Sandra da Silva Mattos

Efeito terapêutico da música em crianças em pós-operatório de cirurgia cardíaca

OBJETIVO: Verificar de forma objetiva e subjetiva o efeito da musica em criancas no pos-operatorio de cirurgia cardiaca em uma unidade de terapia intensiva cardiopediatrica, em conjunto com acoes da pratica convencional. METODOS: Ensaio clinico aleatorizado por placebo, no qual foram avaliadas 84 criancas, com faixa etaria de 1 dia a 16 anos, nas primeiras 24 horas de pos-operatorio, submetidas a sessao de 30 minutos de musicoterapia, utilizando musica classica e observadas no inicio e fim das sessoes quanto as seguintes variaveis: frequencia cardiaca, pressao arterial, pressao arterial media, frequencia respiratoria, temperatura, saturacao de oxigenio, alem de uma escala facial de dor. Foi considerado o nivel de significância estatistica de 5%. RESULTADOS: Dos 84 pacientes iniciais, cinco (5,9%) recusaram participar do estudo. O grupo de cardiopatias mais comum foi o de congenitas acianogenicas com shunt E-D (41% intervencao: 44,4% controle). Quanto a avaliacao subjetiva atraves da escala facial de dor e objetiva das frequencias cardiaca e respiratoria, observou-se diferenca estatisticamente significante entre os dois grupos apos a intervencao (p < 0,001, p = 0,04 e p = 0,02, respectivamente). CONCLUSOES: Observou-se neste estudo uma acao benefica da musica em criancas no pos-operatorio de cirurgia cardiaca, atraves de alguns sinais vitais (frequencias cardiaca e respiratoria) e na reducao da dor (escala facial de dor). Contudo, existem lacunas a serem preenchidas nesta area, necessitando a realizacao de estudos mais aprofundados.OBJECTIVE To investigate, both objectively and subjectively, the effect of music on children in a pediatric cardiac intensive care unit following heart surgery, in conjunction with standard care. METHODS Randomized clinical trial with placebo, assessing 84 children, aged 1 day to 16 years, during the first 24 hours of the postoperative period, given a 30 minute music therapy session with classical music and observed at the start and end of the session, recording heart rate, blood pressure, mean blood pressure, respiratory rate, temperature and oxygen saturation, plus a facial pain score. Statistical significance was set at 5%. RESULTS Five of the initial 84 patients (5.9%) refused to participate. The most common type of heart disease was acyanotic congenital with left-right shunt (41% of cases: 44.4% of controls). Statistically significant differences were observed between the two groups after the intervention in the subjective facial pain scale and the objective parameters heart rate and respiratory rate (p < 0.001, p = 0.04 and p = 0.02, respectively). CONCLUSIONS A beneficial effect from music was observed with children during the postoperative period of heart surgery, by means of certain vital signs (heart rate and respiratory rate) and in reduced pain (facial pain scale). Nevertheless, there are gaps to be filled in this area, and studies in greater depth are needed.

Microcephaly in north-east Brazil: a retrospective study on neonates born between 2012 and 2015

Abstract Objective To assess the number of children born with microcephaly in the State of Paraíba, north-east Brazil. Methods We contacted 21 maternity centres belonging to a paediatric cardiology network, with access to information regarding more than 100 000 neonates born between 1 January 2012 and 31 December 2015. For 10% of these neonates, nurses were requested to retrieve head circumference measurements data from delivery-room books. We used three separate criteria to classify whether a neonate had microcephaly: (i) the Brazilian Ministry of Health proposed criterion: term neonates (gestational age ≥ 37 weeks) with a head circumference of less than 32 cm; (ii) Fenton curves: neonates with a head circumference of less than −3 standard deviation for age and gender; or (iii) the proportionality criterion: neonates with a head circumference of less than ((height/2))+10) ± 2. Findings Between 1 and 31 December 2015, nurses obtained data for 16 208 neonates. Depending on which criterion we used, the number of neonates with microcephaly varied from 678 to 1272 (4.2–8.2%). Two per cent (316) of the neonates fulfilled all three criteria. We observed temporal fluctuations of microcephaly prevalence from late 2012. Conclusion The numbers of microcephaly reported here are much higher than the 6.4 per 10 000 live births reported by the Brazilian live birth information system. The results raise questions about the notification system, the appropriateness of the diagnostic criteria and future implications for the affected children and their families. More studies are needed to understand the epidemiology and the implications for the Brazilian health system.

DigiScope — Unobtrusive collection and annotating of auscultations in real hospital environments

Digital stethoscopes are medical devices that can collect, store and sometimes transmit acoustic auscultation signals in a digital format. These can then be replayed, sent to a colleague for a second opinion, studied in detail after an auscultation, used for training or, as we envision it, can be used as a cheap powerful tool for screening cardiac pathologies. In this work, we present the design, development and deployment of a prototype for collecting and annotating auscultation signals within real hospital environments. Our main objective is not only pave the way for future unobtrusive systems for cardiac pathology screening, but more immediately we aim to create a repository of annotated auscultation signals for biomedical signal processing and machine learning research. The presented prototype revolves around a digital stethoscope that can stream the collected audio signal to a nearby tablet PC. Interaction with this system is based on two models: a data collection model adequate for the uncontrolled hospital environments of both emergency room and primary care, and a data annotation model for offline metadata input. A specific data model was created for the repository. The prototype has been deployed and is currently being tested in two Hospitals, one in Portugal and one in Brazil.

Heart sound segmentation of pediatric auscultations using wavelet analysis

Auscultation is widely applied in clinical activity, nonetheless sound interpretation is dependent on clinician training and experience. Heart sound features such as spatial loudness, relative amplitude, murmurs, and localization of each component may be indicative of pathology. In this study we propose a segmentation algorithm to extract heart sound components (S1 and S2) based on its time and frequency characteristics. This algorithm takes advantage of the knowledge of the heart cycle times (systolic and diastolic periods) and of the spectral characteristics of each component, through wavelet analysis. Data collected in a clinical environment, and annotated by a clinician was used to assess algorithms performance. Heart sound components were correctly identified in 99.5% of the annotated events. S1 and S2 detection rates were 90.9% and 93.3% respectively. The median difference between annotated and detected events was of 33.9 ms.

A Modified Blood Pressure to Height Ratio Improves Accuracy for Hypertension in Childhood

BACKGROUND The blood pressure to height ratio (BP:HT) has been proposed as a simple method for identifying children with elevated BP. This procedure shows good accuracy for the screening of hypertension in adolescents but less so in younger children. Our aim in this study was to modify the BP:HT ratio and determine if this change would increase accuracy when measuring hypertension during childhood. METHODS BP levels of 4,327 children (aged 5-12 years) were retrospectively obtained from medical charts. The modified ratio (BT:eHT13) was calculated as: BP/(HT + 7 × (13 - age in years)). Receiver operating characteristic curves were used to estimate cutoff points and the accuracy of the conventional and modified ratio to detect prehypertension and hypertension. RESULTS The prevalences of prehypertension and hypertension were 3.91% and 5.44%, respectively. In general, BP:eHT13 showed higher sensitivity (ranging from 0.95 to 1.00) and specificity (ranging from 0.80 to 0.98) in detecting prehypertension, level I hypertension, and level II hypertension than BP:HT (sensitivity ranging from 0.91 to 1.00; specificity ranging from 0.59 to 0.89). CONCLUSIONS The modified BP:eHT13 ratio showed better sensitivity and specificity for the screening of BP abnormalities in children aged 5-12 years.

Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service

OBJETIVO: Determinar a frequencia e o perfil das cardiopatias congenitas em portadores de sindrome de Down atendidos em servico de referencia de cardiologia pediatrica, considerando-se a idade do encaminhamento, o sexo, o tipo de cardiopatia diagnosticada ao ecocardiograma transtoracico e sua associacao com hipertensao pulmonar ao diagnostico inicial.METODOS:Estudo de corte transversal com coleta retrospectiva de dados de 138 pacientes portadores de sindrome de Down de um total de 17.873 prontuarios. Os dados foram submetidos a analise descritiva, utilizando-se o programa Epi-Info, versao 7.RESULTADOS: Entre os 138 pacientes com sindrome de Down, houve maior prevalencia do sexo feminino (56,1%) e 112 (81,2%) foram diagnosticados com cardiopatia congenita. Entre as cardiopatias, a mais comum foi a comunicacao interatrial ostium secundum, com frequencia de 51,8%, seguida pelo defeito do septo atrioventricular, com 46,4%. A comunicacao interventricular estava presente em 27,7%, enquanto a tetralogia de Fallot representou 6,3% dos casos. Outras cardiopatias totalizaram 12,5%. A hipertensao pulmonar associou-se a 37,5% das cardiopatias. Apenas 35,5% dos pacientes foram encaminhados ao servico ate os seis meses de idade.CONCLUSOES: O baixo percentual de encaminhamento ate os seis meses chama atencao para a necessidade de um melhor rastreamento dos portadores da sindrome no contexto das cardiopatias congenitas, tendo em vista a alta frequencia e a progressao da hipertensao pulmonar.OBJECTIVE: To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis. METHODS: Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7. RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age. CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension.

Denoising and segmentation of the second heart sound using matching pursuit

We propose a denoising and segmentation technique for the second heart sound (S2). To denoise, Matching Pursuit (MP) was applied using a set of non-linear chirp signals as atoms. We show that the proposed method can be used to segment the phonocardiogram of the second heart sound into its two clinically meaningful components: the aortic (A2) and pulmonary (P2) components.

An index for evaluating results in paediatric cardiac intensive care.

OBJECTIVE To determine if in-hospital mortality after cardiac surgery can be predicted, in children, using a new clinical and surgical index. STUDY DESIGN Observational, retrospective, cross-sectional. METHODS We reviewed 818 charts from children undergoing surgery between January, 2000, and December, 2004. The index was calculated by summing the scores from five variables, specifically age, nutritional state, the presence of associated clinical risk factors, surgical complexity, and use and time of cardiopulmonary bypass. Each variable was subdivided into categories of low, medium or high risk, with scores attributed as zero, one or two, respectively. Risks for death were calculated using the odds ratio. RESULTS Our overall mortality was 14.7%, with our proposed index correlating strongly with mortality (p less than 0.0001). No patients died with scores of zero, but mortality increased from around 10% with a score of three, to close to 30% with scores of five and six, and to over 50% with a score of eight. No patients reached scores of 10, and more than three-fifths of all patients had scores between zero and three. We observed higher mortalities independently for each variable in association with the highest risk scores. CONCLUSIONS We found that surgery undertaken in the neonatal period, weight below the 5th percentile, the presence of associated clinical risk factors, operations of higher complexity, and more than 90 minutes of cardiopulmonary bypass were all significantly associated with mortality. Our suggested new index showed a linear correlation with mortality, and in our current experience, has proved a valuable tool for predicting adverse outcomes.

A telemedicine network for remote paediatric cardiology services in north-east Brazil

Abstract Problem Providing health care for children with congenital heart diseases remains a major challenge in low- and middle-income countries. Approach In October 2011, the Government of Paraíba, Brazil, established a paediatric cardiology network in partnership with the nongovernmental organization Círculo do Coração. A cardiology team supervised all network activities, using the Internet to keep in contact with remote health facilities. The network developed protocols for screening heart defects. Echocardiograms were performed by physicians under direct online supervision of a cardiologist; alternatively, a video recording of the examination was subsequently reviewed by a cardiologist. Cardiovascular surgeons came to a paediatric hospital in the state capital once a week to perform heart surgeries. Local setting Until 2011, the State of Paraíba had no structured programme to care for children with heart disease. This often resulted in missed or late diagnosis, with adverse health consequences for the children. Relevant changes From 2012 to 2014, 73 751 babies were screened for heart defects and 857 abnormalities were identified. Detection of congenital heart diseases increased from 4.09 to 11.62 per 1000 live births (P < 0.001). Over 6000 consultations and echocardiograms were supervised via the Internet. Time to diagnosis, transfers and hospital stays were greatly reduced. A total of 330 operations were carried out with 6.7% (22/330) mortality. Lessons learnt Access to an echocardiography machine with remote supervision by a cardiologist improves the detection of congenital heart disease by neonatologists; virtual outpatient clinics facilitate clinical management; the use of Internet technology with simple screening techniques allows resources to be allocated more efficiently.

Comparison of different screening methods for blood pressure disorders in children and adolescents

OBJECTIVE To compare different methods of screening for blood pressure disorders in children and adolescents. METHOD A database with 17,083 medical records of patients from a pediatric cardiology clinic was used. After analyzing the inclusion and exclusion criteria, 5,650 were selected. These were divided into two age groups: between 5 and 13 years and between 13 and 18 years. The blood pressure measurement was classified as normal, pre-hypertensive, or hypertensive, consistent with recent guidelines and the selected screening methods. Sensitivity, specificity, and accuracy were then calculated according to gender and age range. RESULTS The formulas proposed by Somu and Ardissinos table showed low sensitivity in identifying pre-hypertension in all age groups, whereas the table proposed by Kaelber showed the best results. The ratio between blood pressure and height showed low specificity in the younger age group, but showed good performance in adolescents. CONCLUSION Screening tools used for the assessment of blood pressure disorders in children and adolescents may be useful to decrease the current rate of underdiagnosis of this condition. The table proposed by Kaelber showed the best results; however, the ratio between BP and height demonstrated specific advantages, as it does not require tables.