Silvana Alves Pereira

A comparison between preterm and full-term infants' preference for faces

OBJECTIVE Visual preference for faces at birth is the product of a multimodal sensory experience experienced by the fetus even during the gestational period. The ability to recognize faces allows an ecologically advantageous interaction with the social environment. However, perinatal events such as premature birth, may adversely affect the adequate development of this capacity. In this study, we evaluated the preference for facial stimuli in preterm infants within the first few hours after birth. METHODS This is a cross-sectional observational study of 59 newborns, 28 preterm and 31 full-term infants. The babies were assessed in the first hours of life, with two white boards in the shape of a head and neck: one with the drawing of a face similar to the human face (natural face), and one with the drawing of misaligned eyes, mouth and nose (distorted face). After the newborn fixated the eyes on the presented stimulus, it was slowly moved along the visual field. The recognition of the stimulus was considered present when the baby had eye or head movements toward the stimulus. RESULTS The preterm infants, in addition to showing a lower occurrence of orientation movements for both stimuli, on average (1.8±1.1 to natural faces and 2.0±1.2 for distorted ones) also showed no preference for any of them (p=0.35). Full-term newborns showed a different behavior, in which they showed a preference for natural faces (p=0.002) and a higher number of orientations for the stimulus, for both natural (3.2±0.8) and distorted faces (2.5±0.9). CONCLUSION Preterm newborns recognize facial stimuli and disclose no preference for natural faces, different from full-term newborns.

Thoracic block technique associated with positive end-expiratory pressure in reversing atelectasis.

A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA), which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient.

Thermal and cardiorespiratory newborn adaptations during hot tub bath

Objective: To evaluate thermal and cardiorespiratory adaptation during hot tub bath and shower in healthy newborns in the first hours of life. Study design: This is a randomized blind controlled trial, registered in ReBEC (No. RBR-4z26f3) with 184 newborns divided into hot tub group (n=84) and shower (n=100). Newborns from intervention group were immersed in a hot tub with warm water up to the neck, without exposure to air flow, and control group received traditional shower. Heart rate, respiratory rate and temperature were measured before and immediately after bath by an investigator blinded to the type of bath. Results: Groups were similar in gender, gestational age, birth weight, Apgar score at 5th minute and hours of life, p => 0.05. To analyze thermal and cardiorespiratory adjustments, difference between post-bath variables and pre-bath was calculated. In this analysis, it was found statistically significant difference between two types of bath regarding heart rate, respiratory rate and temperature. Hot tub bath decreases heart and respiratory rates and increases temperature, whereas shower provides the opposite effect (0.0001). Conclusion: This study demonstrates that hot tub baths and shower, in healthy newborns, promote thermal and cardiorespiratory adaptations, reflecting thermal, cardiac and respiratory positive reactions after hot tub bath.

Agreement between MATLAB® 2D and AutoCAD® methods for the evaluation of thoracoabdominal mobility in newborns

Background: The available methods that assess thoracoabdominal complex in neonatology are costly and difficult to manipulate. Biophotogrammetry emerged as an accessible method, which can be analyzed through AutoCAD®, but it is time-consuming and evaluator-dependent. Then, an algorithmic sequence using MATLAB® software was created by a group of researchers, aiming to evaluate the thoracoabdominal movement in newborns bedside. Aim: to evaluate the agreement between MATLAB® and AutoCAD® methods for thoracoabdominal mobility evaluation of neonates. Method: This is an observational cross-sectional study, with healthy term newborns and up to 72 hours of life. The newborns were placed in supine to collect the videos assessing their thoracoabdominal mobility, which were later analyzed through MATLAB and AutoCAD®. The agreement between these methods was analyzed trough Bland Altman, evaluating the difference of means (BIAS) between AutoCAD® and MATLAB®, and considering a confidence interval of 95%. Results: Videos of 26 newborns were collected, totaling 156 frames, but 17 of these were excluded because showed alterations that could harm the analysis. Then, a total of 139 frames were evaluated. The concordance analysis between the mobility measures showed a value difference of -1.68cm2 (BIAS) with a limit of agreement from +3.22 to -6.59 cm2 (Figure 1). Conclusions: In the population studied, there was an agreement between MATLAB® and AutoCAD® for thoracoabdominal mobility evaluation, suggesting that the methods are interchangeable. Thus, MATLAB® emerges as a simple, fast, inexpensive, and reliable alternative software that can be used for bio-photogrammetric analysis.