Thamine de Paula Hatem

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.

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.

Is Active Search for Congenital Heart Disease Possible? Experience from Eight Brazilian Cities

Abstract Manuscript received on February 9, 2015; approved on March 7, 2015; revised on March 20, 2015. ORIGINAL MANUSCRIPT Introduction Heart diseases in children are divided into two main groups: congenital and acquired. Congenital heart diseases affect about 1.0% of the total number of live newborns and it is an important morbidity and mortality factor in newborns 1 . Acquired heart diseases include rheumatic fever and the Kawasaki disease. The former is a serious public health problem in poor regions 2 . What both groups have in common is the need of echocardiography for diagnosing or evaluating cardiac after-pains for properly managing the patient.Despite the importance of heart diseases in childhood, poor regions still have great difficulty in diagnosing and properly treating the patients 3 . This can be explained by the lack of specialized professionals in remote areas and the difficulties of access to health services by the population, leading to the false indication of low incidence