Francisco Eulógio Martinez

Cup or Bottle for Preterm Infants: Effects on Oxygen Saturation, Weight Gain, and Breastfeeding

The impact of cup-feeding or bottle-feeding on weight gain, oxygen saturation, and breastfeeding rates of preterm infantswas studied in 34 bottle-fed and 44 cup-fed preterm infants. At initiation of oral feeding, postconceptional age and weight were 37.2 ± 2.2 weeks and 1676 ± 83 g for the bottle-fed group (BF) and 37.0 ± 1.6 weeks and 1637 ± 40 g for the cup-fed (CF) group, respectively. No significant differences between groups were found with regard to time spent feeding, feeding problems, weight gain, or breastfeeding prevalence at discharge or at 3-month follow-up. Possible beneficial effects of cup-feeding were lower incidence of desaturation episodes (13.6% vs 35.3%, CF vs BF, P= .024) and a higher prevalence of breastfeeding at 3 months among those still breastfeeding at the first follow-up visit (68.4% vs 33.3%, CF vs BF, P= .04).

Hypothermia and Early Neonatal Mortality in Preterm Infants

OBJECTIVE To evaluate intervention practices associated with hypothermia at both 5 minutes after birth and at neonatal intensive care unit (NICU) admission and to determine whether hypothermia at NICU admission is associated with early neonatal death in preterm infants. STUDY DESIGN This prospective cohort included 1764 inborn neonates of 22-33 weeks without malformations admitted to 9 university NICUs from August 2010 through April 2012. All centers followed neonatal International Liaison Committee on Resuscitation recommendations for the stabilization and resuscitation in the delivery room (DR). Variables associated with hypothermia (axillary temperature <36.0 °C) 5 minutes after birth and at NICU admission, as well as those associated with early death, were analyzed by logistic regression. RESULTS Hypothermia 5 minutes after birth and at NICU admission was noted in 44% and 51%, respectively, with 6% of early neonatal deaths. Adjusted for confounding variables, practices associated with hypothermia at 5 minutes after birth were DR temperature <25 °C (OR 2.13, 95% CI 1.67-2.28), maternal temperature at delivery <36.0 °C (OR 1.93, 95% CI 1.49-2.51), and use of plastic bag/wrap (OR 0.53, 95% CI 0.40-0.70). The variables associated with hypothermia at NICU admission were DR temperature <25 °C (OR 1.44, 95% CI 1.10-1.88), respiratory support with cold air in the DR (OR 1.40, 95% CI 1.03-1.88) and during transport to NICU (OR 1.51, 95% CI 1.08-2.13), and cap use (OR 0.55, 95% CI 0.39-0.78). Hypothermia at NICU admission increased the chance of early neonatal death by 1.64-fold (95% CI 1.03-2.61). CONCLUSION Simple interventions, such as maintaining DR temperature >25 °C, reducing maternal hypothermia prior to delivery, providing plastic bags/wraps and caps for the newly born infants, and using warm resuscitation gases, may decrease hypothermia at NICU admission and improve early neonatal survival.

Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers

OBJECTIVE To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g. METHODS A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression. RESULTS A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth. CONCLUSION Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.

Is pain relief equally efficacious and free of side effects with repeated doses of oral sucrose in preterm neonates

&NA; The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty‐three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG = 17) and the control group (CG = 16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates’ facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut‐off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between‐groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects.

Red Blood Cell Transfusions are Independently Associated with Intra-Hospital Mortality in Very Low Birth Weight Preterm Infants

OBJECTIVE To test the hypothesis that red blood cell (RBC) transfusions in preterm infants are associated with increased intra-hospital mortality. STUDY DESIGN Variables associated with death were studied with Cox regression analysis in a prospective cohort of preterm infants with birth weight <1500 g in the Brazilian Network on Neonatal Research. Intra-hospital death and death after 28 days of life were analyzed as dependent variables. Independent variables were infant demographic and clinical characteristics and RBC transfusions. RESULTS Of 1077 infants, 574 (53.3%) received at least one RBC transfusion during the hospital stay. The mean number of transfusions per infant was 3.3 ± 3.4, with 2.1 ± 2.1 in the first 28 days of life. Intra-hospital death occurred in 299 neonates (27.8%), and 60 infants (5.6%) died after 28 days of life. After adjusting for confounders, the relative risk of death during hospital stay was 1.49 in infants who received at least one RBC transfusion in the first 28 days of life, compared with infants who did not receive a transfusion. The risk of death after 28 days of life was 1.89 times higher in infants who received more than two RBC transfusions during their hospital stay, compared with infants who received one or two transfusions. CONCLUSION Transfusion was associated with increased death, and transfusion guidelines should consider risks and benefits of transfusion.

Colostrum Ingested during the First Day of Life by Exclusively Breastfed Healthy Newborn Infants

OBJECTIVE To determine the mass of colostrum ingested by exclusively breastfed newborn infants during the first 24 hours of extrauterine life. STUDY DESIGN Milk ingested during the first 24 hours of life by 90 healthy newborn infants was evaluated by use of a scale with high sensitivity. The masses were measured during 8-hour periods. Associations of the mass measured with prenatal and postnatal variables were tested. RESULTS The mass of colostrum ingested was evaluated in 307 feedings, with 3.4+/-1 feedings recorded per 8-hour period of observation. Mean gain per feeding was 1.5+/-1.1 g. The daily mass of milk ingested by newborn infants was estimated at 15+/-11 g. This volume did not show a tendency to increase during the first 24 postnatal hours, nor was it related to perinatal or postnatal factors or to breastfeeding time. CONCLUSIONS During the first 24 hours of life newborns ingested 15+/-11 g of milk.

Pain and distress reactivity and recovery as early predictors of temperament in toddlers born preterm

BACKGROUND Pain reactivity may reflect underlying mechanisms of constitutional aspects of temperament. AIM To examine whether the neonatal biobehavioral reactivity and recovery responses from pain and distress, as well as the gestational age, the illness severity and the amount of painful procedures undergone the Neonatal Intensive Care Unit (NICU) stay, predict temperament later in toddlerhood, in vulnerable children born preterm. STUDY DESIGN Prospective-longitudinal study. SUBJECTS Twenty-six preterm and very low birth weight infants followed from birth to toddlerhood. OUTCOME MEASURES Illness severity was assessed with the Clinical Risk Index for Babies (CRIB) score. The medical charts were reviewed prospectively for obtaining the amount of pain exposure in NICU. For assessing the behavioral and cardiac reactivity and recovery from pain and distress, the neonates were evaluated during routine blood collection in the NICU in the first 10 days of life. Pain and distress reactivity and recovery was measured using the Neonatal Facial Coding System score, the duration of crying, and the magnitude of average heart rate. At toddlerhood, mothers answered the Early Childhood Behavior Questionnaire. RESULTS Higher biobehavioral reactivity to pain and distress predicted higher temperamental Negative Affect, above and beyond gestational age, illness severity and amount of pain exposure in NICU. However, we did not find a predictive relation between gestational age, CRIB score and number of painful procedures undergone NICU and toddlers temperament. CONCLUSIONS The findings highlight the relevance of the neonatal individual characteristics of reactivity for identifying more vulnerable infants for future problems in biobehavioral regulation.

Ultrasonic homogenization of expressed human milk to prevent fat loss during tube feeding.

Effective use of expressed human milk in infant feeding requires proper handling, processing, storage, and administration in order to maintain its unique nutritional properties. One of the problems with expressed human milk is the separation of fat during processing, storage, and administration to the infant. Administration by continuous nasogastric infusion, either by intermittent gravity flow or by continuous mechanical pump, resulted in significant loss of fat and variation in the constitution of the milk delivered. Homogenization by ultrasonic treatment prevented changes in fat concentration during infusion and essentially eliminated loss of this nutrient during administration. The conditions necessary to achieve fat dispersion and stabilization of fat particles in human milk by ultrasonic treatment are described.

Desenvolvimento psicológico na fase escolar de crianças nascidas pré-termo em comparação com crianças nascidas a termo

O presente estudo objetivou avaliar indicadores do desenvolvimento psicologico na fase escolar de criancas nascidas pre-termo com muito baixo peso e compara-los aos de criancas nascidas a termo, quanto as areas intelectual, emocional e comportamental. A amostra foi composta por 40 criancas de 8 a 10 anos, subdivididas em 2 grupos: Pre-termo (PT), 20 criancas nascidas 2.500g. Foram utilizados o Raven, o Desenho da Figura Humana e a Escala Comportamental Infantil. As criancas PT apresentaram mais frequentemente nivel intelectual inferior a media e problemas comportamentais em comparacao as AT. Nao houve diferenca entre os grupos quanto aos aspectos emocionais. Os problemas de enurese, medo, tiques, impaciencia e dificuldade de permanencia nas atividades foram significativamente mais frequentes no PT do que no AT. Verificou-se que, no grupo PT, quanto menor o nivel intelectual das criancas, mais problemas de comportamento elas apresentavam.

Desenvolvimento de bebês nascidos pré-termo no primeiro ano de vida

The aim of this study was to assess early development of pre-term and low birth weight infants. Forty- two infants born under 34 weeks of gestational age and 1.500 grams were assessed through Developmental and Behavior Child Scale (DBCS) in the first year of life. They have been participated at Developmental Follow-up Program for Pre-term Infants in Clinical Hospital of Faculty of Medicine (USP), since neonatal intensive care hospitalization period. Negative psychosocial events in familiar environment, and maternal conceptions and expectations related with child development were evaluated through interview. Performance of children at 6 and 11 months of post conception age (corrected for gestational age) was classified as Good or Excellent, identifying about 35% of infants with Risk or Delay scores. In spite of psychosocial adversity events in familiar environment, positive child development in the first year of life was observed, related with posite maternal expectations about child development and adherence to a follow-up program.