Joaquim Silva Viana

Early mortality after neonatal surgery: analysis of risk factors in an optimized health care system for the surgical newborn

OBJECTIVE Anesthetic and operative interventions in neonates remain hazardous procedures, given the vulnerability of the patients in this pediatric population. The aim was to determine the preoperative and intraoperative factors associated with 30-day post-operative mortality and describe mortality outcomes following neonatal surgery under general anesthesia in our center. METHODS Infants less than 28 days of age who underwent general anesthesia for surgery during an 11-year period (2000 - 2010) in our tertiary care pediatric center were retrospectively identified using the pediatric intensive care unit database. Multiple logistic regression was used to identify independent preoperative and intraoperative factors associated with 30-day post-operative mortality. RESULTS Of the 437 infants in the study (median gestational age at birth 37 weeks, median birth weight 2,760 grams), 28 (6.4%) patients died before hospital discharge. Of these, 22 patients died within the first post-operative month. Logistic regression analysis showed increased odds of 30-day post-operative mortality among patients who presented American Society of Anesthesiologists physical status (ASA) score 3 or above (odds ratio 19.268; 95%CI 2.523 - 147.132) and surgery for necrotizing enterocolitis/gastrointestinal perforation (OR 5.291; 95%CI 1.962 - 14.266), compared to those who did not. CONCLUSION The overall in-hospital mortality of 6.4% is within the prevalence reported for developed countries. Establishing ASA score 3 or above and necrotizing enterocolitis/gastrointestinal perforation as independent risk factors for early mortality in neonatal surgery may help clinicians to more adequately manage this high risk population.

Medical decision-making inspired from aerospace multisensor data fusion concepts

In recent years, Internet-delivered treatments have been largely used for pain monitoring, offering healthcare professionals and patients the ability to interact anywhere and at any time. Electronic diaries have been increasingly adopted as the preferred methodology to collect data related to pain intensity and symptoms, replacing traditional pen-and-paper diaries. This article presents a multisensor data fusion methodology based on the capabilities provided by aerospace systems to evaluate the effects of electronic and pen-and-paper diaries on pain. We examined English-language studies of randomized controlled trials that use computerized systems and the Internet to collect data about chronic pain complaints. These studies were obtained from three data sources: BioMed Central, PubMed Central and ScienceDirect from the year 2000 until 30 June 2012. Based on comparisons of the reported pain intensity collected during pre- and post-treatment in both the control and intervention groups, the proposed multisensor data fusion model revealed that the benefits of technology and pen-and-paper are qualitatively equivalent . We conclude that the proposed model is suitable, intelligible, easy to implement, time efficient and resource efficient.

Fatores preditivos de complicações graves em cirurgia neonatal

OBJECTIVE To investigate the incidence and severity of early postoperative complications and to identify their risk factors in newborns undergoing surgery under general anesthesia. METHODS We conducted a retrospective analysis of data from 437 critically ill newborns undergoing surgery in a tertiary pediatric surgical center, between January 2000 and December 2010. Complications that occurred within the first 30 days after surgery were classified using the Clavien-Dindo system, for which grades III to V were considered severe. We used univariate and multivariate analysis to evaluate pre- and intraoperative variables potentially predictive of severe postoperative complications. RESULTS The incidence of at least one serious complication was 23%, with a median of one complication per patient 1:3. Altogether, there were 121 serious complications. Of these, 86 required surgical, endoscopic or radiological interventions (grade III), 25 endangered life, with uni or multi-organ failure (grade IV) and ten resulted in death (grade V). The most common complications were technical (25%), gastrointestinal (22%) and respiratory (21%). We identified four independent risk factors for severe postoperative complications: reoperation, operation for congenital diaphragmatic hernia, preterm birth less than 32 weeks of gestational age and abdominal surgery. CONCLUSION The incidence of severe postoperative complications after neonatal surgeries under general anesthesia remains high. The conditions considered independent risk factors for those can guide interventions to improve results.

Applied computer technologies in clinical decision support systems for pain management: A systematic review

Millions of people around the world suffer from pain, acute or chronic and this raises the importance of its screening, assessment and treatment. Pain, is highly subjective and the use of clinical decision support systems CDSSs can play an important part in improving the accuracy of pain assessment, and lead to better clinical practices. This review examines CDSSs, in relation to computer technologies and was conducted with the following electronic databases: CiteSeerx, IEEE Xplore, ISI Web of Knowledge, Mendeley, Microsoft Academic Search, PubMed, Science Accelerator, Science.gov, ScienceDirect, SpringerLink, and The Cochrane Library. The studies referenced were compiled with several criteria in mind. Firstly, that they constituted a decision support system. Secondly, that study data included pain values or results based on the detection of pain. Thirdly, that they were published in English, between 1992 and 2011, and finally that they focused on patients with acute or chronic pain. In total, thirty-nine studies highlighted the following topics: rule based algorithms, artificial neural networks, rough and fuzzy sets, statistical learning algorithms, terminologies, questionnaires and scores. The median accuracy ranged from 53% to 87.5%. The lack of integration with mobile devices, the limited use of web-based interfaces and the scarcity of systems that allow for data to be inserted by patients were all limitations that were detected.