Thaíla Corrêa Castral

A manipulacao de prematuros em uma Unidade de Terapia Intensiva Neonatal

While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.

Handling of preterm infants in a neonatal intensive care unit

While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.

Maternal factors regulating preterm infants' responses to pain and stress while in maternal kangaroo care.

The relationship between maternal factors and the response of preterm infants to pain and stress experienced during heel puncture while in maternal kangaroo care was investigated. This descriptive study included 42 mothers and their preterm infants cared for in a neonatal unit. Data were collected in the baseline, procedure, and recovery phases. We measured the neonates facial actions, sleep and wake states, crying, salivary cortisol levels, and heart rate, in addition to the mothers behavior, salivary cortisol levels, and mental condition. The influence of the maternal explanatory variables on the neonatal response variables were verified through bivariate analysis, ANOVA, and multiple regression. The mothers behavior and depression and/or anxiety did not affect the neonates responses to pain and stress, though the mothers levels of salivary cortisol before the procedure explained the variance in the neonates levels of salivary cortisol after the procedure (p=0.036). Additionally, the mothers baseline levels of salivary cortisol along with the neonates age explained the variance in the neonates heart rate (p=0.001). The ability of mothers to regulate their own stress contributed to the infants responses to pain and stress.Investigou-se associacao entre fatores maternos e resposta de prematuros submetidos a puncao de calcâneo em posicao canguru. Trata-se de estudo descritivo envolvendo 42 maes e prematuros de uma unidade neonatal. A coleta ocorreu nos periodos basal, procedimento e recuperacao. Mensuraram-se a mimica facial, sono e vigilia, choro, cortisol salivar e frequencia cardiaca neonatais, alem de se mensurar o comportamento, cortisol salivar e estado mental maternos. Analisou-se a influencia das variaveis explanatorias maternas nas variaveis de resposta neonatais por analise bivariada, analise de variância e regressao multipla. A depressao e/ou ansiedade e comportamento materno nao influenciaram a resposta do prematuro a dor e estresse. O cortisol salivar pre-puncao materno explicou a variância do cortisol salivar pos-puncao neonatal (p=0,036); e o cortisol salivar noturno materno, juntamente com a idade pos-natal neonatal, explicaram a variância da frequencia cardiaca neonatal (p=0,001). A capacidade das maes em regular seu proprio estresse contribuiu para resposta de dor e estresse do prematuro.canguru”, presentada a la Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigación en Enfermería, Brasil. Apoyo financiero de la FAPESP (2007/05051-1) y del CNPq (200113/2008-9). 2 PhD, Profesor Adjunto, Faculdade de Enfermagem, Universidade Federal de Goiás, Brasil. 3 PhD, Profesor Asistente, University of British Columbia, School of Nursing, Canada. 4 Estudiante de Doctorado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigación en Enfermería, Brasil. 5 PhD, Profesor Adjunto, Departamento de Enfermagem, Universidade Federal de Pernambuco, Brasil. 6 PhD, Profesor Asociado, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigación en Enfermería, Brasil. 7 PhD, Profesor Titular, Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, Centro Colaborador de la OMS para el Desarrollo de la Investigación en Enfermería, Brasil.

Dimensionamento dos procedimentos dolorosos e intervenções para alívio da dor aguda em prematuros

Objective: to dimension the exposure of premature infants to painful procedures, relating the distribution of the exposure to contextual factors, as well as to describe the pharmacological and non-pharmacological interventions health professionals use during the first two weeks of the infant’s hospitalization at two neonatal services. Method: descriptive-exploratory study in which the professionals registered the painful procedures and pain relief interventions on a specific form in the patient file. Results: the daily average of the 89 premature infants was 5.37 painful procedures, corresponding to 6.56 during the first week of hospitalization and 4.18 during the second week (p<0.0001). The most frequent procedures were nasal/oral (35.85%) and tracheal aspirations (17.17%). The children under invasive ventilation were the most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures received some intervention for the purpose of pain relief, the most frequent being sucrose (78.21%) and continuing sedation (19.82%). Conclusion: acute pain was undertreated at these neonatal services, recommending greater sensitization of the team for the effective use of the existing protocol and implementation of other knowledge transfer strategies to improve neonatal pain management.ABSTRACT Objective: to dimension the exposure of premature infants to painful procedures, relating the distribution of the exposure to contextual factors, as well as to describe the pharmacological and non-pharmacological interventions health professionals use during the first two weeks of the infant’s hospitalization at two neonatal services. Method: descriptive-exploratory study in which the professionals registered the painful procedures and pain relief interventions on a specific form in the patient file. Results: the daily average of the 89 premature infants was 5.37 painful procedures, corresponding to 6.56 during the first week of hospitalization and 4.18 during the second week (p<0.0001). The most frequent procedures were nasal/oral (35.85%) and tracheal aspirations (17.17%). The children under invasive ventilation were the most exposed to painful procedures (71.2%). Only 44.9% of the painful procedures received some intervention for the purpose of pain relief, the most frequent being sucrose (78.21%) and continuing sedation (19.82%). Conclusion: acute pain was undertreated at these neonatal services, recommending greater sensitization of the team for the effective use of the existing protocol and implementation of other knowledge transfer strategies to improve neonatal pain management.

Atitudes dos profissionais de saúde na avaliação e tratamento da dor neonatal

Objectives: To describe and analyze the attitudes of health professionals in relation to the evaluation and treatment of pain in newborns undergoing painful procedures in neonatal units. Methods: This descriptive, exploratory, quantitative study was performed in a maternity hospital in the state of Rio de Janeiro. Participants were 42 nursing assistants/technicians, 22 nurses, 20 physicians and 02 physical therapists. Data were collected through a self-administered questionnaire covering the profile of the health professionals and their attitudes in the assessment and treatment of pain. Results: It was found that the professionals mentioned assessing NB pain through behavioral parameters, however, did not use scales and did not perform this evaluation systematically. The majority of the nursing professionals used non-pharmacological measures for pain relief, with wrapping being the most used. Conclusion: There is a difference between what is prescribed and what is performed, indicating the existence of a gap between existing knowledge and the practice. Attitudes need to be changed and actions implemented according to the best available evidence.Objetivos: Describir y analizar las actitudes de los profesionales de salud con relacion a la evaluacion y el tratamiento del dolor en recien nacidos sometidos a procedimientos dolorosos en una unidad neonatal. Metodos: Estudio descriptivo, exploratorio, con analisis cuantitativo, realizado en una maternidad en la ciudad de Rio de Janeiro. Participaron 42 auxiliares/tecnicos de enfermeria, 22 enfermeras, 20 medicos y dos fisioterapeutas. Los datos se recogieron mediante un cuestionario autoaplicable referente al perfil de los profesionales de salud y las actitudes en la evaluacion y tratamiento del dolor. Resultados: La evaluacion del dolor RN se hace por parametros de comportamiento, pero sin escalas o evaluacion sistematica. La mayoria de los profesionales utiliza medidas no farmacologicas para aliviar el dolor. Conclusion: Hay diferencia entre lo prescrito y lo administrado, evidenciando una laguna entre la practica y el conocimiento existente. Las actitudes necesitan ser cambiadas y manipuladas para una mejor evidencia disponible.

Effects of Anhydrous Lanolin versus Breast Milk Combined with a Breast Shell for the Treatment of Nipple Trauma and Pain During Breastfeeding: A Randomized Clinical Trial

INTRODUCTIONnThe purpose of this study was to compare the effect of anhydrous lanolin with the effect of breast milk combined with a breast shell for treatment of nipple trauma and pain during breastfeeding.nnnMETHODSnA randomized clinical trial was conducted in a maternity ward in a hospital accredited as a Baby-Friendly Hospital located in the middle-western region of Brazil. Breastfeeding women with obvious nipple trauma were randomized into 2 groups. In both groups, breastfeeding education was conducted. For up to 10 days, in Group 1, anhydrous lanolin was applied daily after each breastfeeding session, whereas in Group 2, breast milk combined with a breast shell was applied. Trauma was assessed using the Nipple Trauma Score, and pain was assessed using a numerical scale and sensory descriptors from the McGill Questionnaire.nnnRESULTSnOne hundred women participated, with 50 women in each of the 2 groups. The healing of nipple trauma was faster in the group treated with breast milk combined with a breast shell, starting on the third day of intervention (P = .032). The intensity of pain was lower in the group treated with breast milk combined with a breast shell starting on the fifth day of treatment (P = .008). The use of anhydrous lanolin had a progressively reduced treatment efficacy, with values of 86.4% on the third day (95% confidence interval [CI], -4.5%-98.2%),xa058.3% on the fifth day (95% CI, 20.1%-78.3%), 48.1% on the seventh day (95% CI, 20.1%-66.2%), andxa026.9.% on the tenth day (95% CI, 6.4%-43%) of intervention. The resolution of nipple trauma was significantly associated with the use of the nipple shell on all intervention days.nnnDISCUSSIONnThe intervention with breast milk combined with a breast shell was more effective than anhydrous lanolin for the treatment of nipple trauma and pain in breastfeeding women. This treatment should be encouraged among breastfeeding women to promote healing and reduce pain.

Conocimiento de los profesionales de salud sobre la evaluación y tratamiento del dolor neonatal

OBJECTIVEnto identify knowledge of healthcare professionals on the management, evaluation and treatment of pain in a neonatal unit in a municipality of Rio de Janeiro.nnnMETHODndescriptive, exploratory study with quantitative analysis. Data were analyzed using the software R. Core Team Results: of the 96 healthcare professionals who participated in the study, 42 nursing aides/technicians responded, along with 22 nurses, 20 physicians and 2 physical therapists. The results showed that 40.5% of the nursing aides/technicians, 50% of the physicians and 50% of the physical therapists confirmed that they coordinate/perform/assist in the care of babies pain while performing procedures (lumbar puncture, chest tube insertion and central line). There was a significant difference of agreement in relation to the nursing aides/technicians and physicians. Most (69.8%) of the healthcare professionals knew of some non-pharmacological measure effective for relief of acute pain.nnnCONCLUSIONnthere is a need for an educational intervention program, with participation of those involved, in the process to change professional practice.

Knowledge of healthcare professionals on the evaluation and treatment of neonatal pain.

OBJECTIVEnto identify knowledge of healthcare professionals on the management, evaluation and treatment of pain in a neonatal unit in a municipality of Rio de Janeiro.nnnMETHODndescriptive, exploratory study with quantitative analysis. Data were analyzed using the software R. Core Team Results: of the 96 healthcare professionals who participated in the study, 42 nursing aides/technicians responded, along with 22 nurses, 20 physicians and 2 physical therapists. The results showed that 40.5% of the nursing aides/technicians, 50% of the physicians and 50% of the physical therapists confirmed that they coordinate/perform/assist in the care of babies pain while performing procedures (lumbar puncture, chest tube insertion and central line). There was a significant difference of agreement in relation to the nursing aides/technicians and physicians. Most (69.8%) of the healthcare professionals knew of some non-pharmacological measure effective for relief of acute pain.nnnCONCLUSIONnthere is a need for an educational intervention program, with participation of those involved, in the process to change professional practice.

Conhecimento dos profissionais de saúde na avaliação e tratamento da dor neonatal

OBJECTIVEnto identify knowledge of healthcare professionals on the management, evaluation and treatment of pain in a neonatal unit in a municipality of Rio de Janeiro.nnnMETHODndescriptive, exploratory study with quantitative analysis. Data were analyzed using the software R. Core Team Results: of the 96 healthcare professionals who participated in the study, 42 nursing aides/technicians responded, along with 22 nurses, 20 physicians and 2 physical therapists. The results showed that 40.5% of the nursing aides/technicians, 50% of the physicians and 50% of the physical therapists confirmed that they coordinate/perform/assist in the care of babies pain while performing procedures (lumbar puncture, chest tube insertion and central line). There was a significant difference of agreement in relation to the nursing aides/technicians and physicians. Most (69.8%) of the healthcare professionals knew of some non-pharmacological measure effective for relief of acute pain.nnnCONCLUSIONnthere is a need for an educational intervention program, with participation of those involved, in the process to change professional practice.

La manipulacion de prematuros en una Unidad de Cuidados Intensivos Neonatales

While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.While hospitalized in neonatal units, preterm infants undergo various manipulations and procedures that have negative health consequences. The aim of this study was to describe the manipulations that preterm infants are subjected to over a 24-hour period in a neonatal intensive care unit (NICU). An observational, descriptive, exploratory study was conducted with 20 preterm infants who were filmed continuously in a NICU over a 24-hour period from September 2008 to March 2009. Preterm infants were subjected to an average of 768 manipulations and 1341 procedures. The average duration of the manipulations over the 24-hour period was 2 hours and 26 minutes. Each manipulation included an average of 2.2 procedures, most occurring during the morning shift. Individual manipulations accounted for 65.6% of all manipulations, and most manipulations lasted less than a minute. The results of this study show that preterm infants in the NICU underwent an excessive number of manipulations over the 24-hour period evaluated.