Introdução: Recém- nascidos a termo nascem com a habilidade de coordenar as funções de sucção- deglutição- respiração. Recém-nascidos pré-termo não apresentam essa habilidade, consequentemente, necessitam de alimentação por sonda e podem apresentar dificuldade na transição da alimentação por sonda para via oral. O objetivo desse estudo foi comparar o padrão de coordenação sucção-deglutição-respiração de recém-nascidos a termo em aleitamento materno exclusivo e recém-nascidos pré-termo na transição da alimentação por sonda para a via oral com mamadeira. Métodos: Foram avaliados 64 recém-nascidos (32 recém-nascidos pré-termo e 32 recém-nascidos a termo) internados na UTI Neonatal e Alojamento Conjunto do Hospital Fêmina de Porto Alegre. Os recém-nascidos a termo foram avaliados durante as primeiras 48horas de vida e os recém-nascidos pré-termo foram avaliados no início da alimentação por via oral após período de alimentação por sonda orogástrica. O equipamento utilizado na ausculta cervical digital era composto por um detector acústico e por um pré-amplificador com filtro conectados a um computador Coreo 2 Duo. O microfone foi fixado com fita adesiva no pescoço do recém-nascido para captar os sinais da sucção/deglutição durante a alimentação. Três sinais de 30 segundos foram obtidos de cada RN e uma média foi obtida para os seguintes parâmetros: total de “suck-swallow signal” (SSS); duração total dos SSS; total de pausas para respirar >2,5 segundos; duração total das pausas. Os dados dos sinais dos sons da deglutição gravados foram analisados visual e auditivamente pelo Software Raven versão 1.1 Resultados: Os resultados mostraram que houve diferença estatisticamente significante para o parâmetro “duração total dos SSS”, mostrando que o tempo envolvido na sucção/deglutição é maior para os recém-nascidos pré-termo. Em relação ao parâmetro “duração total das pausas”, observou-se um tempo maior para os recém-nascidos a termo. O parâmetro “número de pausas” que indica a quantidade de momentos que o recém-nascido apresenta pausa para respirar durante a mamada no período de gravação também foi significativamente maior para os recém-nascidos a termo em comparação aos recém-nascidos pré-termo. Conclusão: Demonstramos que a ausculta cervical digital é um exame de fácil execução e minimamente invasivo na avaliação da coordenação sucção-deglutição-respiração em recém-nascidos a termo e pré-termo. Os recém-nascidos a termo com aleitamento materno durante os primeiros dias de vida apresentaram pausas para respirar mais prolongadas durante o processo de sucção-deglutiçãorespiração em comparação aos recém-nascidos pré-termo. Isso pode refletir o estágio do desenvolvimento do padrão de maturidade de processo de deglutição. / Background: Fullterm newborn are born with the ability to coordinate the functions of sucking, swallowing and breathing. Preterm infants may not have this ability, therefore, may require tube feeding and may have difficulty in the transition from tube feeding to oral feeding. The aim of this study was to compare the coordination pattern of suck, swallow and breathing in fullterm newborn exclusively breastfed and preterm newborn at the transition from tube feeding to oral bottle feeding . Methods: 64 newborn (32 preterm and 32 fullterm) admitted to the Neonatal Intensive Care Unit and Rooming-in of Femina Hospital of Porto Alegre. Fullterms were evaluated during the first 48 hours of life and preterms were assessed at the beginning of oral feeding after feeding period by orogastric tube. The equipment used in digital cervical auscultation included an acoustic detector and a preamplifier with filter connected to a computer 2 Duo Core. The microphone was fixed with tape on the neck of the newborn to capture the signals of suck / swallow during feeding. Three signals of 30 seconds were obtained from each newborn and an average was obtained for the following parameters: total number of "suck-swallow signal" (SSS); total duration of the SSS; total number of pauses> 2.5 seconds and total duration of pauses and . Signs of swallowing sounds recorded were analyzed visually and audibly by Raven Software version 1.1 Results: The results showed statistically significant differences for the parameter "total duration of the SSS," showing that the time involved in suction / swallowing is greater for preterms. As for the parameter "total duration of pauses," there was more time spent by fullterms. The parameter "number of pauses" that indicates the amount of times that newborn have respiratory pause during feeding in the recording period was also significantly higher for fullterms when compared with preterms. Conclusion: We demonstrated that digital cervical auscultation is a minimally invasive, feasible, and easy-to-perfom tool for evaluation of suck-swallowbreathing coordination in newborn. The fullterm infants with breastfeeding within the first days of life had prolonged respiratory pauses during the process of sucking, swallowing and breathing compared to preterms. This may reflect the stage of development of the natural maturity process of swallowing.

La presente tesis propone el desarrollo de un sistema prototipo de estetoscopio digital para ser usado en consultas médicas remotas, utilizando transmisión por la red celular (GSM) e Internet, con la finalidad de brindarle a los profesionales en la salud una herramienta con la cual puedan seguir realizando sus consultas cotidianas evitando el contacto directo con el paciente, por ende, previniendo el contagio de una enfermedad infecciosa. Por ello, el presente trabajo se divide en tres partes: la adquisición y transmisión de las señales de auscultación, el servidor Web y el software de control. El primer paso que se debe realizar es la adquisición de la señal acústica proporcionada por el estetoscopio. Las señales ingresan al controlador para su grabación y ser transmitidas vía Internet al servidor Web. Además, previo a la grabación de las señales, el médico, utilizando el software de control, podrá escuchar la señal acústica en tiempo real mediante una llamada a celular para indicar al paciente la correcta posición del estetoscopio. En el servidor se encuentran las grabaciones ordenadas en carpetas con los datos del paciente, dichos archivos son descargables y reproducibles. El método de validación se realizó con una encuesta y pruebas del prototipo con diferentes médicos. Los resultados obtenidos demostraron que el prototipo brinda una buena calidad de los sonidos auscultados, siendo así útil para poder realizar un diagnóstico preliminar certero de manera remota. / The present thesis proposes the development of a digital stethoscope prototype system to be used in remote medical attentions using the celular network transmittion (GSM) and Internet, in order to provide to health professionals a tool which they can keep making their attentions avoiding physical contact with the patient. Thus, preventing the spread of an infectious disease. Therefore, the present work is divided in three parts: the acquisition and transmisión of auscultation signals, the Web server and the software. The first step to take is the acoustic signal acquisition provided by stethoscope. Signals enter the controller for recording and transmitted via Internet to Web server. Also, prior to recording the signals, the doctor, using the software, can hear the eliminate signals in real time using the call in order to indicate the correct position of stethoscope to patient. The recordings are stored on the Web server arranged in folders with data patient, the files are downloadable and playable. The validation method was performed using an inquest and testing prototype with different doctors. The results obtained showed that prototype provides a good quality of auscultated sounds, thus being useful to be able to carry out an accurate preliminary diagnosis remotely. / Tesis

Partant de l'hypothèse que, d'une part, aucun rejet ne peut se trouver à une température rigoureusement identique à celle des eaux drainées dans le réseau, et que, d'autre part, la température de la nappe phréatique est systématiquement plus basse que celle de différents rejets domestiques ou industriels, nous avons conçu une sonde autonome à double paramètre : température et conductivité, baptisée Ichtyotherme, pour l'auscultation des réseaux. L'appareil développé est couplé à un microordinateur qui sert à la commande de la mesure, au traitement et à la sauvegarde des données et enfin, à la gestion de la distance ; la corrélation "paramètre-distance" est établie en fonction du temps (cadence de la mesure). Le système développé est défini par une liaison "On-Line" (distance en temps réel) permettant le traitement des données en "Batch-processing". Différents types de réponse des entrées d'eaux parasites ont été obtenus lors des essais d'auscultations de réseaux effectués en région parisienne. La stabilité de la mesure de la température obtenue dans des réseaux ne recevant pas d'eaux parasites présente un grand intérêt : toute entrée d'eau parasite ou rejet se traduit donc par une variation de la température. Une approche mathématique des rejets thermiques dans un écoulement turbulent est abordée et les simulations effectuées à l'aide d'un modèle de diffusion Gaussien correspondent aux résultats obtenus sur le terrain. Deux notions ressortent des résultats obtenus : la notion d'infiltration et la notion de drainage. Ce modèle en outre, détermine les limites théoriques de détection des eaux parasites à l'aide du paramètre "température". L'interprétation des résultats d'auscultation présuppose une connaissance du site de mesure relative aux industries raccordées, au niveau de la nappe phréatique sous-jacente, à l'alimentation en eau potable, etc. Ces connaissances deviennent indispensables dès qu'il s'agit de surveiller la qualité des rejets à l'aide du paramètre conductivité. Une approche systémique des eaux parasites est abordée dans cette thèse et quelques données de base sont établies pour rendre aisé un dressage de diagnostics juste et précis. Les trois approches développées dans cette thèse, l'approche analytique, l'approche mathématique et l'approche systémique, permettent d'apprécier les limites de détection des eaux parasites et facilitent l'interprétation des résultats à partir du matériel étudié.

In developing countries, acute respiratory infections (ARIs) are responsible for two million deaths per year. Most victims are children who are less than 5 years old. Pneumonia kills 5000 children per day. The statistics for cardiovascular diseases (CVDs) are even more alarming. According to a 2009 report from the World Health Organization (WHO), CVDs kill 17 million people per year. In many resource-poor parts of the world such as India and China, many people are unable to access cardiologists, pulmonologists, and other specialists. Hence, low skilled health professionals are responsible for screening people for ARIs and CVDs in these areas. For example, in the rural areas of the Philippines, there is only one doctor for every 10,000 people. By contrast, the United States has one doctor for every 500 Americans. Due to advances in technology, it is now possible to use a smartphone for audio recording, signal processing, and machine learning. In my thesis, I have developed an Android application named Smart Auscultation. Auscultation is a process in which physicians listen to heart and lung sounds to diagnose disorders. Cardiologists spend years mastering this skill. The Smart Auscultation application is capable of recording and classifying heart sounds, and can be used by public or clinical health workers. This application can detect abnormal heart sounds with up to 92-98% accuracy. In addition, the application can record, but not yet classify, lung sounds. This application will be able to help save thousands of lives by allowing anyone to identify abnormal heart and lung sounds.