This diploma thesis examines the role of paediatric nurses caring for newborns in the community. It aims to determine if and how newborn care in the home environment takes place and the role of the paediatric nurse. The research is based on one of the primary objectives set out by the member states of the WHO to improve the health of the entire population in the twenty-first century with the focus on community care and its development. The theoretical part is dedicated to the definition of community care and its history in the Czech Republic. We initially focus on how childcare at home was provided in the past. This is followed by a description of the current situation regarding care of a newborn and the mother during the first weeks following birth, both here and abroad. We evaluate the role of the paediatric nurse in terms of nursing care for newborns and research the duties that the nurse carries out within the clinic, family, and community.We have set out two objectives and five research questions. The first objective was to identify nursing care problems encountered by mothers at home and how they solve these problems. The second objective was set out in order to explore how nurses become involved in the community care of a newborn. We have chosen a qualitative method for the research part of the thesis. Data was collected through semi-structured interviews. Subsequently, a qualitative analysis and categorization of collected data was conducted. Two research sample groups were created in the first phase. The first consisted of mothers with newborns, i.e. children from birth to 28 days. The second group consisted of paediatric nurses who work in outpatient care with children and adolescents. The second phase of the research addressed paediatric nurses working in the neonatal clinic, which is run by the hospital's paediatric department. The result of our thesis is the finding that community care provided by the paediatric nurse in the field, in a natural environment and with the cooperation of the entire family and community, as defined, is almost nonexistent. The long-established system of primary care directs all nursing work into the surgeries of the paediatric practitioner, and only the first visit to the newborn, but not in all cases, is conducted at home. This system is insufficient to cover all the specifics of childcare. The needs of the newborns and their parents are becoming more urgent and in the first weeks following the birth the mothers only very slowly begin to gain healthy self-esteem and confidence in their maternal abilities, hence the need for an individual approach and help in the proper care of their baby. They feel there is a lack of information and they do not know how to deal with the needs of their newborn. The most problematic issue described is breastfeeding. The addressed nurses are of the same opinion and also consider breastfeeding as the most common focus of their intervention, and therefore, the most important part of their work.We have discovered that the skills and competencies of the paediatric nurses are sufficient to enable them to become a relevant element in the comprehensive care of newborns within the community. The interventions delivered by the nurse are fully integrated into paediatric nursing.The parents of newborns would, according to our survey, prefer a home visit from health professionals, particularly if it concerns the first contact with the baby and family. The out-patient care does not provide enough time and space to pursue common nursing issues, therefore, home visits are an essential part of the care that should be offered to the mother and baby. Community nurses would help to coordinate the services provided to families as well as help solve the nursing issues that mothers encounter in the first weeks of their child's life. A paediatric nurse would, therefore, become a partner to the parents in a joint effort to ensure the healthy development of their child.

A neutropenia é um achado freqüente em recém-nascidos de mães com pré-eclampsia. Estudos avaliando a ativação leucocitária nestes recém-nascidos são escassos. No entanto, as principais citocinas pró-inflamatórias envolvidas são a IL-8 e o GRO-α. O objetivo deste estudo foi avaliar os níveis plasmáticos de IL-8 e GRO-α em recémnascidos prematuros de mães com pré-eclampsia. Metodologia: Foram incluídos recém-nascidos com idade gestacional menor de 36 semanas e peso de nascimento inferior a 2000 gramas, sendo divididos em dois grupos de acordo com a presença ou ausência de pré-eclampsia materna. Os critérios de exclusão foram: malformações congênitas, erro inato de metabolismo ou anormalidades cromossômicas, infecções do grupo STORCH, óbito na sala de parto e recém-nascidos nos quais as mães possuíam hipertensão crônica sem a presença de pré-eclampsia. Nas primeiras 48 horas de vida, no momento de coleta assistencial, uma pequena amostra adicional de sangue foi obtida para dosagem de IL-8 e GRO-α pelo método de enzimoimunoensaio. Foram usados os testes qui-quadrado, T student, Mann-Whitney, Kruskal-Wallis e regressão logística múltipla. Resultados: 119 recém-prematuros (64 sem pré-eclampsia e 55 com pré-eclampsia). Os grupos foram similares quanto ao peso de nascimento, idade gestacional, escore de Apgar no 5’minuto, sepse, doença de membrana hialina , ventilação mecânica, nutrição parenteral total, enterocolite necrosante, hemorragia periventricular. O grupo com préeclampsia apresentou mais neutropenia, foi mais PIG, parto cesariano e menos bolsa rota superior a 18 horas. Os níveis de IL-8 foram maiores no grupo sem pré-eclampsia materna [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 para não préeclampticos e pré-eclampticos, respectivamente]. Após análise por regressão múltipla apenas a ausência de pré-eclampsia foi associada com níveis elevados de IL-8. Conclusão: O prematuro de mãe com pré-eclampsia apresenta níveis reduzidos de IL-8, sugerindo que a ativação leucocitária possa estar prejudicada nestes recém-nascidos. / Neutropenia is frequent in newborn infants of preeclamptic mothers.Information on leukocyte activation in those newborns is scarce, but IL-8 and GRO- are the main proinflammatory cytokines involved. The aim was to study IL-8 and GRO- plasma levels in preterm newborn infants of preeclamptic mothers. Methods: Newborn infants with gestational age < 36 weeks and birth weight < 2000 grams were included and divided: non-preeclamptic and preeclamptic groups. Exclusion criteria: major congenital malformations, inborn errors of metabolism or chromosomal anomalies,STORCH infections, inborn preterm that died in the delivery room, and those whose mothers had chronic hypertension without preeclampsia. During the regular blood sample collection in the first 48 hours, a small amount was used for IL-8 and GRO- measurement by enzyme immunoassay. Chi-square, Student s t test, Mann Whitney test, Kruskal-Wallis and multiple logistic regression model were employed. Results: 119 preterm infants (64 non-preeclamptic and 55 preeclamptic). They were similar in birth weight, gestational age, Apgar scores at 5 minutes, sepsis, SDR, mechanical ventilation, TPN, NEC, intraventricular hemorrhage and death. The preeclamptic group had more neutropenia, SGA, C Section, and less rupture of membranes for > 18 hours. IL-8 was higher in the non-preeclamptic [157.1 pg/ml (86.4-261.3) e 26.54 pg/ml (3.6-87.2) p<0.001 non-preeclamptic and preeclamptic groups, respectively]. GRO-α was similar [229.5 pg/ml (116.6-321.3) and 185.5 pg/ml (63.9-306.7) p=0.236 in non-preeclamptic and preeclamptic groups, respectively]. After multiple regression analysis only absence of preeclampsia was associated with high IL-8 levels. Conclusions: Preterm newborn infants of preeclamptic mothers have a decreased plasma level of IL-8, suggesting that the leukocyte activation may be impaired in infants of preeclamptic mothers.

Orientador: João Cesar Lyra / Resumo: Introdução: O transporte inter-hospitalar de recém-nascidos (RN) para centros terciários muitas vezes é inevitável e está associado a maior o risco para morbidades e para o óbito. A hipótese deste estudo é de que os transportes realizados na região estejam ocorrendo de forma inadequada, piorando o prognóstico dos RN transportados. Objetivos: Determinar o perfil dos RN transportados, avaliar a adequação dos transportes e calcular os escores de risco TRIPS e Ca-TRIPS, correlacionando-os com o risco de óbito e hemorragia peri-intraventricular (HPIV), na primeira semana pós-transporte. Metodologia: Estudo prospectivo de corte transversal, realizado de junho 2014 a dezembro de 2017, incluindo todos os RN submetidos a transporte e internados na Unidade Neonatal do Hospital das Clínicas da Faculdade de Medicina de Botucatu, sem exclusão. As variáveis avaliadas foram: peso ao nascer (PN), idade gestacional (IG), sexo, tipo de parto, apgar, necessidade de reanimação em sala de parto, indicação da transferência, utilização de incubadora apropriada, presença de acesso venoso, drogas e fluidos utilizados, suporte respiratório, tempo de vida à internação, temperatura axilar, padrão respiratório, pressão arterial, uso de drogas vasoativas, estado neurológico e valores dos escores de risco à internação. Os pacientes foram acompanhados na primeira semana pós-transporte em relação à evolução para HPIV ou óbito. Resultados apresentados em tabelas de frequência, com cálculo das médias e desvio ... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Interhospital transport of newborns (NB) to tertiary centers is often unavoidable and associated with greater risk for morbidity and death. The hypothesis of this study is that transport in the region is occurring inadequately, worsening the prognosis of the transported NB. Objectives: To determine the profile of the transported NB, to assess the adequacy of the transports and to calculate the TRIPS and Ca-TRIPS risk scores, correlating them with the risk of death and peri-intraventricular hemorrhage (PIVH) in the first week after transport. Methods: Prospective cross-sectional study, carried out from June 2014 to December 2017, including all NB submitted to transportation and hospitalized at the Neonatal Unit of the Hospital das Clínicas da Faculdade de Medicina de Botucatu, without exclusion. The variables evaluated were: birth weight, gestational age, sex, type of delivery, apgar, need for resuscitation in the delivery room, indication of transference, use of appropriate incubator, presence of venous access, drugs and blood flow used, respiratory support, age at admission, axillary temperature, breathing pattern, blood pressure, use of vasoactive drugs, neurological status, and values of risk scores at the time of admission. Patients were followed in the first post-transport week in relation to the progression to PIVH or death. Results presented in frequency tables, with calculation of means and standard deviation or medians and percentiles; values of sensiti... (Complete abstract click electronic access below) / Mestre

Introdução: Adiponectina e leptina são produzidas no ambiente intrauterino, e estão envolvidas no crescimento fetal. Contudo, poucos estudos apresentaram dados de níveis de adiponectina e leptina comparando recém-nascidos (RN) pequenos e adequados para idade gestacional, prematuros de muito baixo peso e a termo. Objetivo: Comparar níveis de adiponectina e leptina em sangue de cordão umbilical de recém-nascidos prematuros muito baixo peso (MBP) e recém-nascidos a termo, e determinar sua relação com peso ao nascer (PN) e ser pequeno (PIG) ou adequado (AIG) para idade gestacional. Métodos: Estudo transversal com recém-nascidos prematuros de muito baixo peso (MBP), com idade gestacional <32 semanas e peso ao nascer <1500g, e recém-nascidos a termo com idade gestacional >37 semanas, nascidos em um hospital terciário, no período de Janeiro de 2010 à Maio de 2011. Critérios de exclusão: presença de malformações congênitas maiores, erros inatos do metabolismo, anomalias cromossômicas. Níveis de adiponectina e leptina em sangue de cordão umbilical foram determinados por enzimoimunoensaio com kit ELISA (R&D Systems). O estudo foi aprovado pelo comitê de ética e pesquisa da instituição sob número (09460). Empregados teste t de Student, Mann-Whitney e regressão linear, e aceito nível de significância p<0.05. Resultados: Ao todo foram estudados 127 recém-nascidos, 55 RNPTMBP e 72 a termo. Gênero, diabetes gestacional, infeção do trato urinário, idade e IMC maternos foram similares em ambos os grupos. Os níveis de adiponectina foram significativamente mais baixo nos recém-nascidos pré-termo do que nos recém-nascidos a termo: 1.57±0.74pg/mL versus 2.4±0.22pg/mL (p<0.001), respectivamente. Os níveis de leptina foram similares entre os grupos: 1.25±0.90pg/mL e 1.38±0.99pg/mL (p=0,481) nos recém-nascidos a termo e prematuros respectivamente. Independente de serem adequados ou pequenos para idade gestacional, RNPTMBP apresentaram níveis de adiponectina mais baixos (p<0,001). Os níveis de leptina e insulina foram similares em ambos os grupos, independentemente de serem AIG ou PIG. Na regressão linear com adiponectina como variável dependente, apenas prematuridade foi estatisticamente significativo. Conclusão: Prematuridade é o principal fator determinante para os baixos níveis de adiponectina em sangue de cordão umbilical em recém-nascidos. / Background: Adiponectin and leptin are produced in the intrauterine environment and are involved in fetal growth. However, few studies present data on adiponectin and leptin leves comparing adequate and small for gestational age very low birth weight preterm newborns. Aim: Compare the levels of adiponectin and leptin in cord blood of full term newborns and very low birth weight preterm, and determine its relation with birth weight and being small for gestational age. Methods: Cross sectional study with cord blood adipocytokines dosage in very low birth weight preterm (VLBW), with gestational age (GA) ≤32 weeks and birth weight ≤1500 grams, full term newborns, with GA ≥37 weeks, born at tertiary hospital between January 2010 and May 2011. Exclusion criteria were presence of major congenital malformation, metabolism innate errors, chromosomal anomalies. All includes newborn had a protocol filled with maternal and neonatal data. Adiponectin and leptin levels were determined by ELISA kits (R & D Systems). The study protocol was approved by the institutional review boards and hospital’s ethics committee under the number 09-460. Applied student T test, Mann- Whitney and linear regression. Accepted p <0,05 as significant level. Results: Included 127 newborns, being 55 VLBW preterm and 72 full term. There were no statistic difference regarding gender, maternal gestational diabetes, urinary tract infection, age and BMI. Adiponectin levels were significantly lower in preterm than in full term newborns (1.57±0.74 pg/mL versus 2.4±0.22pg/mL (p<0,001), respectively. Leptin levels were similar in both groups: 1.25 ±0.90pg/mL in full term infants and e 1.38±0.99pg/mL in preterm (p=0,481). When we evaluate adequacy for gestational age inside groups, despite being adequate or small for gestational age, VLBW preterm showed lower levels of adiponectin (p<0,001) and again, there was no statistically significant difference for leptin levels. In the linear regression, prematurity was the only independent variable associated to the low levels of adiponectin (p <0,001). Conclusion: our data suggests that been born prematurely is the main determinant factor for adiponectin levels in umbilical cord of newborns. It’s important to know perinatal factors that may interfere in the secretion of adipocytokines so that it’s possible to develop preventive strategies of metabolic syndrome, not only in adulthood but also in early childhood.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-11-27T19:16:53Z No. of bitstreams: 1 Fabio David Couto Estudo da prevalencia... 2002.pdf: 44946029 bytes, checksum: 5521f6983cf2f27b55c924fff532ed06 (MD5) / Made available in DSpace on 2012-11-27T19:16:53Z (GMT). No. of bitstreams: 1 Fabio David Couto Estudo da prevalencia... 2002.pdf: 44946029 bytes, checksum: 5521f6983cf2f27b55c924fff532ed06 (MD5) Previous issue date: 2002 / Fundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / O metabolismo da fiomocisteina pode ser afetado por carência nutricional de vitaminas (Be, B12 e folatos) ou por alterações genéticas que afetam o funcionamento de enzimas envolvidas em sua via metabólica. A homozigose para a mutação C677T no gene da enzima metilenotetrahidrofolato redutase (MTHFR) tem sido relacionada com a hiperhomocisteinemia, descrita como fator de risco importante e Independente para a ocorrência de doenças cardiovasculares. As hemoglobinopatias estruturais, principalmente a hemoglobina S, também tem sido associada a estes eventos. No presente estudo foi determinada a prevalência da mutação C677T da MTHFR, por PCR e RFLP, em 843 recém-nascidos de Salvador-Bahia, correlacionando a presença desta mutação com o perfil de hemoglobinas determinado por HPLC. Os níveis séricos de homocisteína, vitamina Bi2 e folatos foram determinados em um subgrupo de 75 recém-nascidos, com os diferentes genótipos para o polimorfismo C677T da MTHFR: 25 selvagens (C/C), 25 heterozigotos (C/T) e 25 homozigotos (T/T) mutantes, todos portadores de hemoglobina AA. A freqüência do alelo T foi de 23,4%, com prevalências de 36,2% da heterozigose e 5,3% da homozigose para o polimorfismo C677T da MTHFR. O alelo T foi normalmente distribuído entre os gêneros (p = 0,206) e entre os diferentes genótipos de hemoglobinas p = 0,696. Diferenças estatísticas nâo foram encontradas para os níveis de homocisteína, folatos e vitamina B12 entre os diferentes genótipos do polimorfismo C677T da MTHFR. Contudo as análises estratificadas para os níveis de folatos e vitamina B12 demonstraram que os recém-nascidos com níveis destas vitaminas abaixo dos valores medianos e portadores dos genótipos C/T e T/T apresentaram maior freqüência entre os neonatos com níveis de homocisteína acima de 6,7 |amol/L. Também foram encontradas diferenças estatisticamente significantes entre os pesos dos recém- nascidos e os níveis de folatos (p = 0,043). Nossa população apresenta freqüência elevada do alelo T do polimorfismo C677T da MTHFR associada as hemoglobinopatias estruturais, o que pode influenciar na incidência das doenças vasculares freqüentemente observadas entre os portadores de hemoglobinopatias estruturais. De acordo com os resultados, os folatos são poderosos preditores dos níveis de homocisteína assim como do peso dos recém-nascidos, independente da mutação C677T; contudo, este efeito é potencializado pela presença da homozigose do alelo T. / The homocysteine metabolism is affected by nutritional status of B12 and folate vitamins or can results from genetics mutations of genes responsable for proteins expression involved in re-methylation or trans-sulphuration metabolism pathway. A common mutation, C677T, in the methylenetetrahydrofolate reductase gene (MTHFR) reduces the MTHFR activity and increase the total homocysteine serum levels (tHcy). Hyperhomocysteinaemia has been identified as a risk factor for cardiovascular disease as established for variant hemoglobins. Here we investigated the C677T mutation prevalence in MTHFR gene by PCR and RFLP techniques, in 843 neonates from Salvador-Bahia-Brazil, and its coexistence with variant hemoglobins, which was determinated by HPLC. We estimated homocysteine, B12, and folate vitamins serum levels concentrations by chemiluminescence in a subgroup of 75 neonates with hemoglobin AA pattern, carriers different genotypes for MTHFR polimorphism: 25 wide type (C/C), 25 heterozygous (C/T), and 25 mutant homozygous (T/T). The mutant allele frequency was 0.23. Among heterozygous and mutant homozygous states the prevalence for polymorphism C677T of MTHFR gene were 36.2% and 5.3%, respectively. No gender (p = 0.206) or hemoglobin genotypes (p = 0,696) related differences were observed for T allele distribution, even for homocysteine, folate, and B12 vitamin levels among different MTHFR polymorphism. Stratified analysis for B12 vitamins or folate levels showed high frequency of newborns C/T and T/T with homocysteine levels above 6.7 |imol/L in the groups of B12 vitamin and folate levels below of it median values. Statistical differences was found in newborns with low folate serum levels and weight according to them with it serum levels above of it median value (p = 0.043). The 672 studied newborn population had high frequency of T allele associated with variant hemoglobins. It become important once may contribute for occlusive vascular disease development. Our results showed relationship among folate and homocysteine serum levels, that folate is an important homocysteine serum levels predictor as well newborns weight, and this effect can be enhanced by T allele homozygouse

The thesis is focused on nutrition of a preterm infant at an intensive care unit from the point of view of nursing activities. A nurse is faced to problems resulting from prematurity state like insufficient sucking, poor coordination of sucking and swallowing, she enters into interaction with parents who are afraid of the life and subsequently of the future of their beloved child. Natural nutrition, preferably with breast milk is irreplaceable in spite of the high development of initial formulas. This is why the mother of the child, who is vital for the newborn?s nutrition, has to be invited into the team. A hundred per cent enteral nutrition is not always possible, parenteral method has to be applied as well. Provision, evaluation and optimization of infant?s nutrition are results of activities of the whole team, i.e. of a nurse as well. The theoretical part of the thesis contains the findings of trophotherapy of a preterm newborn. It deals with parenteral as well as enteral alimentation, its composition and administration techniques. The empiric part lists and evaluates the research results that led to replies to research questions related to nurse?s contribution to trophotherapy of a preterm newborn, to the influence of permanent nasogastric tube on breathing and mucus congestion of the nose as well as to the awareness of nutrition problems among mothers of preterm infants. Measures resulting from the research results and recommendation for further examination are proposed at the end of the thesis. A brochure Preterm Baby Nutrition designed for distribution among mothers at neonatology and perinatology departments and Recommendations for Gastric Tube Introduction belong to the outputs. We should mention that the latter is based on procedures already presented. It was extended by recommendation of the place of introduction with regard to further intention of enteral nutrition administration.

Abstract Hygiene plays a very important role in our lives. It is often influenced by social, cultural, family and individual factors, as well as by knowledge about health and hygiene. The skin of a child is very soft and sensitive, and therefore requires careful and considerate care throughout the whole period of childhood, especially in the neonatal period and infancy. Skin care of newborns and infants is an essential attribute of the child?s health care. Such care is an individual matter, and it will always depend on family circumstances in which the child lives and on a suitable and proper approach of parents and physicians. The aim of this thesis was to determine the level of knowledge of mothers and the use of such knowledge in skin care of newborns and infants at home. The second objective was to prepare educational material for mothers. The thesis makes use of the questionnaire method. For this purpose, 274 questionnaires were collected. The questionnaire was distributed to mothers of newborns and infants, who take care of their skin at home. The investigation was carried out at pediatrics in the South Bohemian and Pilsen regions. The results of the research are introduced using graphs and some of the results are statistically evaluated by a chi-square test. Two hypotheses were set. Hypothesis 1: Mothers have enough information regarding the skin care of newborns and infants at home. Hypothesis 2: Mothers correctly use the acquired information about skin care of newborns and infants. We were successful in answering both hypotheses in the research study. The analysis and evaluation of the questionnaires shows that mothers are knowledgeable in treating skin of their children in the neonatal period and infancy. However, we managed to prove that some information of the parents is inconsistent with the literature. Therefore an educational material for mothers was created, focusing on skin care of newborns and infants. This educational booklet may be used at pediatric wards.

This thesis deals with neonatal pain and possibility of its reduction during three most painful interventions, to which newborns are exposed. The interventions were selected based on the study of literature, among them belongs collection of capillary blood for screening of newborns, insertion and removal of a gastric tube and airway suctioning of the newborn. Pain has protective reasons as it shall protect us from harming tissues. But sometimes it is necessary to cause pain for the purpose of performing a diagnostic or medical treatment. But there are some ways how to reduce pain at newborns. The theoretical part describes the basic facts about pain, its origin and transfer, importance and types of pain. This thesis also describes the specifics of fetus nervous system maturation during pregnancy. Furthermore, it mentions evaluation of pain manifestation and ways of treating it. Another sub-chapter contains a description of selected medical treatments and ways of palliating pain during their implementation. The last section is dedicated to clinical recommended procedures. The practical part of the work was carried out in four neonatal intensive care units. There were intentionally selected three respondents in each unit, with whom were led guided interviews which are recorded in chapter 4.2. Results of interviews with each respondent are summarized in transparent tables. This thesis had three objectives. The first objective was to compare the method of implementation of selected painful procedures at newborns in theory and practice. We wanted to know whether nursing procedures carried out in selected neonatal units correspond with procedures described in literature. By questioning and observation was found out that some respondents did not follow recommendations. The differences are described in chapter "Results and discussion". The second objective was to determine whether nurses at selected wards have selected performance standards and whether they are also interested in latest procedures of palliating pain at newborns. All respondents stated that performance standards are selected, but not all are prescribed only for newborns. Almost all respondents (except one) have stated that they were interested in new ways of reducing pain, but not all methods are listed in the standards. The third objective was to determine whether nurses abide selected nursing care standards and whether they employ their most recent knowledge about neonatal pain reduction in practice. By observiation was not found non-observance of standards, but also was not found implementation of new procedure knowledge that respondents stated in an interview. At the same time the respondents (except two) reported that there was no need to change the standards at selected performances. The outcome of this work is a new standard for each performance which was dealt with in this thesis. Standards were created eventhough the respondents stated that there was no need to change them. It is necessary to verify new standards in practice.

O manejo da terapia medicamentosa em unidade de terapia intensiva neonatal é complexo e agrega inúmeras drogas. Nesse sentido, manter a atenção ao preparar e administrar corretamente os medicamentos é fundamental em todo o período de assistência ao recém-nascido. Portanto, faz-se necessário que os enfermeiros tenham o entendimento acerca do conceito do erro com medicação, para que possa identificá-lo, bem como os fatores contribuintes para sua ocorrência. Diante do exposto, esta pesquisa teve como objetivos: analisar o entendimento dos enfermeiros neonatologistas sobre o conceito do erro de medicação em uma unidade de terapia intensiva neonatal; conhecer na visão destes enfermeiros quais os fatores contribuintes para a ocorrência desse erro e discutir a partir desta visão como estes fatores podem afetar a segurança do neonato. Metodologia: trata-se de uma pesquisa qualitativa, do tipo descritiva. O cenário do estudo foi uma unidade de terapia intensiva neonatal de um hospital universitário, situado no município do Rio de Janeiro. Os sujeitos foram 14 enfermeiros entre plantonistas e residentes que atuavam no manejo da terapia medicamentosa. Para a coleta dos dados utilizou-se a entrevista semiestruturada, que foram analisadas através da análise de conteúdo de Bardin, emergindo 04 categorias: Diversos conceitos sobre erros de medicação; Fatores humanos contribuintes ao erro de medicação; Fatores ambientais contribuintes ao erro de medicação e Conhecendo como os fatores contribuintes ao erro podem afetar a segurança do paciente. Para as enfermeiras o erro de medicação significa errar um dos cinco certos na administração de medicamentos (paciente, dose, via, horário e medicamento certo), e este pode acontecer em alguma parte do sistema de medicação. Neste sentido, elas entendem que uma pessoa não pode ser considerada a única responsável pela ocorrência de um erro medicamentoso. Quanto aos fatores contribuintes ao erro de medicação elencaram aqueles relacionados à prescrição medicamentosa (letra ilegível, prescrição da dose e via incorretas), ao próprio profissional de enfermagem (como sobrecarga de trabalho, número reduzido de profissionais e os múltiplos vínculos empregatícios) e ao ambiente de trabalho (ambiente inadequado e estressante; conversas paralelas com os colegas e os ruídos no setor). Na visão das enfermeiras, os fatores contribuintes ao erro podem afetar a segurança do recém-nascido, levando às situações de danos a sua saúde, podendo trazer consequências clínicas e risco de óbito. O estudo aponta a necessidade de se buscar sistemas de medicação mais confiáveis e seguros. Neste sentido, é imprescindível desenvolver e implementar programas de educação centrados nos princípios gerais da segurança do paciente. Além disso, é de suma importância que as políticas públicas de saúde, direcionem ações para o aprimoramento de medidas na segurança do RN, do sistema de medicação e da cultura de segurança. / The management of drug therapy in a neonatal intensive care unit is complex and combines innumerous drugs. In this way, paying attention in the correct preparation and administration of drugs is fundamental in the whole period of assistance to the newborn infants. Therefore, is necessary that the nurses have the understanding of the concept of medication error, in order to be able to identify it as well as the contributing factors for its occurrence. In the presence of what was told, this research had as its aims: to analyze the understanding of the neonatal nurses of the concept of medication error in a neonatal intensive care unit; to apprehend from the perspective of these nurses, which contributing factor could affect the safety of the neonate. Methodology: it is a qualitative research with a descriptive design. The study setting was a neonatal intensive care unit from a university hospital in the city of Rio de Janeiro. The participants were 14 nurses, attending and resident physicians, which operate in the management of drug therapy. For the data collection a semi-structured interview was used, and then analyzed through the content analysis of Bardin, from what 04 categories emerged: different concepts of medication error; human contributing factors to the medication error; environmental contributing factors to the medication error; and understanding how the contributing factors to the medication error can affect the safety of the patient. For the nurses the medication error means making a mistake in one of the five rights in the medication administration (the right patient, the right dose, the right route, the right time, and the right drug), and this can happen in any part of the medication-use process. Thus, they understand that one person cannot be considered the only responsible for the occurrence of a medication error. About the contributing factors to the medication error it was listed those related to the medical prescription (illegible handwriting, dosage prescription, and incorrect route of administration), to the nurses (such as work overload, reduced number of workers and multiple jobs) and to the work environment (unsuitable and stressful environment, casual conversation with the co-workers and noises in the ward). From the nurses perspective the contributing factors to the error can affect the safety of the newborn, causing harm to its health, what could have clinical consequences and risk of death. The study points to the necessity of searching for medication-use processes more reliable and safer. In this way, to develop and to implement educational programs centered on the general principles of patient safety. Moreover, it is extremely important that the public health policies conduct actions for the improvement of measures for the safety of the newborn, the medication-use process, and the safety culture.

This diploma thesis deals with the onset of full breastfeeding in preterm infants and with the possible influence of alternative feeding methods on breastfeeding in immature newborns. Based on the study of literature, research questions were identified to find out in which gestation week full breastfeeding is taking place in premature babies and to what extent alternative feeding methods affect the onset of full breastfeeding in premature babies. They also had to find out whether feeding the infant bottles actually leads to unsuccessful breastfeeding. Three objectives were set for the diploma thesis. The first was to find out in which gestational week full breastfeeding is taking place in premature babies, provided the mother has enough breast milk. The second goal investigated the extent to which alternative feeding methods affect early pregnancy, provided the mother has enough breast milk. The third objective was to find out whether feeding a baby bottle actually leads to unsuccessful breastfeeding. To achieve the objectives of my thesis, I chose qualitative research, which was done in two groups of respondents, namely preterm newborns and their mothers. For each group of respondents, I chose different research techniques. For research on premature newborns, I chose structured observation. In a research survey among mothers of preterm babies, I chose a semi-standardized interview.