Saint Clair Gomes Junior

Effects of non-nutritive sucking and oral stimulation on breastfeeding rates for preterm, low birth weight infants: a randomized clinical trial

OBJECTIVE To determine the influence of non-nutritive sucking and oral stimulation programs on breastfeeding rates at discharge, at 3 and at 6 months of corrected age in preterm infants with very low birth weight. METHODS Preterm infants were randomized into experimental and control groups. Ninety-eight preterm infants were randomized and 96 remained in the study until reaching the corrected age of 6 months. The experimental group received sensory-motor-oral stimulation and non-nutritive sucking, while infants in the control group received a sham stimulation program. Both were administered from reaching enteral feeding (100 kcal/kg/day) until the beginning of oral feeding. RESULTS Fifty-nine infants (61.5%) were breastfeeding at the time of hospital discharge, 31 (36.9%) at 3 months, and only 18 (20.5%) at 6 months of corrected age. At discharge, 46.9% of the control group and 76.5% of the experimental group were breastfeeding. There were statistically significant differences between rates of breastfeeding at discharge (47 vs. 76%), 3 months (18 vs. 47%) and 6 months after discharge (10 vs. 27%). The experimental group showed significantly higher rates of breastfeeding (p < 0.05). CONCLUSION Non-nutritive sucking, associated with oral stimulation programs, can contribute to the improvement of breastfeeding rates among preterm infants with very low birth weight.

Resultado do teste rápido anti-HIV após o parto: uma ameaça à amamentação ao nascimento

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.

Deficiência de Vitamina A em mães e filhos no Estado de Pernambuco

Analisou-se a prevalencia e os fatores associados a deficiencia de vitamina A (DVA) em maes (664) e seus filhos (790) menores de cinco anos em Pernambuco/2006. Estudo transversal populacional, com amostra representativa do meio urbano e rural. A DVA foi definida como niveis de retinol serico < 20µg/dL para os dois grupos (maes e filhos). Analises bi e multivariadas foram realizadas utilizando o modelo log-log complementar como funcao de ligacao adotando-se modelo de ordenacao hierarquica explicativa da DVA para as criancas e modelo logistico para as maes. A prevalencia de DVA foi 6,9% nas maes e 16,1% em seus filhos, com ocorrencias semelhantes para cada grupo na comparacao urbano x rural. Na area urbana, o regime de ocupacao da moradia teve relacao significante com a DVA nas maes. Para criancas urbanas, apos o ajuste final do modelo, figuraram como variaveis preditivas a idade da mae; no de consultas pre-natais e peso ao nascer. No meio rural a DVA materna se associou a DVA dos filhos RP = 3,99 (IC:1,73-9,19), ao peso ao nascer e diarreia nos ultimos 15 dias. A DVA mantem-se como um problema de saude publica em Pernambuco, com marcantes diferencas de prevalencia e fatores associados em maes e filhos.The aim of this study was to assess the prevalence and associated factors of high Blood Pressure (BP) among adolescents in a Brazilian city. A cross-sectional study was conducted with 653 adolescents (57.9% female) of high school level between 14 and 19 years of age. Systolic blood pressure (SBP) and diastolic blood pressure (DBP) of all subjects were measured. Social and demographic variables and lifestyle factors and body mass index were obtained. Binary logistic regression, crude and adjusted, was employed with a significance level of 5%. The mean SBP and DBP were 111.9 mmHg and 69.9 mmHg, respectively. The prevalence of high BP levels was 12.4%. The multivariable analysis revealed that males (OR: 2.37, 95% CI: 1.45, 3.90), adolescents with maternal education < 8 years (OR: 1.84, 95% CI: 1.03, 3.30) and overweight (OR: 3.79, 95% CI: 2.23, 6.43) had greater indices of high BP. The interaction term between males and overweight represented the subgroup with greater indices of high BP (OR: 6.41, 95% CI: 3.00, 13.16). High BP affects adolescents from Ponta Grossa, State of Parana, and the groups with greater indices of high BP were males, with low maternal educational level and overweight.

Prevalence of bone mineral disease among adolescents with cystic fibrosis

OBJECTIVE To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS Mean age was 13.2 (+/-2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Freezing and thawing effects on fat, protein, and lactose levels of human natural milk administered by gavage and continuous infusion

OBJECTIVES to analyze the changes in human milk macronutrients: fat, protein, and lactose in natural human milk (raw), frozen and thawed, after administration simulation by gavage and continuous infusion. METHOD an experimental study was performed with 34 human milk samples. The infrared spectrophotometry using the infrared analysis equipment MilkoScan Minor® (Foss, Denmark) equipment was used to analyze the macronutrients in human milk during the study phases. The analyses were performed in natural (raw) samples and after freezing and fast thawing following two steps: gavage and continuous infusion. The non-parametric Wilcoxon test for paired samples was used for the statistical analysis. RESULTS the fat content was significantly reduced after administration by continuous infusion (p<0.001) during administration of both raw and thawed samples. No changes in protein and lactose content were observed between the two forms of infusion. However, the thawing process significantly increased the levels of lactose and milk protein. CONCLUSION the route of administration by continuous infusion showed the greatest influence on fat loss among all the processes required for human milk administration.

Modelo de simulação para estimar a infraestrutura necessária à assistência oncológica no sistema público de saúde

Objective. To develop a simulation model using public data to estimate the cancer care infrastructure required by the public health system in the state of Sao Paulo, Brazil. Method. Public data from the Unified Health System database regarding cancer surgery, chemotherapy, and radiation therapy, from January 2002–January 2004, were used to estimate the number of cancer cases in the state. The percentages recorded for each therapy in the Hospital Cancer Registry of Brazil were combined with the data collected from the database to estimate the need for services. Mixture models were used to identify subgroups of cancer cases with regard to the length of time that chemotherapy and radiation therapy were required. A simulation model was used to estimate the infrastructure required taking these parameters into account. Results. The model indicated the need for surgery in 52.5% of the cases, radiation therapy in 42.7%, and chemotherapy in 48.5%. The mixture models identified two subgroups for radiation therapy and four subgroups for chemotherapy with regard to mean usage time for each. These parameters allowed the following estimated infra-structure needs to be made: 147 operating rooms, 2 653 operating beds, 297 chemo-therapy chairs, and 102 radiation therapy devices. These estimates suggest the need for a 1.2-fold increase in the number of chemotherapy services and a 2.4-fold increase in the number of radiation therapy services when compared with the parameters cur-rently used by the public health system. Conclusion. A simulation model, such as the one used in the present study, permits better distribution of health care resources because it is based on specific, local needs.

Indirect calorimetry: a tool to adjust energy expenditure in very low birth weight infants

OBJECTIVE To determine the resting metabolic rate in very low birth weight infants through indirect calorimetry. METHODS Cross-sectional study including 29 clinically stable very low birth weight infants receiving an enteral diet > 100 kcal/kg/day. Malnutrition was defined as weight-for-age z score < or = - 2 SD. Resting energy expenditure was measured using open circuit indirect calorimetry. RESULTS At the time of the examination, mean weight was 1,564+/-393 g and corrected gestational age was 35+/-3 weeks. Malnutrition was diagnosed in 62.1% of the preterm infants. The mean resting metabolic rate was 57.01+/-7.76 kcal/kg/day. CONCLUSION Since resting energy expenditure is the main caloric component of total energy expenditure, the high resting metabolic rate observed may have a strong impact on the development of malnutrition during hospitalization.

Delivering rapid HIV tests results after delivery: a threat to breastfeeding at birth

OBJECTIVE To analyze factors associated with failure to breastfeed during the first hour of life, especially the influence of time of delivery of rapid HIV test results. METHODS Cohort study, beginning with the administration of the rapid test and ending the first time the baby is breastfed. The study population included 944 delivering mothers that received rapid HIV testing with a negative result in five Baby-Friendly hospitals of the High-Risk Pregnancy System in the city of Rio de Janeiro, Southeastern Brazil, in 2006. Trained interviewers obtained data from laboratory and patient charts and interviewed mothers shortly after delivery. The influence of sociodemographic variables and antenatal and delivery care characteristics on failure to breastfeed during the first hour of life was determined through a multilevel model. RESULTS Among participants, 15.6% received the result of rapid HIV testing before delivery, 30.8% after delivery, and 53.6% had not yet been informed of their results at the time of the interview. Prevalence of failure to breastfeed in the first hour of life was 52.5% (95% CI: 49.3;55.8). After adjustment, having received the result of rapid testing only after delivery doubled the risk of failing to breastfeed in the first hour (RR=2.06; 95% CI: 1.55;2.75). Other risk factors included nonwhite skin color, maternal income of up to one minimum wage, delivery by C-section, mothers lack of desire to breastfeed at birth, and mothers report that the hospital staff did not listen to her. Lack of knowledge of HIV testing from the mothers part was found to be a protective factor. CONCLUSIONS The major risk factor for not breastfeeding in the first hour of life was failure to receive the results of rapid HIV testing prior to delivery. HIV testing should be made widely available during antenatal care; rapid testing should be performed upon admission, only when indicated, and with active search and prompt delivery of results to expecting mothers.OBJETIVO: Analisar fatores associados a nao-amamentacao na primeira hora de vida, sobretudo a influencia do momento do resultado do teste rapido anti-HIV. METODOS: Estudo de coorte, sendo o ponto inicial a submissao ao teste rapido e o final a primeira mamada do bebe. A populacao estudada incluiu 944 parturientes submetidas ao teste rapido anti-HIV, com resultado negativo, em 2006, nos cinco hospitais amigos da crianca do Sistema de Gestacao de Alto Risco no municipio do Rio de Janeiro, RJ. Entrevistadoras treinadas obtiveram dados do laboratorio e do prontuario e no pos-parto aplicaram questionario para entrevista as maes. O modelo multinivel foi adotado para analisar a influencia de caracteristicas sociodemograficas, de assistencia pre-natal e ao parto sobre a nao-amamentacao na primeira hora de vida. RESULTADOS: Dentre as participantes, apenas 15,6% receberam seu resultado antes do parto, 30,8% depois do parto e 53,6% ainda desconheciam o resultado ao ser entrevistada. A prevalencia de nao-amamentacao na primeira hora de vida foi de 52,5% (IC 95%: 49,3;55,8). Apos ajuste, o recebimento do resultado do teste rapido apos o parto dobrou o risco da nao-amamentacao na primeira hora de vida (RR=2,06; IC 95%: 1,55;2,75). Outros fatores de risco foram: cor nao branca, renda materna de um salario minimo ou menos, parto cesareo, mae nao querer amamentar o bebe ao nascimento e mae referir que a equipe hospitalar nao a escutava. O desconhecimento da realizacao do teste rapido anti-HIV pela mae se mostrou como fator de protecao. CONCLUSOES: O principal fator de risco para a nao-amamentacao na primeira hora de vida foi o recebimento do resultado do teste rapido apos o parto. O teste anti-HIV deve ser amplamente disponibilizado no pre-natal e o teste rapido deve ser realizado sob indicacao, na admissao, com busca ativa e pronta comunicacao do resultado a mulher.

Prevalência de doença mineral óssea em adolescentes com fibrose cística

OBJECTIVE: To evaluate the prevalence of bone mineral disease among adolescents with cystic fibrosis and to relate the findings with the variables studied. METHODS: The study enrolled 37 adolescents who were assessed for: nutritional status according to height/age and body mass/age ratios; bone mineral density of the lumbar spine and entire body by densitometry with dual emission X-ray; daily dietary intake according to a 3-day dietary recall; and pulmonary function by the forced expiratory volume in one second test. RESULTS: Mean age was 13.2 (±2.8) years. Nutritional status was adequate in 70.3 and 75.7% of patients according to the height/age and body mass/age indices, respectively; 54.1% of the patients exhibited reduced lumbar spine bone mineral density and 32.5% for the whole body. There was a positive correlation between bone mineral density and body mass index (p = 0.04). Lung disease and pancreatic insufficiency exhibited a correlation with altered bone mineral density. The dietary recall revealed adequate percentages of calcium, phosphorous and calories, according to the nutritional recommendations laid out in the European Cystic Fibrosis Consensus. The multivariate analysis indicated that these variables were not statistically significant. CONCLUSIONS: There is a high prevalence of bone mineral disease among adolescents. Good nutritional status, pancreatic enzyme replacement and control of lung disease may have a protective effect on bone mass.

Abordagem diagnóstica e terapêutica da toxoplasmose em gestantes e as repercussões no recém-nascido

Objective: To analyze the diagnostic and therapeutic approach of pregnant women with positive IgM test for toxoplasmosis and the follow-up of their children in a public hospital of Rio de Janeiro, Brazil. Methods: This cross-sectional retrospective study from 2003 to 2006 enrolled 98 pregnant women with positive IgM test for toxoplasmosis and 99 children. The follow-up of the children with or without congenital infection was reviewed, as well as the clinical presentation of those with congenital infection and the laboratory tests used to diagnose the infection by Toxoplasma gondii during pregnancy. Results: Toxoplasmosis was diagnosed in the second and third trimesters of pregnancy in 76 patients. In 36 pregnant women, determination of the serum levels of IgM was the only laboratory method used to diagnose the infection. Low