Sônia Bechara Coutinho

Comparison of the effect of two systems for the promotion of exclusive breastfeeding

BACKGROUND Promotion of breastfeeding is an important child-survival intervention, yet little is known about which promotional strategies are the most effective. We aimed to compare the effects on rates of breastfeeding of two systems for promotion of breastfeeding in Brazil--a hospital-based system and the same system combined with a programme of home visits. METHODS In February, 2001, maternity staff from two hospitals in Pernambuco, Brazil, were trained according to the Baby-Friendly Hospital Initiative (BFHI). In a randomised trial between March and August, 2001, 350 mothers giving birth at these hospitals were assigned ten postnatal home visits to promote and support breastfeeding (n=175) or no home visits (n=175). Breastfeeding practices were studied on days 1, 10, 30, 60, 90, 120, 150, and 180 by researchers unaware of group allocation. The primary outcome measure was the rate of exclusive breastfeeding from birth to 6 months. Analyses were by intention to treat. FINDINGS The hospital-training intervention achieved a high rate (70%) of exclusive breastfeeding in the hospitals, but this rate was not sustained at home and at 10 days of age only 30% of infants were exclusively breastfed The patterns of exclusive breastfeeding in the two trial groups for days 10-180 differed significantly (p<0.0001), with a mean aggregated prevalence of 45% among the group assigned home visits compared with 13% for the group assigned none. INTERPRETATION The BFHI achieves high rates of exclusive breastfeeding in hospital; however, in Brazil at least, the rates fall rapidly thereafter. Reliance on the BFHI as a strategy for breastfeeding promotion should be reassessed. A combination of promotional systems (hospital-based and in the community) is needed.

Impacto de treinamento baseado na Iniciativa Hospital Amigo da Criança sobre práticas relacionadas à amamentação no interior do Nordeste

OBJETIVO: Avaliar o impacto de treinamento baseado na Iniciativa Hospital Amigo da Crianca sobre praticas relacionadas a amamentacao na maternidade e frequencias de aleitamento materno nos primeiros 6 meses de vida. METODOS: Foram treinadas 90% das auxiliares de enfermagem e parteiras de duas maternidades (A e B) de Palmares (PE). Foram entrevistadas 334 maes nas primeiras 48 horas e 10 dias apos o parto, para avaliar praticas que estimulam a amamentacao nas maternidades e o cumprimento do quarto ao 10o passo da Iniciativa Hospital Amigo da Crianca. Uma subamostra de 166 maes recebeu sete visitas domiciliares, para avaliar as frequencias do aleitamento materno nos 6 primeiros meses de vida. Os resultados foram comparados com os de estudo de coorte realizado na area em 1998. RESULTADOS: O desempenho da maternidade B foi melhor que o da maternidade A quanto as praticas que promovem o aleitamento materno relacionadas aos passos avaliados e quanto as frequencias de amamentacao exclusiva. Comparacao com coorte historica evidenciou melhora nas praticas relacionadas a amamentacao nas maternidades e aumento nas frequencias do aleitamento materno exclusivo (de 21,2 para 70%), nas primeiras 48 horas apos o parto e durante os 6 primeiros meses de vida. CONCLUSOES: O treinamento promoveu mudancas parciais em algumas praticas relacionadas a amamentacao, repercutindo de forma positiva sobre as frequencias de aleitamento materno e aleitamento materno exclusivo nas maternidades. Contudo, nao houve mudancas expressivas nessas frequencias ao longo dos 6 meses de vida, sugerindo a necessidade de intervencoes efetivas no apoio ao aleitamento exclusivo nos servicos de saude e na comunidade.

Determinants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive history

Objective To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history.OBJECTIVE To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. METHODS This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. RESULTS The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR=3.08), hospitalization during pregnancy (OR=2.48), inadequate prenatal care (OR=2.49), lack of ultrasound examination during prenatal care (OR=3.89), transfer of the newborn to another unit after birth (OR=5.06), admittance of the newborn at the ICU (OR=5.00), and low birth weight (OR=2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR=1.73) and with no children younger than five years (OR=10.10). CONCLUSION Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.

Original articleDeterminants of neonatal death with emphasis on health care during pregnancy, childbirth and reproductive historyFatores de risco para mortalidade neonatal, com especial atenção aos fatores assistenciais relacionados com os cuidados durante o período pré-natal, parto e história reprodutiva materna☆

Objective To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history.OBJECTIVE To identify risk factors for neonatal mortality, focusing on factors related to assistance care during the prenatal period, childbirth, and maternal reproductive history. METHODS This was a case-control study conducted in Maceió, Northeastern Brazil. The sample consisted of 136 cases and 272 controls selected from official Brazilian databases. The cases consisted of all infants who died before 28 days of life, selected from the Mortality Information System, and the controls were survivors during this period, selected from the Information System on Live Births, by random drawing among children born on the same date of the case. Household interviews were conducted with mothers. RESULTS The logistic regression analysis identified the following as determining factors for death in the neonatal period: mothers with a history of previous children who died in the first year of life (OR=3.08), hospitalization during pregnancy (OR=2.48), inadequate prenatal care (OR=2.49), lack of ultrasound examination during prenatal care (OR=3.89), transfer of the newborn to another unit after birth (OR=5.06), admittance of the newborn at the ICU (OR=5.00), and low birth weight (OR=2.57). Among the socioeconomic conditions, there was a greater chance for neonatal mortality in homes with fewer residents (OR=1.73) and with no children younger than five years (OR=10.10). CONCLUSION Several factors that were associated with neonatal mortality in this study may be due to inadequate care during the prenatal period and childbirth, and inadequate newborn care, all of which can be modified.

Maternal periodontitis as a risk factor for prematurity.

Background:  The aim of this study was to investigate maternal periodontitis associated with prematurity.

Periodontitis-associated risk factors in pregnant women

OBJECTIVE: The main objective of this study was to investigate the risk factors associated with periodontitis in pregnant women. METHODS: This study was conducted in two stages. In Stage 1, a cross-sectional study was conducted to determine the prevalence of periodontitis among 810 women treated at the maternity ward of a university hospital. In Stage 2, the factors associated with periodontitis were investigated in two groups of pregnant women: 90 with periodontitis and 720 without. A hierarchized approach to the evaluation of the risk factors was used in the analysis, and the independent variables related to periodontitis were grouped into two levels: 1) socio-demographic variables; 2a) variables related to nutritional status, smoking, and number of pregnancies; and 2b) variables related to oral hygiene. Periodontitis was defined as a probing depth ≥4 mm and an attachment loss ≥3 mm at the same site in four or more teeth. A logistic regression analysis was also performed. RESULTS: The prevalence of periodontitis in this sample was 11%. The variables that remained in the final multivariate model with the hierarchized approach were schooling, family income, smoking, body mass index, and bacterial plaque. CONCLUSION: The factors identified underscore the social nature of the disease, as periodontitis was associated with socioeconomic, demographic status, and poor oral hygiene.

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil

OBJECTIVE Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching. DESIGN Cross-sectional surveys of breast-feeding practices were conducted pre- and post-intervention in random samples of 1266 and 1245 infants aged 0-5.9 months, respectively. SETTING Recife, Brazil, with a population of 2 million. SUBJECTS CHA (n 1449) of Brazils Family Health Programme were trained to provide breast-feeding counselling at home visits. RESULTS Rates of exclusive breast-feeding improved when CHA were trained to provide breast-feeding counselling and were significantly higher by 10-13 percentage points at age 3-5.9 months when compared with pre-intervention rates (P < 0.05). Post-intervention point prevalence of exclusive breast-feeding for infants aged <4 months was 63% and for those aged <6 months was 50%. CONCLUSIONS Multifunctional CHA were able to deliver breast-feeding counselling at scale within a routine health service and this was associated with a significant increase in rates of exclusive breast-feeding. The study reinforces the need to focus training on counselling and practical skills; a key component was an interactive style that utilized the knowledge and experience of CHA. The findings are relevant to the call by international organizations to scale up breast-feeding counselling.

Fatores associados ao atraso do desenvolvimento motor de crianças prematuras internadas em unidade de neonatologia

Abstract Objectives: to assess the frequency of late motordevelopment in premature children admitted to aneonatal unit and to identify associated factors.Methods: a descriptive analytical study carriedout at the Neonatal Unit of a high-risk maternityhospital in Recife, Brazil. Motor development wasassessed using the Test of Infant Motor Performance,in 98 preterm children with a minimal post-concep-tion age of 34 weeks, during admission to hospital,between January and June 2009. Associations wereexamined between variables relating to the mother,the newborn, the care provided and motor deve-lopment.Results: the mean post-conception age on evalua-tion was 37 weeks and 39.8% of the children hadsome kind of impaired motor development (atypicalor suspected to be atypical). Factors significantlyassociated with changes in motor development were:lower birth weight; higher age on evaluation; greaternumber of prenatal sessions; occurrence of hypoxiaand bronco-pulmonary dysplasia; longer stay in ICUand neonatal unit. There was a significant trend formotor development to worsen with prolonged use ofoxygen-therapy and mechanical ventilation.Conclusions: premature children admitted tohospital may show early signs of delayed motor deve-lopment of a severe or borderline nature. Birthweight, neonatal morbidities and care received at theneonatal unit were the factors that most stronglyinfluenced the outcome. These results justify initiationof preventive strategies and stimulation while thechild is still in hospital.

Characteristics and factors associated with health care in children younger than 1 year with very low birth weight

OBJECTIVES To identify the characteristics of health care in infants with very low birth weight during the first year of life and the factors associated with this care. METHODS This was a descriptive study with an analytical component conducted in the city of Maceió, Northeastern Brazil, with a sample of 53 children with a median age of five months at the time of the interview, and their mothers. The mothers were interviewed at home regarding socioeconomic and demographic data and health care provided for the child. Health care was assessed through an index using 16 variables related to the recommended actions for this type of care. RESULTS Multivariate linear regression analysis showed that maternal education and family income were the variables that best explained the health care index variation (18.9%), followed by parity (6.6%), and breastfeeding at the time of the interview (6.9%). CONCLUSIONS Considering that families with lower socioeconomic status, women with a higher number of children, and women who did not breastfeed were factors associated with poor health care of children born with very low birth weight, these variables should be included in measures of public health planning.

Fatores relacionados ao uso de analgesia sistêmica em neonatologia

The purpose of this paper was to carry out a review of literature on the history and current stage of the knowledge of systemic analgesia in neonatology and the factors influencing its use. A search for scientific articles was made in the MEDLINE, SciELO and LILACS databases using the keywords: analgesia, systemic analgesics, pain, neonatology, newborn, intensive care units and neonatal intensive care units. Additional research was made on dissertations and thesis databanks as well as text books. Literature consulted disclosed that, in general, analgesia is not a routine practice in neonatal intensive care units, despite the numerous studies demonstrating its importance. Although pain relief is a basic principle of medicine, involving ethic and humanitarian issues and despite the current availability of a number of practical guidelines and consensus regarding pain management in newborns at risk, findings of the present study fall far short of current recommendations. Urgent intervention is required to redress this situation.