Maria Cândida Ferrarez Bouzada

Diagnostic accuracy of fetal renal pelvis anteroposterior diameter as a predictor of uropathy: a prospective study.

The purpose of this study was to assess the accuracy of prenatal ultrasound measurement of anteroposterior renal pelvis diameter (APD) to discriminate between significant uropathy and idiopathic renal pelvis dilatation.

Risk factors and lethality of laboratory-confirmed bloodstream infection caused by non-skin contaminant pathogens in neonates

OBJECTIVE To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (LCBI) in a Brazilian neonatal unit for progressive care (NUPC). METHODS This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset LCBI, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset LCBI, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. RESULTS 50 patients with late onset LCBI were matched with 100 patients without late onset LCBI. In the group of patients with late onset LCBI, a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. CONCLUSIONS Surgical procedures and CVC usage were significant risk factors for LCBI. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.

Preterm children have unfavorable motor, cognitive, and functional performance when compared to term children of preschool age

OBJECTIVE to compare the motor coordination, cognitive, and functional development of preterm and term children at the age of 4 years. METHODS this was a cross-sectional study of 124 four-year-old children, distributed in two different groups, according to gestational age and birth weight, paired by gender, age, and socioeconomic level. All children were evaluated by the Movement Assessment Battery for Children - second edition (MABC-2), the Pediatric Evaluation of Disability Inventory (PEDI), and the Columbia Mental Maturity Scale (CMMS). RESULTS preterm children had worse performance in all tests, and 29.1% of the preterm and 6.5% of term groups had scores on the MABC-2 indicative of motor coordination disorder (p=0.002). In the CMMS (p=0.034), the median of the standardized score for the preterm group was 99.0 (± 13.75) and 103.0 (± 12.25) for the term group; on the PEDI, preterm children showed more limited skill repertoire (p=0.001) and required more assistance from the caregiver (p=0.010) than term children. CONCLUSION this study reinforced the evidence that preterm children from different socioeconomic backgrounds are more likely to have motor, cognitive, and functional development impairment, detectable before school age, than their term peers.

Antenatal Ultrasonographic Anteroposterior Renal Pelvis Diameter Measurement: Is It a Reliable Way of Defining Fetal Hydronephrosis?

Purpose. It was to quantify the intraobserver and interobserver variability of the sonographic measurements of renal pelvis and classify hydronephrosis severity. Methods. Two ultrasonographers evaluated 17 fetuses from 23 to 39 weeks of gestation. Renal pelvis APD were taken in 50 renal units. For intraobserver error, one of them performed three sequential measurements. The mean and standard deviation from the absolute and percentage differences between measurements were calculated. Bland-Altman plots were used to visually assess the relationship between the precision of repeated measurements. Hydronephrosis was classified as mild (5.0 to 9.9 mm), moderate (10.0 to 14.9 mm), or severe (≥15.0 mm). Interrater agreement were obtained using the Kappa index. Results. Absolute intraobserver variation in APD measurements was 5.2 ± 3.5%. Interobserver variation of ultrasonographers was 9.3 ± 9.7%. Neither intraobserver or interobserver error increased with increasing APD size. The overall percentage of agreement with the antenatal hydronephrosis diagnosis was 64%. Cohens Kappa to hydronephrosis severity was 0.51 (95% CI, 0.33 to 0.69). Conclusion. Inter and intraobserver APD measurement errors were low in these group, but the agreement to hydronephrosis diagnosis and classification was fair. We suggest that standard and serial APD measurement can better define and evaluate fetal hydronephrosis.

Prevalência de alterações auditivas em crianças de risco

UNLABELLED Hearing impairment is prevalent in the general population; early intervention facilitates proper development. AIM To establish the prevalence of hearing impairment in infants at risk, born between June 2006 and July 2008, and to correlate the variables with hearing loss. TYPE OF STUDY descriptive and cross-sectional. MATERIALS AND METHODS 188 newborns were evaluated using evoked otoacoustic emissions and distortion product and auditory behavior. Tests were repeated if the results were altered. If altered results persisted, the child was referred for impedance testing and, when necessary, for medical evaluation. Infants with normal conduction were referred for brainstem auditory evoked potential testing. RESULTS Of 188 children two (1.1%) were excluded, and 174 (92.6%) had results within normal limits. Hearing impairment was found in 12 children (6.3%); hearing loss was retrocochlear in three infants (25%). Unilateral hearing loss was present in two infants (16.7%); bilateral hearing loss was present in 10 infants (83.3%). CONCLUSION The high prevalence of hearing impairment in this population underlines the importance of early audiological testing.Hearing impairment is prevalent in the general population; early intervention facilitates proper development. AIM: To establish the prevalence of hearing impairment in infants at risk, born between June 2006 and July 2008, and to correlate the variables with hearing loss. TYPE OF STUDY: descriptive and cross-sectional. MATERIALS AND METHODS: 188 newborns were evaluated using evoked otoacoustic emissions and distortion product and auditory behavior. Tests were repeated if the results were altered. If altered results persisted, the child was referred for impedance testing and, when necessary, for medical evaluation. Infants with normal conduction were referred for brainstem auditory evoked potential testing. RESULTS: Of 188 children two (1.1%) were excluded, and 174 (92.6%) had results within normal limits. Hearing impairment was found in 12 children (6.3%); hearing loss was retrocochlear in three infants (25%). Unilateral hearing loss was present in two infants (16.7%); bilateral hearing loss was present in 10 infants (83.3%). CONCLUSION: The high prevalence of hearing impairment in this population underlines the importance of early audiological testing.

Conservative management of multicystic dysplastic kidney: clinical course and ultrasound outcome

OBJECTIVE The aim of this study was to describe the clinical course and ultrasound outcome of prenatally detected multicystic dysplastic kidney. METHODS Fifty-three children with unilateral multicystic dysplastic kidney detected by prenatal ultrasound between 1989 and 2004 were included in the analysis. All children were submitted to conservative management with follow-up visits every six months. Follow-up ultrasound examinations were performed at six-month intervals during the first two years of life and yearly thereafter. The following clinical parameters were evaluated: blood pressure, urinary tract infection, renal function, and growth. The following ultrasound parameters were evaluated: involution of multicystic dysplastic kidney and contralateral renal growth. RESULTS The mean follow-up time was 68 months. Two children presented hypertension during follow-up and five had urinary tract infection (only one with recurrent episodes). There was no malignant degeneration of multicystic dysplastic kidney. A total of 334 ultrasound scans were analyzed. US scan demonstrated involution of the multicystic dysplastic kidney in 48 (90%) cases, including complete involution in nine (17%). The involution rate was faster in the first 30 months of life. There was progressive compensatory renal hypertrophy of the contralateral renal unit; the rate of growth was greater in the first 24 months of life. CONCLUSION The results of prolonged follow-up of children with conservatively managed multicystic dysplastic kidney suggest that clinical approach is safe, the incidence of complications is small, and that there is a clear tendency for multicystic dysplastic kidney to decrease in size. Our data also suggest that the involution rate of multicystic dysplastic kidney as well as the growth of the contralateral kidney is greater in the first 24 months of life.

Preterm newborn readiness for oral feeding: systematic review and meta-analysis

PURPOSE To identify and systematize the main studies on the transition from enteral to oral feeding in preterm infants. RESEARCH STRATEGY Articles that describe the transition from oral to enteral feeding in preterm infants were located in MEDLINE, LILACS, and SciELO databases. SELECTION CRITERIA Original studies, with available abstract, published in the last 10 years were included. DATA ANALYSIS Analysis of the methodology and the main results of the studies, and meta-analysis of the effects of sensory-motor-oral stimulation at the time of transition to full oral feeding and duration of hospitalization were conducted. RESULTS Twenty-nine national and international publications were considered. Most studies were clinical trials (44.8%) and did not use rating scales to start the transition process (82.7%). In the meta-analysis, positive effect of stimulation of the sensory-motor-oral system was observed with respect to the transition time to oral diet (p=0.0000), but not in relation to the length of hospital stay (p=0.09). However, heterogeneity between studies was found both in the analysis of the transition time to full oral feeding (I2=93.98) and in the length of hospital stay (I2=82.30). CONCLUSION The transition to oral feeding is an important moment, and various physical and clinical characteristics of preterm infants have been used to describe this process. Despite the impossibility of generalizing the results due to the heterogeneity of the studies, we have noted the importance of strategies for stimulation of sensory-motor-oral system to decrease the period of transition to full oral feeding system.

Influence of prone position on oxigenation, respiratory rate and muscle strength in preterm infants being weaned from mechanical ventilation

OBJECTIVE:To verify the influence of preterm infant positioning on respiratory muscle strength, oxygenation and respiratory rate. METHODS: Cross-sectional study with a paired sample of intubated infants born with gestational age less than 34 weeks, in the final process of weaning from mechanical ventilation. Infants with malformation, genetic syndromes, neuromuscular diseases, tracheotomies and in the postoperative period of abdominal and thoracic surgery were excluded. Maximum inspiratory pressure measures were checked by a digital manometer; respiratory rate was visually observed during one minute and oxygen saturation was measured by a pulse oximeter in prone and supine postures. Kruskal-Wallis and Students t-test and Pearson correlation coefficient were applied, being significant p<0.05. RESULTS: 45 infants with respiratory distress syndrome were evaluated. The mean gestational age was 30.4 weeks and the mean birth weight was 1522g. The oxygen saturation was higher in prone position (p<0.001). Values of maximum inspiratory pressure were lower in prone when compared to infants in the supine position (p<0.001).Respiratory rate was similar in the two studied positions (p=0.072). CONCLUSIONS: There was a lower inspiratory pressure and a higher oxygen saturation in prone position when compared to the supine one. Concerning the respiratory rate there was no variation between prone and supine position.OBJETIVO: Verificar a influencia do posicionamento do recem-nascido prematuro sobre a forca da musculatura respiratoria, oxigenacao e frequencia respiratoria. METODOS: Estudo transversal com amostra pareada de recem-nascidos com idade gestacional inferior a 34 semanas, intubados, em processo final de desmame de ventilacao mecânica. Foram excluidos aqueles com malformacoes, sindromes geneticas, doencas neuromusculares, traqueostomizados e em pos-operatorio de cirurgias abdominais ou toracicas. As medidas de pressao inspiratoria maxima foram aferidas utilizando-se manovacuometro digital; a frequencia respiratoria atraves da observacao das incursoes respiratorias das criancas em um minuto e a saturacao de oxigenio por oximetro, nas posturas prona e supino. Os testes estatisticos aplicados foram Kruskal-Wallis, o teste t de Student e o coeficiente de correlacao de Pearson, sendo significante p<0,05. RESULTADOS: Foram estudadas 45 criancas com sindrome do desconforto respiratorio. A idade gestacional media foi de 30,4 semanas e o peso medio ao nascer de 1522g. Os valores de saturacao de oxigenio foram mais elevados (p<0,001) e os de pressao inspiratoria maxima mais baixos (p<0,001) na posicao prona. Os valores de frequencia respiratoria foram semelhantes nas duas posicoes estudadas (p=0,072). CONCLUSOES: Observaram-se menores valores de pressao inspiratoria alem de aumento da saturacao de oxigenio na posicao prona quando comparada a supino. Em relacao a frequencia respiratoria, nao foi observada variacao entre as posturas prona e supino.

Accuracy of chest radiography for positioning of the umbilical venous catheter

OBJECTIVES To evaluate the accuracy of the simultaneous analysis of three radiographic anatomical landmarks - diaphragm, cardiac silhouette, and vertebral bodies - in determining the position of the umbilical venous catheter distal end using echocardiography as a reference standard. METHODS This was a cross-sectional, observational study, with the prospective inclusion of data from all neonates born in a public reference hospital, between April 2012 and September 2013, submitted to umbilical venous catheter insertion as part of their medical care. The position of the catheter distal end, determined by the simultaneous analysis of three radiographic anatomical landmarks, was compared with the anatomical position obtained by echocardiography; sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. RESULTS Of the 162 newborns assessed by echocardiography, only 44 (27.16%) had the catheter in optimal position, in the thoracic portion of the inferior vena cava or at the junction of the inferior vena cava with the right atrium. The catheters were located in the left atrium and interatrial septum in 54 (33.33%) newborns, in the right atrium in 26 (16.05%), intra-hepatic in 37 (22.84%), and intra-aortic in-one newborn (0.62%). The sensitivity, specificity and accuracy of the radiography to detect the catheter in the target area were 56%, 71%, and 67.28%, respectively. CONCLUSION Anteroposterior radiography of the chest alone is not able to safely define the umbilical venous catheter position. Echocardiography allows direct visualization of the catheter tip in relation to vascular structures and, whenever possible, should be considered to identify the location of the umbilical venous catheter.

Influência da posição prona na oxigenação, frequência respiratória e na força muscular nos recém-nascidos pré-termo em desmame da ventilação mecânica

OBJECTIVE:To verify the influence of preterm infant positioning on respiratory muscle strength, oxygenation and respiratory rate. METHODS: Cross-sectional study with a paired sample of intubated infants born with gestational age less than 34 weeks, in the final process of weaning from mechanical ventilation. Infants with malformation, genetic syndromes, neuromuscular diseases, tracheotomies and in the postoperative period of abdominal and thoracic surgery were excluded. Maximum inspiratory pressure measures were checked by a digital manometer; respiratory rate was visually observed during one minute and oxygen saturation was measured by a pulse oximeter in prone and supine postures. Kruskal-Wallis and Students t-test and Pearson correlation coefficient were applied, being significant p<0.05. RESULTS: 45 infants with respiratory distress syndrome were evaluated. The mean gestational age was 30.4 weeks and the mean birth weight was 1522g. The oxygen saturation was higher in prone position (p<0.001). Values of maximum inspiratory pressure were lower in prone when compared to infants in the supine position (p<0.001).Respiratory rate was similar in the two studied positions (p=0.072). CONCLUSIONS: There was a lower inspiratory pressure and a higher oxygen saturation in prone position when compared to the supine one. Concerning the respiratory rate there was no variation between prone and supine position.OBJETIVO: Verificar a influencia do posicionamento do recem-nascido prematuro sobre a forca da musculatura respiratoria, oxigenacao e frequencia respiratoria. METODOS: Estudo transversal com amostra pareada de recem-nascidos com idade gestacional inferior a 34 semanas, intubados, em processo final de desmame de ventilacao mecânica. Foram excluidos aqueles com malformacoes, sindromes geneticas, doencas neuromusculares, traqueostomizados e em pos-operatorio de cirurgias abdominais ou toracicas. As medidas de pressao inspiratoria maxima foram aferidas utilizando-se manovacuometro digital; a frequencia respiratoria atraves da observacao das incursoes respiratorias das criancas em um minuto e a saturacao de oxigenio por oximetro, nas posturas prona e supino. Os testes estatisticos aplicados foram Kruskal-Wallis, o teste t de Student e o coeficiente de correlacao de Pearson, sendo significante p<0,05. RESULTADOS: Foram estudadas 45 criancas com sindrome do desconforto respiratorio. A idade gestacional media foi de 30,4 semanas e o peso medio ao nascer de 1522g. Os valores de saturacao de oxigenio foram mais elevados (p<0,001) e os de pressao inspiratoria maxima mais baixos (p<0,001) na posicao prona. Os valores de frequencia respiratoria foram semelhantes nas duas posicoes estudadas (p=0,072). CONCLUSOES: Observaram-se menores valores de pressao inspiratoria alem de aumento da saturacao de oxigenio na posicao prona quando comparada a supino. Em relacao a frequencia respiratoria, nao foi observada variacao entre as posturas prona e supino.