Andréa Monteiro Correia Medeiros

Alimentação do recém-nascido pré-termo: aleitamento materno, copo e mamadeira

ABSTRACT Purpose: To assess the offer of the maternal breast in preterm babies hospitalized at the Intensive Care Unit of the Hospital and Maternity Neomater, linking this datum with the manner to feed them (cup or bottle) in the absence of the mother, and the speech-language stimulation carried out. Methods: Forty-eight newborn preterm infants with gestational age less than or equal to 36 6/7 weeks, weighting ≤2500 grams and with stable respiratory pattern participated in this study. The newborns were divided into two groups: group A (35 newborns) with bottle feeding, and group B (13 newborns) with cup feeding. Speech-Language Pathology monitoring was organized in Stage 1 (non-nutritive sucking in “gloved finger” or “empty breast” concomitant with enteral feeding); Stage 2 (oral feeding offer – maternal breast, bottle or cup – with complement provided by enteral feeding); Stage 3 (exclusive oral feeding offer – maternal breast, bottle or cup); Stage 4 (effective breastfeeding offer). A comparison was carried out between the groups regarding the number of days in each phase. Data were statistically analyzed using the independent t-test, with significance level of 5%.

Intervenção fonoaudiológica na transição alimentar de sonda para peito em recém-nascidos do Método Canguru

Purpose : Verify the relationship between gestational age and duration of speech therapy to start oral feeding, when used the technique of feeding transition of the probe directly to the chest. Methods : This is a study of newborn medical/speech records of 38 risk in Kangaroo unit. Were collected : gestational age at birth and corrected days of life, birth weight and current, type and duration of speech therapy, enteral feeding volume. We used time use of antibiotics and ventilatory support as criteria for division of newborns into two groups (G1 and G2). At the statistical analysis was applied the nonparametric test of Mann-Whitney and the Pearson’s correlation coefficient. Results : Intervention time for newborns were discharged speech showed no significant results between groups (G1 = 9.35 days and G2 = 10.12 days), although the initial hypothesis of this study was that the newborn G1 would require fewer days of speech therapy than the G2. There was statistically significant difference in birth weight between G1 (1563.53 g) and G2 (1409.62 g). Conclusion : It was observed that both groups started speech therapy and oral feeding practically medium of similar gestational ages and both speech intervention, demonstrating ability to coordinate sucking movements/breathing/swallowing, and consequently the effective and exclusive breastfeeding.

Aleitamento materno e aspectos fonoaudiológicos: conhecimento e aceitação de mães de uma maternidade

Purpose To investigate the knowledge of mothers about breastfeeding and aspects of Speech-Language Pathology; to compare mothers from a Kangaroo unit to others in a Rooming-in, considering time of admission; and to verify the acceptance in the intervened group.Methods Interventionist and comparative study with 163 mothers from a public maternity. The mothers were divided into two groups (G1 and G2) according to their type of allocation (Kangaroo Unit and Rooming-in). It was done an assertiveness test and guidelines with the mothers, focusing on breastfeeding, language, orofacial motricity/ speech and hearing aspects. Based on such aspects, guidelines were made and the acceptance test applied. In order to characterize the affirmatives and compare the knowledge between the groups, it was applied the Birnbaums Three-Parameter Unidimensional Model, based on the Item Response Theory, and Mann-Whitney U Test for the estimated knowledge, with p 85%.Results Concerning the assertiveness test, the highest percentage of correct answers was achieved by language (G1=98%; G2=95%), followed by orofacial motricity/ speech (G1=45%; G2=39%) and audition (G1=36%; G2=30%). There were no statistical significant relationship between hospitalization time and knowledge. 97% accepted the guidelines.Conclusion This health guidelines activity provided access to information, independently of time or type of hospitalization of the nursing mothers. The intervention good acceptance allows inferring about the viability of expand such practices in the hospital environment.

Efeitos da estimulação gustativa nos estados comportamentais de recém-nascidos prematuros

PURPOSE: To observe the behavioral states presented by premature newborns in response to gustatory stimulation. METHODS: Experimental, analytical and double-blind study. Ninety premature newborns born in a public maternity hospital in Sergipe took part in the test which was filmed and divided into three parts of five minutes. In the first and last, there was no stimulus; in the second, the gustatory stimulation was applied and the newborn children were divided into two groups (water or analysis for sucrose 12%). The observed behavioral states were deep sleep, light sleep, drowsy, alert, agitated/irritated and crying. The data were statistically analyzed. RESULTS: In the sucrose group, during and after stimulation, the correlation was strong in the light sleep and alert behavioral states and decreased in the drowsy, agitated/irritated and crying states. In the water group there was an increase in correlation in the agitated/irritated and crying states after stimulation. CONCLUSION: The continuity or change of the behavioral state of the premature newborns was positively influenced by the administration of gustatory stimulus, pointing to the possibility of using sucrose in benefit of the favorable behavioral states of that population.

INVESTIGAÇÃO DE UM SISTEMA DE ALIMENTAÇÃO EM RECÉM-NASCIDOS PREMATUROS A PARTIR DE ESTIMULAÇÃO GUSTATIVA

Purpose to investigate the existence of the alimentation system in premature newborns in response to gustatory stimulation. Methods experimental, analytical, double-blind study. 90 premature newborns of a public maternity in Sergipe took part in the test which was filmed and divided into three parts of five minutes. In the first and last, there was no stimulus; in the second, the gustatory stimulation was applied and the newborn children were divided into two groups (water or sucrose). We studied the specific behaviors suction right and left hands, tongue protrusion and suction movements in behavioral states deep sleep, light sleep, drowsy, restless / irritable and crying. In the statistical analysis of the population, average, standard deviation and prevalence studies were performed. We used the non-parametric Mann-Whitney test to compare averages. The Spearman test observed correlation between behavioral states at each time of the test. The p value was significant when less than 0.05. Results independent of the given stimulus, the correlation increased in all specific behaviors. Comparing the groups separately, after stimulation, we observed an increase in correlation in right hand suction and tongue protrusion for both. The same happened in suction, except for the agitated/irritated state. After stimulation, there was a higher correlation to the behavior of left hand suction in the sucrose group when compared to water. The results show that gustatory stimuli may contribute to the readiness to feed this population. Conclusions it was found in premature newborns an increased in correlation for the specific behaviors related to the alimentation system after oral stimulation, which envisions the possibility of gustatory stimulation be used for activating a alimentation system in premature newborns.

Tempo de transição alimentar na técnica sonda-peito em recém-nascidos baixo peso do Método Canguru.

Purpose Measure the intervention time required for transition from gavage to exclusive oral feeding, comparing newborns exposed exclusively to the mothers breast with those who, in addition to breastfeeding, received supplementation using a cup or baby bottle. Methods Analytical, longitudinal, cohort study conducted with 165 newborns (NB) divided into groups according to severity of medical complications (G1-with no complications; G2-with significant complications), and into subgroups according to feeding mechanism (A and B). All NBs were low birth weight, on Kangaroo Mother Care, and breast stimulated according to medical prescription and hospital routine. Regarding feeding pattern, subgroup A comprised NBs exclusively breastfed at hospital discharge, whereas subgroup B was composed of NBs fed through cup/bottle at some time during hospitalization. The number of days spent in each stage of transition was recorded for each NB. Results History of clinical complications significantly influenced total intervention time. Study participants in subgroups G1-A (10 days), G1-B (9 days), and G2-A (12 days) displayed greater chances of early discharge compared with those in subgroup G2-B (16 days). Conclusion NBs with no important history of clinical complications displayed greater chances of early hospital discharge. NBs with significant history of clinical complications that underwent gavage to exclusive breastfeeding transition presented smaller intervention time than those that required supplementation using cup/bottle. Feeding transition using the gavage-to-exclusive oral feeding technique is recommended for Speech-language Pathology practice in Neonatology.

Laterality research in premature newborns

El objetivo del estudio fue investigar la existencia de coordinacion mano-boca y la preferencia manual en recien nacidos prematuros a partir de la estimulacion gustativa, comparando la lateralidad de los bebes y sus progenitores. Se trata de un estudio experimental y analitico, con procedimiento doble ciego. Participaron 90 recien nacidos prematuros de una maternidad publica de Sergipe. El test duro 15 minutos, dividido en tres periodos de cinco minutos. En los primeros cinco minutos, linea de base inicial - LB1, ningun estimulo fue aplicado. En un segundo momento, existio estimulacion gustativa con sacarosa PA a 12% o agua, en cinco dosis de 0,2 mL a cada minuto, y en el ultimo periodo, linea de base final - LB2, existio observacion del recien nacido sin aplicacion de estimulo, durante cinco minutos. Fue realizado registro de la frecuencia y duracion de los comportamientos en la mano derecha (MBD) y/o mano izquierda (MBI) en la region oral y succion de la mano derecha (SMD) y/o izquierda (SMI) de los recien nacidos durante los estados comportamentales (sueno profundo, sueno leve, somnoliento, alerta, agitado/irritado y llanto) presentados por estos. Los datos fueron analizados en el software Stastistical Package for the Social Sciences. Como resultado se encontro correlacion fuerte de MBD y SMD en la LB2, independiente del estimulo recibido, evidenciando que la estimulacion aumento la correlacion de los comportamientos del lado derecho del cuerpo. Se sugiere realizacion de nuevas investigaciones sobre lateralidad, contemplando mayor numero de padres zurdos en la muestra.

Investigação da lateralidade em recém-nascidos prematuros

El objetivo del estudio fue investigar la existencia de coordinacion mano-boca y la preferencia manual en recien nacidos prematuros a partir de la estimulacion gustativa, comparando la lateralidad de los bebes y sus progenitores. Se trata de un estudio experimental y analitico, con procedimiento doble ciego. Participaron 90 recien nacidos prematuros de una maternidad publica de Sergipe. El test duro 15 minutos, dividido en tres periodos de cinco minutos. En los primeros cinco minutos, linea de base inicial - LB1, ningun estimulo fue aplicado. En un segundo momento, existio estimulacion gustativa con sacarosa PA a 12% o agua, en cinco dosis de 0,2 mL a cada minuto, y en el ultimo periodo, linea de base final - LB2, existio observacion del recien nacido sin aplicacion de estimulo, durante cinco minutos. Fue realizado registro de la frecuencia y duracion de los comportamientos en la mano derecha (MBD) y/o mano izquierda (MBI) en la region oral y succion de la mano derecha (SMD) y/o izquierda (SMI) de los recien nacidos durante los estados comportamentales (sueno profundo, sueno leve, somnoliento, alerta, agitado/irritado y llanto) presentados por estos. Los datos fueron analizados en el software Stastistical Package for the Social Sciences. Como resultado se encontro correlacion fuerte de MBD y SMD en la LB2, independiente del estimulo recibido, evidenciando que la estimulacion aumento la correlacion de los comportamientos del lado derecho del cuerpo. Se sugiere realizacion de nuevas investigaciones sobre lateralidad, contemplando mayor numero de padres zurdos en la muestra.

Investigación de lateralidad en recién nacidos prematuros

El objetivo del estudio fue investigar la existencia de coordinacion mano-boca y la preferencia manual en recien nacidos prematuros a partir de la estimulacion gustativa, comparando la lateralidad de los bebes y sus progenitores. Se trata de un estudio experimental y analitico, con procedimiento doble ciego. Participaron 90 recien nacidos prematuros de una maternidad publica de Sergipe. El test duro 15 minutos, dividido en tres periodos de cinco minutos. En los primeros cinco minutos, linea de base inicial - LB1, ningun estimulo fue aplicado. En un segundo momento, existio estimulacion gustativa con sacarosa PA a 12% o agua, en cinco dosis de 0,2 mL a cada minuto, y en el ultimo periodo, linea de base final - LB2, existio observacion del recien nacido sin aplicacion de estimulo, durante cinco minutos. Fue realizado registro de la frecuencia y duracion de los comportamientos en la mano derecha (MBD) y/o mano izquierda (MBI) en la region oral y succion de la mano derecha (SMD) y/o izquierda (SMI) de los recien nacidos durante los estados comportamentales (sueno profundo, sueno leve, somnoliento, alerta, agitado/irritado y llanto) presentados por estos. Los datos fueron analizados en el software Stastistical Package for the Social Sciences. Como resultado se encontro correlacion fuerte de MBD y SMD en la LB2, independiente del estimulo recibido, evidenciando que la estimulacion aumento la correlacion de los comportamientos del lado derecho del cuerpo. Se sugiere realizacion de nuevas investigaciones sobre lateralidad, contemplando mayor numero de padres zurdos en la muestra.