to assess the possible side effects arising from the continued use of sucrose to newborns. Thirty-three preterm neonates with very low birth weight were divided into two groups: Sucrose Group (n = 17) and Water Group (n = 16). The newborns were assessed during four consecutive days during puncture procedure for blood collection. Each assessment was divided into five phases: Baseline, Antisepsis, Puncture, Dressing, and Recovery. The indicator of pain was assessed by facial activity, measured by the Neonatal Facial Coding System (NFCS). The level of activation of the neonates was measured by the sleep-wake states and heart rate. In the first assessment, the newborns of both groups did not receive any substance before the painful procedure. During the next three days, Sucrose Group received 0.5ml/kg of oral sucrose and Water Group received sterile water two minutes before each painful procedure. Clinical outcomes data of newborns were obtained in the medical records. The results showed that on the first day of assessment newborns of both groups have anticipated the reactivity to painful stimuli, with significant increase of NFCS score, sleep-wake states and heart rate as early as antisepsis, and during recovery heart rate remained increased in comparison to the Baseline phase. From the second day of assessment, the Sucrose Group had lower NFCS scores and sleep-wake states during the procedure, compared to the Water Group. The physiological indicator of heart rate showed no significant difference between groups, however, sucrose has reduced the time required for the infant to recover and achieve physiological stability after passing through the painful procedure of puncture. There was no significant difference in clinical outcome of newborn in both groups, demonstrating that sucrose did not cause short term side effects in neonates. The finding was that the dose of 0.5 ml/kg of sucrose solution to 25% administered in repeated doses was effective for pain relief in preterm and did not caused short term side effects to the health of newborns.

Orientador: Márcia Guimarães da Silva
Banca: José Antonio Simões
Banca: Maria Terezinha Serrão Peraçoli
Resumo: O Trabalho de Parto Prematuro (TPP) é uma grave intercorrência obstétrica que acomete de 5-10% das gestações. Embora sua etiologia seja multifatorial, a infecção da cavidade amniótica (CA) é um importante fator associado ao seu desencadeamento. Objetivo: Comparar a freqüência de infecção na cavidade amniótica de gestantes em TPP em relação a gestantes fora de trabalho de parto e correlacionar com os níveis de citocinas pró-inflamatórias no líquido amniótico (LA). Material e Métodos: Foram incluídas neste estudo 20 gestantes em TPP e 20 gestantes fora de trabalho de parto, com idades gestacionais pareadas. No grupo TPP, amostras de LA foram obtidas no momento da resolução da gestação ou durante amniocentese transabdominal. O grupo de gestantes fora de trabalho de parto foi constituído de pacientes com indicação de amniocentese transabdominal. Para avaliação da infecção na CA foram realizadas reações em cadeia da polimerase (PCR) para a detecção de Mycoplasma hominis, Ureaplasma urealyticum e do gene bacteriano RNAr 16S. Os produtos de RNAr 16S foram seqüenciados para a identificação da espécie bacteriana. Os níveis das citocinas inflamatórias, interleucina (IL)-1β, IL-6, IL-8 e fator de necrose tumoral (TNF-α) no LA foram quantificados por ensaio imunoenzimático (ELISA). Resultados: A incidência de TPP no período do estudo foi de 5,8%. No grupo TPP, a pesquisa de invasão microbiana da CA foi positiva para M. hominis (35,0%), U. urealyticym (10,0%) e gene RNAr 16S (30,0%), sendo todas as freqüências superiores às encontradas no grupo fora de trabalho de parto (p<0,05). Quanto às citocinas, níveis aumentados de IL-1β (p=0,03), IL-6 (p<0,001) e IL-8 (p<0,001) foram detectados no LA das pacientes em TPP em relação às gestantes fora de trabalho de parto. Além disso, amostras de LA, com presença de infecção, apresentaram níveis... (Resumo completo, clicar acesso eletrônico abaixo)
Abstract: Preterm labor (PL) represents a serious obstetric complication whose rate is 5-10%. Although the PL etiology is multifactorial, intraamniotic infection is strongly associated to its occurrence. Objective: To compare the frequency of intraamniotic infection in women presenting PL with women not in labor and to correlate with inflammatory cytokines levels in amniotic fluid (AF). Material and Methods: Twenty women with PL and 20 women with same gestational age, but not in labor, were included in this study. AF samples of women in PL were collected at delivery or by amniocentesis. The control group was composed by women with indication for amniocentesis. The evaluation of intraamniotic infection was performed detecting Mycoplasma hominis, Ureaplasma urealyticum and the bacterial rRNA 16S gene using polymerase chain reaction (PCR). The PCR rRNA 16S products were sequenced for bacterial species identification. The IL-1β, IL-6, IL-8 and TNF-α levels in AF were measured by enzyme-linked immunoabsorbent assay (ELISA). Results: During the study period, PL rate was 5,8%. Intraamniotic infection in women with PL was positive for M. hominis (35,0%), U. urealyticum (10,0%) and bacterial rRNA 16S (30,0%). AF infection rates for all tested microorganism were superior in PL when compared to women not in labor (p<0,05). Regarding to the cytokine measurement, AF of PL women showed increased IL-1β (p=0,03), IL-6 (p<0,001) and IL-8 (p<0,001) levels in comparison to AF samples from women not in labor. Additionally, AF with infection presented increased levels of IL-1β e IL-6 (p=0,03). Conclusion: Women with PL present high frequency of intraamniotic infection when compared with women not in labor and such infection correlates with increased IL-1β e IL-6 AF levels.
Mestre

I Sverige sker cirka 2500 transporter av nyfödda barn varje år. Socialstyrelsen publicerade i slutet av år 2013 en ny vägledning ”Vård av extremt tidigt födda barn”. Ett av de områden som har prioriterats är neonatala transporter. Betydelsen av en väl fungerande transportorganisation är nödvändig för att skapa en säker och jämlik vård för denna patientgrupp. Syftet med studien var att beskriva prematura och nyfödda barns påverkan av transport mellan sjukhus. Studien genomfördes som en litteraturstudie där 14 vetenskapliga artiklar analyserades. Fyra teman identifierades och besvarade frågeställningarna vad påverkar prematura och nyfödda barn under transport och hur påverkas de under transport, dessa var Höga ljudnivåer, Transportteamets kompetens, Uppvisar tecken på obehag samt Ökad risk för hjärnblödning. Genom att transportsjuksköterskan använder sig av NIDCAP kan påverkan på barnet minskas och transporten blir mindre stressande. Fler studier bör genomföras där fokus ligger på hur sjuksköterskans omvårdnadsåtgärder kan minska obehaget hos barnet under transport mellan sjukhus.
In Sweden, about 2.500 newborn infants are transportedeach year. In late 2013, the Swedish National Board of Health and Welfare (Socialstyrelsen)published a new guide, Care for Extremely Premature Babies (Vård av extremttidigt födda barn); in which one prioritized area were neonatal transports.The importance of an efficient transport organization is essential to create asafe and equal care fore these patients. The purpose of this study was todescribe the impact on preterm and newborn infants who are transported between hospitals.The study was conducted as a review of 14 academic articles. Two questions wereasked (what affects preterm and sicknewborn infants during transportation between hospitals; how are preterm and sick infant affected during transportationbetween hospitals) across four themes (High noise levels; Transport Team´s competence;Exhibition sign of discomfort; Increased risk of cerebral haemorrhage). Whenthe transport nurse uses NIDCAP, the effect on the infant may be reduced andthe transport less stressful. More studies should be conducted with a focus onhow nursing care measures can reduce anxiety to the infant during transportbetween hospitals.

Titel: En omvälvande erfarenhet för föräldrar- en litteraturstudie om att få ett för tidigt fött barn. Bakgrund: Cirka 5 % av alla barn som föds årligen i Sverige är för tidigt födda. Flera studiers resultat visar att det är påfrestande för föräldrar till för tidigt födda barn att vistas på en neonatalavdelning. Trots att detta ämne är väl beforskat visar nutida studier att det finns delar i omvårdnaden som kan förbättras. Syfte: Syftet med litteraturstudien var att beskriva föräldrars erfarenheter av tiden på en neonatalavdelning med deras förtidigt födda eller lågviktiga barn. Metod: En litteraturstudie genomförd med tolv artiklar med kvalitativt resultat. Resultat: Tre huvudkategorier och sex underkategorier identifierades. Huvudkategorierna innefattar: att få vara nära sitt barn, föräldrars behov av information, kommunikation och stöd och föräldrars erfarenhet av miljön på neonatalavdelningar. Konklusion: Sjuksköterskor har stor inverkan på hur föräldrar upplever tiden på neonatalavdelningen. En viktig uppgift för dem är att involvera föräldrar i vården och se dem som en del av deras barns vårdteam. Inte enbart för föräldrars skull utan även för barnens välmående.   Nyckelord: Föräldrar, neonatalavdelning, erfarenheter, prematur.
Title: A transformative experience for parents- a literature study about having a prematurely born infant. Background: Approximately 5 % out of all children born annually in Sweden are born prematurely. Several studies' results show that it is stressful for parents of premature infants to stay at a neonatal unit. Although this topic is well researched, recent studies show that there are parts of the care that could be improved. Aim: The aim of this study was to describe parents' experiences of the time spent at a neonatal unit with their premature or low birth weight infants. Methods: A literature study was conducted from twelve articles with a qualitative result. Results: Three main categories and six subcategories were identified. The main categories included: being allowed to be close to ones child, parents need of information, communication and support and parents experience of the enviorment at the neonatal unit. Conclusion: Nurses have a major impact on how parents perceive their time at the neonatal ward. An important task for them is to involve parents in the care and to see them as part of their child's healthcare team. Not only for the parents sake but also for the infant's well-being.   Keywords: Parents, NICU, experiences, premature.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico
Objetivos: avaliar a influÃncia da via de parto sobre os resultados perinatais, em mulheres que tiveram parto prematuro (PP); avaliar caracterÃsticas demogrÃficas e obstÃtricas como determinantes da via de parto. Sujeitos e mÃtodos: estudo transversal, a partir dos prontuÃrios de mulheres que tiveram PP, acompanhadas no ServiÃo de Medicina Materno-Fetal da Maternidade-Escola Assis Chateaubriand â Universidade Federal do CearÃ. Foram analisadas 195 gestantes e os 195 recÃm-nascidos (RNs) oriundos dessas gestaÃÃes, Ãnicas, sem complicaÃÃes clÃnicas maternas, fetais e obstÃtricas, apresentando idade gestacional (IG) entre 22 e 36 semanas e seis dias e com peso fetal igual ou acima de 500 gramas. As caracterÃsticas demogrÃficas e obstÃtricas e os resultados perinatais foram avaliados na populaÃÃo geral e em cada grupo (partos vaginal e abdominal), sendo posteriormente comparados entre si. Para a avaliaÃÃo estatÃstica comparativa entre os dois grupos, utilizou-se o teste de Mann-Whitney. O cÃlculo da razÃo de risco ajustado foi realizado atravÃs do software SAS versÃo 9.1.3 e atravÃs de RegressÃo LogÃstica e Multivariada. Todos foram considerados estatisticamente significantes quando p<0.05. Resultados: a maioria das gestantes (81.5%) foi admitida em trabalho de parto prematuro (TPP) ativo espontÃneo e 43.1% apresentaram bolsa rota. Agentes tocolÃticos e corticosteroides foram usados, respectivamente, em 41.6% e 58.3% das mulheres em prÃdromo de TPP e a maioria dos partos (74.4%) ocorreu por via vaginal. No momento do parto, a IG mÃdia foi 32.6 semanas. Quando os dois grupos foram comparados, o prÃdromo de TPP, a bolsa rota e a administraÃÃo de tocolÃticos e corticoides aumentaram, significativamente, o risco de cesÃrea (RRs 6.10, 1.64, 1.95 e 1.82, respectivamente), enquanto o TPP ativo diminuiu, significativamente, esse risco (RR 0.16, IC 95% - 0.11 a 0.25). O peso mÃdio dos RNs foi 1873g, sendo classificados como adequados para IG em 76.7%. Necessitaram de internamento em UTI 62.1% dos casos, 21% usaram surfactante, 90.8% necessitaram de ventilaÃÃo mecÃnica, 4.6% apresentaram tocotraumatismos e o Ãndice de Ãbito neonatal foi de 8.7%. Quando se compararam os dois grupos, a cesÃrea aumentou, significativamente, a chance do Ãndice de Apgar ao 5Â minuto ser ≥ 7 (RR 1.06, IC 95% - 1.01 a 1.13). ApÃs regressÃo logÃstica de COX, ajustada para fatores que poderiam influenciar nos resultados perinatais, nÃo foram observadas diferenÃas estatisticamente significativas entre os dois grupos. ConclusÃes: nÃo foram encontradas diferenÃas estatisticamente significativas nos resultados perinatais entre RNs de partos vaginal e abdominal de mulheres que tiveram parto prematuro. Quanto Ãs caracterÃsticas obstÃtricas, o prÃdromo de TPP, a bolsa rota e o uso de agentes tocolÃticos e corticoides aumentaram, significativamente, o risco de cesÃrea, enquanto o TPP ativo diminuiu, significativamente, esse risco.
Objectives: to evaluate the influence of route of delivery on perinatal outcomes, in women who had preterm delivery; to evaluate demographic and obstetric characteristics as determinants of mode of delivery. Subjects and methods: it is a cross-sectional study from the charts of women who had preterm delivery, followed in the Service of Maternal-Fetal Medicine of Maternidade-Escola Assis Chateaubriand â Universidade Federal do CearÃ. There were analyzed 195 pregnant women and 195 newborns coming from these singleton pregnancies, without clinical maternal, fetal and obstetric complications, presenting gestational age between 22 and 36 weeks and six days and fetal weight equal or above 500 grams. Demographic and obstetric characteristics and perinatal outcomes were evaluated in the general population and in each group (vaginal and abdominal delivery), being later compared with each other. For comparative statistical analysis among the two groups, it was utilized the Mann-Whitney test. The calculation of the reason of adjusted risk was accomplished through the software SAS version 9.1.3 and through Logistical and Multinomial Regression. All were considered statistically significant when p < 0.05. Results: the majority of pregnant women (81.5%) was admitted in active spontaneous preterm labor and 43.1% had premature rupture of the membranes. Tocolytic agents and corticosteroids were used, respectively, in 41.6% and 58.3% of women in false preterm labor and most of deliveries (74.4%) happened by vaginal route. At the moment of delivery, the average gestational age was 32.6 weeks. When the two groups were compared, false preterm delivery, premature rupture of the membranes and the administration of tocolytic drugs and corticosteroids increased, significantly, the risk of cesarean section (RRs 6.10, 1.64, 1.95 e 1.82, respectively), while the active preterm delivery decreased, significantly, this risk (RR 0.16, 95% CI - 0.11 a 0.25). The mean weight of the newborns was 1873g and they were classified as appropriate for gestational age in 76.7%. They needed for admission to the intensive care unit in 62.1% of cases, 21% required surfactant, 90.8% needed mechanic ventilation, 4.6% presented neonatal injury and the index of neonatal death was 8.7%. When the two groups were compared, the cesarean section significantly increased the chance of the Apgar score at 5Â minute to be ≥ 7 (RR 1.06, 95% CI - 1.01 a 1.13). After logistic regression of COX adjusted for factors that could influence perinatal outcomes, had not been observed statistically significant differences between the two groups. Conclusions: it had not been found statistically significant differences in perinatal outcomes among newborns of vaginal delivery and cesarean section in women who had preterm delivery. Regarding obstetric characteristics, false preterm delivery, premature rupture of the membranes and the use of tocolytic agents and corticosteroids increased, significantly, the risk of cesarean section while the active preterm delivery decreased, significantly, this risk.

Hyponatremia is common in preterm infants. The causes are usually related to the inability of the premature kidneys to excrete a given water load, excessive sodium losses, or inadequate sodium intake. Here, we present a case of severe hyponatremia in an extreme preterm infant, associated with the use of aminophylline. Aminophylline was administered intravenously on day 1 for the treatment of apnea of prematurity. On day 3, the patient developed hyponatremia which was not responsive to sodium replacement and fluid restriction. Due to concerns of aminophylline‑induced hyponatremia, aminophylline was discontinued on day 6, and within 48 h of discontinuation, serum sodium normalized without the need for sodium supplementation. The purpose of the case report is to present a rare complication associated with aminophylline use and to shed light on potential deleterious effects associated with drug shortages.

This research explored the fathers' experiences of having a premature baby. This included their experiences both during the baby's admission to neonatal care and following discharge from the hospital. The aims were to elicit their subjective accounts in order to gain further insight into the phenomena and improve clinical practice. This research employed a qualitative methodology and seven participants took part in the research. Participants were interviewed using a semi-structured interview design and the interviews were tape recorded. An interpretative phenomenological approach was used to analyse the data. The analysis revealed three superordinate themes: Uncertainty and coping, Fatherhood and Changes. A number of subordinate themes are also identified. An important feature of the experiences described by fathers was the uncertainty and powerlessness they experienced over a prolonged period of time as a consequence of the critical condition of their baby. In addition, the fathers were required to fulfil a number of competing roles and expectations. A key strategy described by all was to simply "get on with it". However, all fathers described the distress and sense of loss they experienced as a consequence of being separated from their baby. Yet an important finding was that in the context of loss the fathers reported that the trauma of early birth and the difficulties experienced by their baby appeared to be a catalyst for greater involvement.

Thesis (MSc)--University of Stellenbosch, 2006.
ENGLISH ABSTRACT: Premature luteal regression occurs on average in 30% of superovulated sheep ewes. This phenomenon occurs early in the cycle before the embryo’s can be collected and is a major contributor to failure in embryo transfer programs. This research was done to understand the physiological mechanisms involved. Chapter two provides a general background of the physiology of natural luteolysis and the maternal recognition of pregnancy. The chapter introduces some new concepts on the topic of cell death and provides a recent literature review on research done on the phenomenon of premature luteal regression. This chapter forms the base of ideas and arguments that follows in the two studies containing new original work in this field. The research contained in this thesis comprises of two in vivo studies. The first study (Chapter 3) compare premature luteal regression to Prostaglandin F2α (PGF2α) induced regression with emphasis on the changes in levels of the steroid hormones progesterone (P4) and estradiol - 17β (E2-17β) and changes in structure and ultra structure. The following conclusions were made: 1. Premature luteal regression is not merely inadequate luteal support, but indeed early luteal regression, since seasonal influences could merely be nutritional influences, and a definitive increase in P4 were recorded in animals exhibiting the phenomena. 2. Nutritional influences could play a role, but the type and quality of nutrients and mechanism involved, is still unclear. 3. PGF2α-induced regression differs from premature luteal regression in that: a) The progression of functional and structural regression in PGF2α -induced regression is slower than in premature luteal regression. b) Regressed corpora lutea do not occur with normal functioning corpora lutea. 4. There is a distinct second E2-17β peak preceding the decline in P4 in animals that exhibits signs of premature luteal regression. A threshold initiating premature luteal regression was not established. The second study (Chapter 4) compares the changes in the ovine β estradiol - 17 β receptor (oERβ) between premature luteal regression and PGF2α induced regression. The study concludes that there could be a potential role for oERβ in premature luteal regression. The findings of these two studies raise some questions about the conventional perception that early release of PGF2α is the cause of premature luteal regression. The thesis concludes in a hypothesis (Chapter 4) explaining the phenomenon.
AFRIKAANSE OPSOMMING: Premature luteale regressie kom gemiddeld in 30% van gesuperovuleerde skaap-ooie voor. Die verskynsel kom vroeg in die siklus voor, voor die embrios gekollekteer kan word, en is een van die belangrikste oorsaake van mislukkings in ‘n embrio-oorplaasingsprogram. Die huidige navorsing poog om die fisiologiese meganismes betrokke by premature luteale regressie te verstaan. Hoofstuk twee verskaf ‘n algemene agtergrond van die fisiologiese aspekte betrokke by natuurlike luteale regressie en maternale herkenning van swangerskap. Die hoofstuk stel nuwe konsepte voor oor sel afsterwing en verskaf ‘n opgedateerde literatuuroorsig met betrekking tot die navorsing wat in die veld oor die verskynsel gedoen is. Die hoofstuk vorm die basis vir die idees en argumente, wat volg in die twee studies en wat oorspronklike nuwe navorsing bevat oor die onderwerp. Die navorsing in die tesis bestaan uit twee in vivo studies. Die eerste studie (Hoofstuk 3) vergelyk premature luteale regressie en prostaglandien F2α (PGF2α) ge-induseerde regressie met ‘n klem op die vlakke van die steröiedhormone progesteroon (P4) en estradiol - 17β (E2-17β) en veranderinge in die mikroskopiese struktuur en ultra struktuur van die corpus luteum. Die studie bevind: 1. Premature luteale regressie is nie slegs onvoldoende luteale funksie nie, maar vroë luteale regressie aangesien seisoenale invloede eitlik voedings invloede kan wees en P4 gestyg het in diere waar die verskynsel voorgekom het. 2. Voeding kan ‘n rol speel maar die tiepe en gehalte van die voedingstowwe en die meganismes betrokke is nie duidelik nie. 3. PGF2α - ge-induseerde regressie verskil van premature regressie in dat: a) Die verloop van funksionele en strukturele regressie is stadiger in PGF2α - ge-induseerde regressie in vergelyking met premature luteale regressie. b) Corpora lutea wat regressie ondergaan het kom nie voor saam met corpora lutea wat normal voorkom nie. 4. Daar die ‘n duidelike tweede piek van E2-17β gaan die afname in P4 vooraf in diere waar premature regressie voorkom. 5. Daar is nie geslaag om ‘n drempel vas te stel waar premature regressie ge-inisieer word nie. Die tweede studie vergelyk die veranderinge in estradiol-17β reseptore (oERβ) in die skaap tydens premature luteale regressie en PGF2α geinduseerde regressie. Die studie bevind dat daar ‘n moontlike rol is vir ERβ in premature luteale regressie. Die bevindinge van die twee studies bevraagteken die konvensionele opvatting dat vroë vrystelling van PGF2α verantwoordelik is vir premature luteale regressie. Die tesis sluit af met ‘n nuwe hipotese om die verskynsel te verduidelik.

I have carried out a detailed assessment of platelet function and reactivity in 205 subjects that suffered a premature MI (at a mean age 42.3 +/- 5.7) and 200 age and sex matched controls, to two endogenous platelet agonists adenosine diphosphate (ADP) and thrombin receptor activating peptide (TRAP). I have further analysed the effect on platelet function of polymorphisms in two platelet receptors (GPIIbIIIa C196T and GPIaIIa G873A), which have been proposed as genetic risk factors for MI. Platelet reactivity to several concentrations of ADP and TRAP, measured as degree of fibrinogen binding by flow cytometry, showed marked inter-individual variation (4-5 fold) in both cases and controls. There was a strong correlation between the ADP and TRAP responses and experimental analysis suggested that this was because the TRAP response is substantially mediated via the ADP receptor.;Expression of the GPIaIIa receptor on the platelet surface showed up to 10-fold variation between subjects. The G837A polymorphism in the GP1a gene had a marked effect on GPIaIIa expression (accounting for about one-fifth of the variation) but did not influence the risk of MI (odd ratio 1.12 (95%CI 0.86-1.46)). Expression of the GPIIbIIIa receptor in both the resting state and after agonist stimulation was not affected by C196T polymorphism in the GPIIIa gene and did not influence risk of MI (odds ratio=0.94 (0.61-1.45)).;Of the emerging risk factors, fibrinogen (p<0.001) and Lp(a) (p = 0.016) were higher in the cases. There were significant effect of the G455A polymorphism in the fibrinogen beta chain gene and the C93T polymorphism in the apolipoprotein (a) gene on fibrinogen and Lp(a) levels, respectively.

Establishing breastfeeding in the infant born prematurely remains one of the most important challenges to neonatal midwives. Many obstacles stand in the way of mothers becoming successful in this art; probably the most notable being unit guidelines established through anecdotal rather than evidence based on information. Difficulties arise in gathering "evidence" and this may in some part account for the lack of literature on breastfeeding and the preterm infant. Earlier studies indicate that breastfeeding premature infants regulate feeding differently to bottle feeding infants but these qualitative data do not adequately describe feeding performance. A convenience sample of preterm infants was selected and variables associated with feeding measured. A pulse oximeter measured heart rate and oxygen saturation pre, during and post feed, whilst feeding variables of sucking, swallowing and breathing were monitored throughout feeding using pressure sensors and auscultation. The data were continuously collected and stored in a computer using the Snapshot programme. The findings of this study indicate that practice at feeding affects outcome, bursts become longer and pauses shorter, sucks and swallows/second increase with breaths/second being influenced by milk flow and swallow rate; that total feeding time is variable and not dependent on post menstrual age (PMA); that immature infants (those of 31 weeks PMA) are able to coordinate sucking, swallowing and breathing and produce rhythmic bursts and pauses and possibly adapt feeding performance according to physiological status; finally that suckling does not cause any obvious increase in heart rate and therefore cannot be considered as an energy consuming activity.

The purpose of the study was to identify and compare characteristics of preterm infants' pulse rate, respiratory rate, stress related behavior and self comforting behavior in two situations: (1) the infant receiving routine nursing care in the environment of a neonatal intensive care nursery, and (2) the infant in the same environment after experiencing a gentle back massage. Specifically, the research question for this study was: what patterns of pulse rate, respiratory rate and behavior, are associated with massage? Preterm infants between 33 and 36 weeks gestational age were observed for a baseline period of 50 minutes, given a 10 minute back massage, and observed for an additional 50 minutes. Exploratory data analysis revealed changes in the pulse rate, and in the frequencies of stress related and self comforting behaviors after massage that were associated with gestational age. Younger infants displayed a decline in pulse rate and an increase in respiratory rate after massage when compared to baseline observations, whereas older infants showed an increase in pulse rate immediately following massage. Stress related behavior declined during the first 10 minutes after massage in all age groups. Most preterm infants in this sample did not manifest any stress related behavior for several minutes after the massage. The frequency of self comforting behaviors increased after infants experienced a massage. Behavioral patterns were coupled with physiological variables; the frequency of self comforting behaviors was reflected in the pattern of respiratory rate whereas the frequency of stress related behaviors was more closely coupled with pulse rate. As infants became more aroused, they used a greater variety of behaviors. The behavioral reportoire also increased with gestational age. Content analysis demonstrated that infants spent more time in quiet sleep after having a massage than before massage. There were more frequent changes between active and quiet sleep before massage than afterward among infants who were treated concurrently with ultraviolet light. There was a trend for infants of all ages to take less time to console themselves after having a massage than before. None of these observed differences was statistically significant. Rotational movements were noted among more mature infants and were associated with quiet sleep. Infant behaviors showed a general decrease in the amplitude of movement over time. Several infants appeared alert, opening their eyes and looking around after having a massage. In general, preterm infants in this sample manifested changes in arousal and in activity which were observed in the differences in their behavior and vital signs after having a massage.

Premature children are at greater risk for developing communication delays than full-term children, although it is not inevitable. Recent research links specific temperament characteristics to early language development. Thus, temperament may provide a way to identify premature children who are at increased risk. The first purpose of this study was to determine if temperament characteristics of premature children are the same as full-term children when measured by the Infant Behavior Questionnaire-Revised. The second purpose was to determine if temperament and language acquisition, as measured by the MacArthur Communicative Development Inventory: Words and Gestures, are linked in premature infants and, if so, are the relationships similar to those of full-term populations. Participants included 19 children 8-12 months, chronological age. Results indicated that they exhibited similar temperament characteristics to full-term children. Additionally, temperament was linked to vocabulary comprehension and, unlike findings for full-term children, to expressive communication as well .

Background: Almost every 20th child is borne premature in Sweden, before the parents are ready to care for a new family member. The parents need to cope with the stress and anxiety of having their newborn child in the neonatal ward and influenced by nursing care of neonatal staff grow their parental role.

Purpose: The aim of this study was to illustrate experiences of parenthood within the care of premature at the neonatal ward.

Method: A review where 18 articles between 2000 and 2005 were chosen and examined. The articles were analysed according to VIPS, which facilitates the practical use of the result.

Result: The study reveals that parenthood is experienced as a time dependent process with three phases, primary, secondary and tertiary, where the parent’s needs and experiences changed character. The parents experienced that they developed from passive to active in the care of the premature child when the neonatal staff guided their participation, gave information/education and support. Interventions concerned the environment and coordination was experienced as enhancing parenthood because it made it possible for the parents to be close to their premature child.

Conclusion: There’s still interventions that needs to be done at the neonatal ward to enhance parents experience of their parenthood.

INTRODUCTION: Preterm birth (PTB) remains a major contributor to perinatal morbidity and mortality being the second leading cause of death in children under 5 years of age. The rate of spontaneous preterm birth (sPTB) still accounts for approximately 5%-12% in USA and in most developing countries. Cervical length (CL) <25 mm measured with transvaginal ultrasound at mid-gestation is a known risk factor for sPTB. However, its value for screening a whole pregnant population consisting mainly of women without risk factors for sPTB remains controversial because of the low sensitivity of short CL in low-risk women. MAIN OBJECTIVE: To improve the identification of women at increased risk of sPTB in low and high sPTB risk asymptomatic pregnancies during mid-gestation with two innovative transvaginal ultrasound techniques, the Cervical Consistency Index (CCI) and the Quantitative Cervical Texture Analysis (CTx). The CCI is an ultrasound measurement that aims to estimate cervical softness by measuring maximal tissue compressibility with a vaginal ultrasound probe. The CTx, extracts information from the speckle pattern of the ultrasound image and identifies the patterns associated with SPTB. METHODS: Articles 1 and 2 are prospective cohort studies that compare the predictive capacity of the ICC with that of the CL. Article 3 is a cross-sectional study that analyzes the cervical texture along a term gestation. Article 4 is a case-control study, in which a CTx-score is obtained, which is compared with the CL. RESULTS: STUDY 1. Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a low-risk population: The cervix was significantly shorter (median CL 39.8 mm vs. 36.2 mm, p=0.004) and the CCI was significantly lower (median 73.0% vs. 58.1%, p<0.001) in the sPTB group. The area under the ROC curve (AUC) for CCI with regard to predicting sPTB <37+0 weeks was 0.84 (95% CI 0.75-0.93) and that for CL 0.68 (95% CI 0.56-0.81), P = 0.03. STUDY 2. Mid-trimester sonographic cervical consistency index to predict spontaneous preterm birth in a high-risk population: The CCI (%) was significantly inferior in women who had a preterm delivery compared to the term group. CCI adjusted OR, 0.91 (95% CI, 0.83-0.99; P=0.03). The AUC of the CCI to predict sPTB <37+0 weeks was 0.73 (95% CI, 0.61-0.85) while that of CL was 0.51 (95% CI, 0.35-0.67), P=0.03. STUDY 3. Quantitative Analysis of the Cervical Texture by Ultrasound and Correlation with Gestational Age: The correlation between the gestational age at which the images were obtained and the estimated gestational age by quantitative analysis of the cervical texture was R=0.88. Ce STUDY 4. Quantitative analysis of the cervical texture by ultrasound in the mid-pregnancy is associated with spontaneous preterm birth: The median CTx-based score obtained was significantly lower in cases compared to controls. The CTx-based crude OR 0.31 (95% CI 0.17-0.56; P<0.001) vs. adjusted OR 0.37 (95% CI 0.19-0.64; P=0.001). The AUC for the CTx-based score to identify women delivering < 37+0 weeks was higher (0.77; 95% CI 0.66-0.87) than for CL (0.60; 95% CI 0.47-0.72), P=0.02. DISCUSSION: The CCI and CTx have the potential to improve the identification of women at increased risk of sPTB compared to CL. The large number of scenarios in which these tools could be applied have demonstrated their potential impact on the current management of a large number of pregnancies. Cervical assessment is required in a wide range of clinical situations and the main reason why it is not yet universally implemented is the limited performance of the current cervical assessment techniques. Therefore, it is a healthcare priority to develop sPTB predictive tools with sufficiently improved performance to be used as screening tools.
INTRODUCCIÓN: El parto prematuro representa la segunda causa de morbimortalidad infantil a nivel mundial. Las estrategias actuales de detección de las mujeres con un riesgo aumentado de parto prematuro espontáneo (SPTB), han demostrado ser insuficientes y el desarrollo de nuevas herramientas predictivas es una prioridad en el campo de la medicina materno-fetal. OBJETIVOS: Mejorar la identificación de las mujeres con riesgo de SPTB en el segundo trimestre, evaluando dos nuevas herramientas ecográficas: el Índice de Consistencia Cervical (CCI) y el análisis cuantitativo de la textura cervical (CTx). MÉTODOS: El CCI, evalúa la máxima compresibilidad del cuello del útero. El CTx, extrae información del patrón de moteado de la imagen ecográfica e identifica los patrones asociados con SPTB. Los artículos 1 y 2, son estudios prospectivos de cohortes que comparan la capacidad predictiva del CCI con la de la CL. El artículo 3 es un estudio transversal que analiza la textura cervical a lo largo de una gestación a término. El artículo 4 es un estudio de casos y controles, en el cual se obtiene un CTx-score, que se compara con la CL. RESULTADOS: Las curvas ROC para la predicción de SPTB <37 y <34 semanas del CCI (0.84 y 0.73), son significativamente mejores que las de la CL (0.68 y 0.51). El CTx-score en los casos de SPTB es significativamente inferior que en los controles. La curva ROC del CTx-score es mejor en comparación con la de la CL (0.77 vs 0.60). CONCLUSIONES: Los artículos 1 y 2, demuestran que el CCI es mejor predictor de SPTB que la CL en poblaciones de bajo y alto riesgo de prematuridad. El artículo 3 demuestra que la CTx puede identificar cambios a lo largo de la gestación normal. El artículo 4 demuestra que el CTx-score obtenido en casos y controles, se relaciona con el SPTB.

Orientadores: Antonio Wilson Sallum, Jose Guilherme Cecatti
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba
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Resumo: Este estudo teve por objetivo avaliar a prevalência de doença periodontal em uma amostra de gestantes de baixo risco gestacional, os fatores a ela associados, e sua correlação com a ocorrência de resultados perinatais adversos, como parto pré-termo, recém-nascido de baixo peso, recém-nascido pequeno para a idade gestacional e amniorrexe prematura. Trata-se de um estudo de coorte com 334 gestantes fazendo acompanhamento pré-natal no Hospital das Clínicas da UNICAMP, que aceitaram participar voluntariamente e tiveram um único exame periodontal realizado no dia da consulta pré-natal. Os dados foram coletados da anamnese, do exame clínico periodontal e de informações relativas à gestação, parto e puerpério. Os parâmetros clínicos periodontais foram: índice de placa, índice de sangramento gengival à sondagem, profundidade de sondagem, nível de inserção clínica periodontal e retração gengival. As gestantes foram divididas em dois grupos: as com periodontite moderada a grave (P2-P4), e as sem doença ou com doença periodontal leve (P0-P1), pela classificação do índice WS. Avaliaram-se também a idade, paridade, raça, escolaridade, estado civil, hábitos alimentares, índice de massa corpórea (IMC), número de consultas de pré-natal, fumo, uso de bebidas e drogas, uso de medicação, vaginose bacteriana e doenças sistêmicas. Inicialmente foi utilizada uma abordagem analítica de corte transversal para a identificação de fatores associados à ocorrência de doença periodontal na gestação. Depois utilizou-se uma abordagem de estudo de coorte propriamente dito, estimando-se o risco de ocorrência dos resultados perinatais desfavoráveis (parto pré-termo, recém-nascido de baixo peso, recém-nascido pequeno para a idade gestacional e amniorrexe prematura, variáveis dependentes principais do estudo) em função da condição periodontal. Foram analisadas as distribuições de freqüência das variáveis independentes pelas categorias de doença periodontal, estimando-se a Razão de Prevalência e seu IC95% para abordagem transversal. Foi então realizada a análise uni e multivariada para a estimativa do risco de ocorrência das variáveis perinatais desfavoráveis na abordagem de coorte, calculando-se a Razão de Risco e seu IC95% para cada uma delas. Foi estabelecido o nível de significância de 5%. A prevalência de periodontite moderada a grave nas 334 gestantes foi de 47%, e se associou significativamente com a idade gestacional mais avançada ao exame periodontal (17-24 semanas: RP 1,40, IC95% 1,01-1,94; e 25-32 semanas: RP 1,52, IC95% 1,10-2,08), com a idade materna entre 25 e 29 anos (RP 1,65, IC95% 1,02-2,68), com a obesidade (RP 1,38, IC95% 1,04-1,82) e com a presença de sangramento gengival (ORajustado 2,01 - IC95% 1,41-2,88). Foram coletados os dados do parto de 327 gestantes e, entre elas, a doença periodontal esteve associada a um maior risco de ocorrência de parto pré-termo (RR 3,47 IC95% 1,62-7,43), de RN de baixo peso (RR 2,93 IC95% 1,36-6,34) e de amniorrexe prematura (RR 2,48 IC95% 1,35-4,56) na análise multivariada. A prevalência de doença periodontal entre gestantes de baixo risco gestacional é alta e associada com a maior idade gestacional, obesidade e sangramento gengival. A doença periodontal foi um fator de risco para a ocorrência de parto pré-termo, RN de baixo peso e de amniorrexe prematura
Abstract: This study was aimed to evaluate the prevalence of periodontal disease in a sample population of low-risk pregnant women, the factors associated with it and its correlation with the occurrence of adverse perinatal outcomes, including preterm births, low birth weigth, small for gestational age babies and premature rupture of the membranes. This cohort study included 334 pregnant women under prenatal care at the Hospital das Clinicas of the University of Campinas, Brazil, who voluntarily accepted to participate and had one single periodontal examination performed in the same day of a prenatal visit. Data was collected from anamnesis, periodontal clinical exam, and from information regarding pregnancy, delivery and postpartum. The clinical periodontal parameters were: plaque index, bleeding on probing index, probing pocket depth, clinical attachment level and gingival recession. Pregnant women were divided into two groups: those with moderate-to-severe periodontitis (P2-P4) and those with no disease or only mild disease (P0-P1), according to the WS classification index. Age, parity, race/color, years of schooling, marital status, number of prenatal visits, dietary habits, BMI (body mass index), smoking habits, use of alcohol and drugs, use of medication and presence of systemic diseases d bacterial vaginosis were also evaluated. Initially a cross sectional analytic approach was used for identifying factors associated with the occurrence of periodontal disease during pregnancy. After that, a real cohort approach was used, with the estimate of the risk of adverse perinatal outcomes (preterm birth, low birth weight, small for gestational age baby and premature rupture of membranes, the main dependent variables of this study) according to the condition of periodontal disease. Distribution of independent variables within the two groups was analyzed by calculating prevalence ratios and their respective 95% confidence intervals for the cross sectional approach. Uni and multivariate analysis for the estimation of the risk of adverse perinatal outcomes were performed for the cohort approach. The Risk Ratior and its 95%CI were estimated for each outcome. The significance level assumed was 5%. The prevalence of moderate to severe periodontitis in 334 pregnant women was 47%, and it was significantly associated with more advanced gestational age at periodontal examination (17-24 weeks: PR 1.40, 95%CI 1.01-1.94; and 25-32 weeks: PR 1.52, 95%CI 1.10 ¿ 2.08), with maternal age between 25 - 29 years (PR 1.65, 95%CI 1.02 ¿ 2.68), with obesity (PR 1.38, 95%CI 1.04 ¿ 1.82) and with the presence of gingival bleeding (ORadjusted 2.01, 95%CI 1.41 ¿ 2.88). The data of 327 deliveries were collected and, among them, the periodontal disease was associated to a higher risk of preterm birth (RR 3.47 95%CI 1.62-7.43), of low birth weight (RR 2.93 95%CI 1.36-6.34) and of premature rupture of membranes (RR 2.48 95%CI 1.35-4.56) in the multivariate analysis. The prevalence of periodontal disease among low-risk pregnant women is high and it is associated with more advanced gestational age, obesity and gingival bleeding. Periodontal disease was a risk factor for the occurrence of preterm birth, low birth weight and premature rupture of membranes
Mestrado
Periodontia
Mestre em Clínica Odontológica

LabPasteur
Objetivos deste estudo: identificar a prevalÃncia e os fatores de risco da colonizaÃÃo materna e infecÃÃo neonatal por streptococcus do grupo B (SGB), em mulheres com trabalho de parto prematuro (TPP) e/ou ruptura prematura de membranas (RPM); medir e comparar taxas de colonizaÃÃo vaginal e anorretal por SGB, comparar taxas de detecÃÃo do SGB em meio de cultura seletivo (Todd-Hewitt) e nÃo seletivo (Stuart) e com cultivo em Ãgar-sangue e Ãgar- CPS. Estudo transversal de 112 mulheres e 220 recÃm-nascidos realizou-se na Maternidade Escola Assis Chateaubriand da Universidade federal do Cearà (MEAC-UFC), de maio de 2008 a julho de 2009. Amostras vaginais e anorretais foram colhidas de cada mulher, usando swabs estÃreis. Em 71 mulheres, 2 swabs (vaginal e anorretal), colocaram-se separadamente em meio de transporte Stuart e 2 swabs (vaginal e anorretal), inocularam-se separadamente em meio seletivo Todd-Hewitt, todos subcultivados em placas de Ãgar-sangue. Outras gestantes do grupo, 41 mulheres, foram investigadas somente em meio seletivo com subcultivo em placas de Ãgar-CPS. Colheu-se hemocultura de cada recÃm-nascido pretermo com algum sinal de infecÃÃo. A taxa de colonizaÃÃo materna de 71 mulheres foi de 4,2% e do grupo de 41, de 17%. Meio seletivo Todd-Hewitt detectou 4,4% e meio nÃo seletivo, 7,2% das culturas positivas para SGB no grupo de 71 mulheres, resultados sem diferenÃa significativa. Amostras vaginais tiveram taxas de detecÃÃo de 10,7% e anorretais de 7,1%, nÃo alcanÃando significÃncia estatÃstica. Houve diferenÃa significativa no isolamento de SGB, entre o meio Ãgar-CPS e o Ãgar-sangue. InfecÃÃo urinÃria mostrou ser importante fator de risco (P < 0,01) e a profissÃo Do lar tambÃm associou-se significativamente com a colonizaÃÃo por SGB Dos RNs incluÃdos no estudo, nenhuma hemocultura teve resultado positivo para SGB, embora apresentassem sinais de infecÃÃo e hemogramas alterados. à possÃvel que o resultado tenha ocorrido pelo fato de que as mÃes tomaram antibiÃticos antes ou durante o trabalho de parto. As taxas de colonizaÃÃo por SGB, em nosso meio, sÃo semelhantes Ãs encontradas em outras regiÃes do Brasil, podendo ser tambÃm, aqui, agente de relevÃncia na sepse neonatal que requer, sÃrias medidas de prevenÃÃo.
The objectives of this study: to identify the prevalence and the risk factors from maternal colonization and neonatal infection from group B Streptococcus in women with preterm labor and/or premature rupture membranes. It measures and compare vaginal and anorectal colonization rates. It compare detection rates with selective and non-selective culture media and it compare detection rates with blood Ãgar and CPS Ãgar. A transversal study of 112 women and 220 newborns was performed at Maternidade Escola Assis Chateaubriand from Universidade Federal do Cearà (MEAC-UFC) from may /2008 to july/2009. Vaginal and anorectal samples from each woman were collected using sterile swabs. In 71 women two swabs (vaginal and anorectal) were placed separately in Stuart transport medium and two swabs (vaginal and anorectal) were inoculated separately in Todd-Hewitt selective medium. All subcultered in blood agar plates. The other pregnancies 41 women were investigated only in selective medium and subcultered in a CPS agar plates. A blood culture was collected from each preterm newborn that with any sign of infection. The maternal colonization rate from 71 women was of 4,2% and from the 41 women group was of 17%. Todd-Hewitt selective medium detected 4,4% and non-selective medium 7,2% GBS positive culture (not statistical relevant âNSR). Vaginal samples had a detection rate of 10,7% and anorectal samples had detection rate of 7,1% ( NSR). Urinary infection and be a housewife showed to be meaningful risk factors (p < 0,05). From the newborns studied none of them had GBS positive blood culture due to the sign of infection and altered hemogram. It,s possible that the result had occurred for the fact that the mothers had taken antibiotic before or during the labor. The GBS women colonization in our environment is similar to the other regions of Brazil. The GBS could be to here an important agent for neonatal infection disease and its necessary to take serious prevent measures.

Orientador: Antonieta Keiko Kakuda Shimo
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Este estudo foi desenvolvido pela necessidade de conhecermos melhor a mulher-mãe que, logo após o parto, além de ter seu filho levado para a Unidade de Tratamento Intensivo Neonatal (UTIN) por ter nascido prematuramente e precisar de cuidados especiais, tem a responsabilidade de suprir suas necessidades nutricionais. Trata-se de um estudo exploratório descritivo, com abordagem qualitativa e que tem como objetivo desvelar os fatores que influenciam o processo de manutenção da lactação em mães de recém-nascido pré-termo (RNPT) internado na UTIN de um hospital filantrópico do Estado de São Paulo, identificando as barreiras e fatores facilitadores para a manutenção da lactação e sua rede de apoio social. Os atores sociais de nossa pesquisa foram mães de RNPT internados na UTIN do hospital em estudo, as quais foram previamente orientadas pelos profissionais do Banco de Leite sobre como proceder para estimular e manter a lactação. A amostra foi definida por saturação de dados e a coleta foi realizada no Banco de Leite Humano (BLH) e na UTIN, utilizando-se dos seguintes instrumentos: a) entrevista semi-estruturada; b) observação participante; c) diário de campo. A análise dos dados foi realizada através do Discurso do Sujeito Coletivo. Nas entrevistas realizadas com as dezenove mulheres-mães, observamos que os principais problemas encontrados para manter a lactação foram a dificuldade no manejo da ordenha, mesmo com a bomba tira-leite; dor nos mamilos ao retirar o leite; dificuldade para levar o leite ao BLH; desconhecimento quanto à freqüência da retirada do leite; desconhecimento da importância do leite materno; estresse, ansiedade, tristeza causada por não ter o bebê em seus braços; falta de apoio dos profissionais e da família. Os fatores que facilitam a produção láctea foram abordados, podendo-se citar, entre eles, a possibilidade de permanência das mães na UTIN, assim como estas obterem informações sobre o estado de saúde de seu bebê; o apoio dos profissionais do BLH; a realização da ordenha com bomba tira leite; a mulher ser encorajada pelo marido; fazer o método canguru e ter conhecimento sobre como ordenhar a mama e sobre o processo de produção láctea. Em relação à rede de apoio, pode-se concluir que o marido ou companheiro é o principal incentivador e quem ajuda nos afazeres de casa. Assim, concluímos que o profissional de saúde tem um importante papel no incentivo ao aleitamento, exercendo a sua paciência, sabendo ouvir sem pré-julgamentos, revendo normas que dificultam a proximidade entre mãe e filho e utilizando o seu conhecimento para apoiar a mulher-mãe que, muitas vezes, não tem a quem recorrer e precisa de uma palavra de incentivo
Abstract: This study was developed in order to understand and know better the mother-woman, who right after the childbirth, not only has her son taken to the Neonatal Intensive Care Unit (NICU) for having been born prematurely and consequently needs special cares, but also has to supply her nutritional needs. This is a descriptive exploratory study, with a qualitative approach which is aimed to unveiling the factors that influence the breastfeeding maintenance process in mothers of pre-term newly born (PTNB), who stay in the NICU of a philanthropic hospital in Sao Paulo state, by identifying the obstacles and the factors that cooperate for breastfeeding maintenance and her social net support. The social partakers of our research were PTNB mothers in the NICU of the hospital in study, who were previously guided by Human Milk Bank (HMB) professionals about how to act for stimulating and keeping the breastfeeding on. The sample was defined by data saturation and the collection was done at the Milk Bank (MB) and NICU making use of the following tools: a) Semi-structured interview; b) Partakers¿ observation; c) Field diary. The data analysis was carried out through the Colletive Speech. In the interviews put into practice with the nineteen mother-women, we realized that the main existing problems in keeping the breastfeeding were: difficulty in drawing the milk from the breast, even making use of a nursing milk pump; pain on the nipples when removing the milk; difficulty in taking the milk to MB; lack of knowledge of how often the milk should be removed and its importance; stress; anxiety; sadness for not having the baby in their arms and lack of support from professionals and family. The factors that cooperate for breastfeeding maintenance were the possibility of having the mothers together with the babies in the NCTI and keeping them informed about their babies¿ health; more support from MB professionals; the use of a nursing milk pump; more encouragement by the husband/partner; the kangaroo method and more knowledge of how to draw the milk and of the breastfeeding process. As the net support, we concluded that the husband/partner is the most important person to motivate the mothers and help with household chores. Thus we came to the conclusion that health professionals have an important role in encouraging their patients to breastfeed, working with their patience, listening to them without pre-judgment, reviewing rules that make it difficult for the mothers to be near their babies and making use of their vast knowledge to support the mother-woman, who, very often, doesn¿t have someone to run to and needs a comfort word
Mestrado
Enfermagem e Trabalho
Mestre em Enfermagem

O presente estudo buscou investigar a experiência de tornar-se mãe de um bebê prematuro na adolescência, em particular, a relação que a mãe adolescente estabelece com o bebê prematuro, durante a internação hospitalar do bebê. Participaram quatro mães adolescentes entre 17 e 18 anos de idade, que tiveram seus bebês prematuros em dois hospitais públicos de Porto Alegre, as quais foram entrevistadas em três momentos da internação do bebê na UTI Neonatal (aproximadamente no 15º dia de vida do bebê, uma semana após este contato e no momento de pré-alta hospitalar do bebê). Os resultados apontaram para um somatório de crises concomitantes como a adolescência, a maternidade e a prematuridade, o que representou um impacto importante neste momento de transição para as adolescentes. Para algumas mães foi possível recuperar-se do choque inicial causado pelo nascimento prematuro de seu bebê, fato relacionado à variação no grau de desenvolvimento individual e nos modos de funcionamento psíquico de cada uma. Além disso, aspectos típicos do funcionamento adolescente mostraram-se evidenciados, mesmo com a exigência de que as mães interrompessem seu processo de adolescer para cuidar do bebê na UTI Neo. Assim também, notou-se que há diferentes tempos que marcaram esta transição para a maternidade: o tempo da UTI, o tempo do bebê e o tempo da adolescente, muito distintos e com características próprias. Outros estudos devem ser realizados nesta temática específica, uma vez que não se conhece os efeitos a médio e longo prazo deste tipo de transição para a maternidade para a mãe e para o bebê. Espera-se que este estudo possa contribuir para se considerar as especificidades do momento da adolescência no contexto da UTI Neo.
The present study investigates the experience of giving birth to a premature baby in adolescence, specifically examining the relationship the adolescent mother establishes with the premature baby during its hospital internment. Four adolescent mothers between 17 and 18 years old took part in the research. They gave birth to their premature babies in two different public hospitals of Porto Alegre and were interviewed at three moments of the babies' internment in the NICU (about 15 days after the babies were born, a week after this first contact and right before the babies' hospital discharge). The results pointed to a sum of simultaneous crisis, such as adolescence, motherhood and prematurity, which represented a major impact at this time of transition for adolescents. For some mothers it was easy to recover from the initial shock caused by the premature birth of their babies, and this fact is related to variations in the degree of individual development as well as to the different modes of psychic functioning of each one of them. Furthermore, some typical aspects of adolescence were shown, even though the adolescents were demanded to interrupt their process of being adolescents to take care of a premature baby in NICU. Thus, it was possible to notice that there were different times that marked the transition to motherhood: the time of NICU, the babies' and the adolescents' time, which were very distinct from each other, showing specific characteristics. Other studies should be conducted in this specific area, since the medium and long term effects of this kind of transition to motherhood, regarding the adolescent mother and the baby, are not known. It is expected that this study contributes to better understanding the specificities of adolescent mothers in the NICU.

O avanço na qualidade de atendimento intensivo na fase neonatal levou ao aumento dos índices de sobrevivência de bebês prematuros. A grande preocupação, não diz respeito tão somente à sobrevida, mas principalmente à qualidade de vida. O presente estudo teve por objetivo principal caracterizar o desenvolvimento neurocomportamental de bebês nascidos pré-termo antes de atingir o termo de 40 semanas de idade pós-concepcional. Os objetivos específicos foram: a) comparar o desempenho neurocomportamental da amostra de estudo com a amostra original da padronização do teste NAPI; b) comparar os indicadores de desenvolvimento neurocomportamental em grupos diferenciados pelos problemas perinatais; c) comparar os indicadores de desenvolvimento neurocomportamental em grupos diferenciados quanto ao sexo. A amostra foi composta por 202 bebês pré-termo ( 37 semanas de idade gestacional), de ambos os sexos, com baixo peso (< 2500g), estáveis clinicamente e internados na Unidade de Terapia Intensiva Neonatal ou Berçário de Cuidados Intermediários do Hospital Materno-Infantil da cidade de Goiânia (GO), no período de setembro de 2004 a janeiro de 2006. Foram utilizados os seguintes instrumentos: Avaliação Neurocomportamental do Pré-Termo (NAPI), roteiro de anamnese, prontuário médico e Questionário de Classificação Sócio Econômico. O procedimento de avaliação dos bebês foi filmado. O índice de acordo entre observadores foi de 88%. A análise dos vídeos foi processada para obter a pontuação do desempenho dos bebês, de acordo com o NAPI. Primeiramente, os dados foram submetidos à análise estatística descritiva. As variáveis discretas foram quantificadas em termos de frequência, prevalência ou porcentagem e as variáveis contínuas em termos de média e desvio padrão, mediana, valores mínimo e máximo. Procedeu-se à comparação entre os desempenhos no NAPI obtidos na amostra do estudo e os resultados da amostra do teste, entre meninos e meninas e entre dois grupos (Grupo com problema perinatal - PIG, anóxia, hemorragia e hidrocefalia e Grupo sem problema perinatal). Os resultados mostraram que houve diferença significativa entre os grupos nos domínios do NAPI. A amostra do estudo (AE) apresentou menor tonicidade muscular no sinal de cachecol, menor vigor e movimentação espontânea e maior alerta e orientação do que o grupo de padronização do teste (AT). Além disso, o grupo AE apresentou choro levemente mais fraco e maior quantidade de sono, indicando que os bebês dormiram mais durante a realização do teste, do que o grupo AT. Ao analisar a classificação geral do NAPI, de acordo com o desvio-padrão da amostra de padronização do teste, foi possível notar que a maior parte dos bebês estudados foi classificada na média e cerca de um terço foram classificados como abaixo da média. Verificou-se que não houve diferença estatística significativa entre os desempenho de meninos e meninas. Os resultados do desenvolvimento neurocomportamental dos grupos sem problemas e com problemas perinatais, em comparação à amostra de padronização do teste foram semelhantes em relação ao desempenho nos itens do NAPI. A avaliação forneceu dados sobre a detecção de risco no desenvolvimento de bebês nascidos prematuros, a fim de implementar medidas efetivas de intervenção preventiva para evitar problemas de desenvolvimento no futuro.
The quality improvement on newborns intensive care leaded to higher levels for premature babies survival rates. The bigger preoccupation doesnt regard simply their survival, but further on, regards quality of life. This study has the main objective to typify the neurobehavioral development on preterm born babies, before the 40th week of post-conceptional age. As specific objectives: a) to compare neurobehavioral performance of this studys sample to the original standard sample of NAPI test; b) to parallel indicators of neurobehavioral development in groups classified according to perinatal problems; c) to compare neurobehavioral development indicators from groups created according the gender. The sample has been composed of 202 preterm infants (gestational age 37 weeks), both genders, underweight (< 2500 g), clinically stable and on therapy at the Neonatal Intensive Care Unit or Intermediary Care Nursery of the Goiânias Hospital Materno-Infantil, for the period of September 2004 to January 2006. The following instruments were applied: Neurobehavioral Assessment for the Preterm Infant (NAPI), guide for anamnesis, medical history and a Questionnaire for Socioeconomical Individuation. The procedure for babies evaluation was filmed. The accordance rate among the beholders has been about 88%. The videos analysis had the purpose of rating babies performances according to NAPI. Firstly, data were submitted to descriptive statistic analysis. The discret variances were quantified depending on frequency, prevalence or percentage and continuous variances in terms of medium value and standard deviation, median, minimum and maximum values. Then the comparison of NAPI performances on studys sample and tests standard results, between both genders and two groups (one with perinatal problems PIG, such as anoxia, hemorrhaging and hydrocephalus and another group without any perinatal problem). Results shown meaningful difference between the groups on NAPI basis. The sample of this study (AE) has shown less muscular tonicity at the scarf sign, less vigor and spontaneuos movements, higher alert and orientation regards tests standard group (AT). Furthermore, the the AE group shown lightly weaker crying and higher quantity of sleeping, what means the newborns slept more during the test, regards AT group. When analyzed NAPI general ratings, according standard deviation on tests sample, it was remarkable that the the most of the newborns on study were rated at medium rating, besides around one third of them under that rate. No meaningful statistic difference was verified between boys and girls ratings. The results of neurobehavioral development on groups with and without perinatal problems, regards the standard of the test were simillar on NAPI. The assessment provided data about risk detection on babies born preterm, with the purpose of putting into effect effective measures for preventive intervention to avoid future development problems.