Rosana Maria Tristão

Hyper-responsiveness to acute stress, emotional problems and poorer memory in former preterm children

Abstract The prevalence of preterm birth (PTB) is high worldwide, especially in developing countries like Brazil. PTB is marked by a stressful environment in intra- as well as extrauterine life, which can affect neurodevelopment and hormonal and physiological systems and lead to long-term negative outcomes. Nevertheless, little is known about PTB and related outcomes later on in childhood. Thus, the goals of the current study were threefold: (1) comparing cortisol and alpha-amylase (sAA) profiles, including cortisol awakening response (CAR), between preterm and full-term children; (2) evaluating whether preterm children are more responsive to acute stress and (3) assessing their memory skills and emotional and behavioral profiles. Basal cortisol and sAA profiles, including CAR of 30 preterm children, aged 6 to 10 years, were evaluated. Further, we assessed memory functions using the Wide Range Assessment of Memory and Learning, and we screened behavior/emotion using the Strengths and Difficulties Questionnaire. The results of preterm children were compared to an age- and sex-matched control group. One week later, participants were exposed to a standardized laboratory stressor [Trier Social Stress Test for Children (TSST-C)], in which cortisol and sAA were measured at baseline, 1, 10 and 25 min after stressor exposure. Preterm children had higher cortisol concentrations at awakening, a flattened CAR and an exaggerated response to TSST-C compared to full-term children. These alterations were more pronounced in girls. In addition, preterm children were characterized by more emotional problems and poorer memory performance. Our findings illustrate the long-lasting and in part sex-dependent effects of PTB on the hypothalamic–pituitary–adrenal (HPA) axis, internalizing behavior and memory. The findings are in line with the idea that early adversity alters the set-point of the HPA axis, thereby creating a more vulnerable phenotype.

Heart rate, oxygen saturation, and skin conductance: A comparison study of acute pain in Brazilian newborns

Heart rate variability (HRV), oxygen saturation variability (OSV) and skin conductance activity (SCA) are recognized physiological markers of acute pain. In order to verify which of them has the best correlation with psychophysical parameters of pain (intensity, reactivity, direction, regulation and slope), an observational prospective study was performed, including 41 healthy full term newborns. The measurements studied were the HRV, the OSV, and the following SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC). The measurements were performed in periods labeled before, during, and after a heel prick. The variation measured for intensity between periods was significant for the NWps (p=0.001), AUC (p=0.03), HRV (p=0.001) and OSV (p=0.004). Also, the reactivity and direction were significant for all variables, except AUC. The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), HRV (p<0.01) and OSV (p<0.01). The slope was statistically significant only for the OSV variable (p=0.000). We concluded that the responses of the SCA, HRV and OSV to painful events fit the psychophysical parameters of a physiological marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context.

Sleep deprivation, pain and prematurity: a review study.

The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.

Psychophysical parameters of a multidimensional pain scale in newborns.

The Premature Infant Pain Profile (PIPP) is a promising multidimensional tool for comparison and testing of new technologies in newborn pain assessment studies since it may adhere to basic psychophysical parameters of intensity, direction, reactivity, regulation and slope described in analyses of physiological pain indicators. The aim of this study was to evaluate whether these psychophysical parameters can be achieved using the PIPP in acute pain assessment. Thirty-six healthy term newborn infants were conveniently sampled whilst being videotaped before, during and after heel prick blood sampling. The images were blind-scored by three trained independent raters and scored against the PIPP. The PIPP and its facial action indicators met the parameters of intensity, reactivity and regulation (all p < 0.001). The heart rate variability did not meet any parameter (all p > 0.05). The oxygen saturation variability met only the intensity parameter (p < 0.05). The behavioural state indicator met all parameters and had the best correlation to the psychophysical parameters of all indicators of PIPP (all p < 0.001). We concluded that the overall PIPP meets the assumptions of these psychophysical parameters, being the behavioural state indicator which best fit the model.

Aleitamento materno exclusivo e fatores associados a sua interrupção precoce: estudo comparativo entre 1999 e 2008

Objective: To analyze the indicators of exclusive breastfeed- ing (EB) in Brasilias University Hospital (BUH) during a 10- year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was con- ducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associa- tions were found in the study. Conclusions: Similarly to what was found in Brazilian capitals and Brasilia, there was an increase in the length of exclusive breastfeeding related to mother educational level. Nevertheless, the duration exclusive breastfeeding is still below the threshold of 180 days recommended by the World Health Organization.Objective: To analyze the indicators of exclusive breastfeeding (EB) in Brasilia’s University Hospital (BUH) during a 10-year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was conducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associations were found in the study.

Percepção da fala em bebês no primeiro ano de vida

A fala humana e um som de grande complexidade, cujo processamento perceptual, producao e relacoes com a linguagem e a cognicao necessitam de uma analise integrada, tanto do ponto de vista do conhecimento disponivel como tambem das especificidades metodologicas. Neste artigo faz-se uma breve revisao da literatura sobre as principais aquisicoes e desenvolvimento da linguagem no primeiro ano de vida de bebes com desenvolvimento normal com enfoque na percepcao da fala humana. Busca-se, tambem, analisar a ocorrencia de disturbios auditivos que podem causar alteracoes na percepcao da fala, com possiveis implicacoes para o desenvolvimento pre-linguistico. Atencao especial e dada ao desenvolvimento da habilidade de percepcao de fala e de linguagem em bebes com sindrome de Down. E analisada a predisposicao, nesta populacao, a problemas audiologicos, sua relacao com alteracoes no desenvolvimento de linguagem, e a tendencia apresentada no primeiro ano de vida para padroes diferenciados de atencao a fala.

COMFORT behaviour scale and skin conductance activity: what are they really measuring?

To assess how efficiently the COMFORT behaviour scale measures acute pain in neonates, in comparison with skin conductance activity, a validated measure of pain and stress.

Exclusive breastfeeding and factors related to early weaning: a comparative study between 1999 and 2008

Objective: To analyze the indicators of exclusive breastfeed- ing (EB) in Brasilias University Hospital (BUH) during a 10- year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was con- ducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associa- tions were found in the study. Conclusions: Similarly to what was found in Brazilian capitals and Brasilia, there was an increase in the length of exclusive breastfeeding related to mother educational level. Nevertheless, the duration exclusive breastfeeding is still below the threshold of 180 days recommended by the World Health Organization.Objective: To analyze the indicators of exclusive breastfeeding (EB) in Brasilia’s University Hospital (BUH) during a 10-year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was conducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associations were found in the study.

P981: Electrodiagnosis in carpal tunnel syndrome, contribution of nerve conduction study of the first digit median nerve

ities were collected. Muscle strength was measured according to Medical Research Council (MRC) scale. Results: A total of 192 nerves were evaluated. MCV, CMAP amplitude, and MRC were significantly decreased in nerves of upper limbs than lower limbs (P<0.01); while there was no difference between median nerve and ulnar nerve in MCV, CMAP amplitude and MRC (P>0.05), the same between tibial and peroneal nerve. No CMAP response was evoked in almost half of nerves in lower limbs, which was significantly higher than upper limbs (P<0.01). MCV decreased in all nerves with decreased CMAP amplitude or decreased MRC, in 93% nerves with normal amplitude and in 95% nerves with normal MRC. CMAP amplitude decreased in 67% nerves with normal MRC, and in 96% nerves with decreased MRC. Abnormal SA was presented in 32.4% muscles of upper limbs, 94.6% of lower limbs. Conventional needle EMG showed that abnormal spontaneous activity (SA) presented in 32.4% muscles in upper limbs, in 94.6% muscles of lower limbs. EMG was followed up in 3 patients. All showed that decreased MCV was the earliest change in motor NCS. Conclusion: Decreased MCV is the earliest change in motor NCS, demyelinating changes happen earlier than axonal loss, and the damage of the nerves happen earlier and more severe in lower limb than upper limb. Recognition of these features can lead to early diagnosis of POEMS syndrome, and give some clues for better understanding the mechanism and pathophysiology of POEMS neuropathy.

Lactancia materna exclusiva y factores asociados a su interrupción temprana: estudio comparativo entre 1999 y 2008

Objective: To analyze the indicators of exclusive breastfeed- ing (EB) in Brasilias University Hospital (BUH) during a 10- year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was con- ducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associa- tions were found in the study. Conclusions: Similarly to what was found in Brazilian capitals and Brasilia, there was an increase in the length of exclusive breastfeeding related to mother educational level. Nevertheless, the duration exclusive breastfeeding is still below the threshold of 180 days recommended by the World Health Organization.Objective: To analyze the indicators of exclusive breastfeeding (EB) in Brasilia’s University Hospital (BUH) during a 10-year interval and to verify associated factors to early weaning. Methods: A retrospective cross-sectional study was conducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years. Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associations were found in the study.