Este estudo teve como objetivo descrever a assistência ao recém-nascido (RN) no período neonatal, realizada em uma unidade do Programa de Saúde da Família (PSF) do Município de Guarapuava-PR, com vistas a subsidiar a organização da atenção à saúde da criança no contexto da família. Trata-se de estudo descritivo, a partir do levantamento de dados registrados em declarações de nascidos vivos e em prontuários de famílias com bebês nascidos no período de 01/10/2003 a 30/09/2004, num total de 90 RNs. Verificou-se que grande parte dos RN apresentou Apgar 9/10, nasceu na faixa de normalidade de peso e a termo (acima de 3.000g e de 37 a 41 semanas de gestação), porém há um número expressivo de RN de baixo peso ao nascer (peso menor que 2.500g) e prematuros (menos que 36 semanas de gestação). No tocante às mães, mais da metade realizaram 7 ou mais consultas de pré-natal, sendo que uma parcela significativa o fez abaixo do recomendado; a maioria dos partos foi cesáreo; metade delas tem idade entre 20 e 29 anos, sendo encontrado número expressivo de gestantes em idade considerada de risco gestacional (16 entre 15 e 19 anos e 14 acima de 35 anos); e grande parte tem nível de escolaridade inferior a 8 anos de estudo. Constatou-se que a maioria dos RNs recebeu aleitamento materno exclusivo e vacinação completa no período neonatal e 6 (6,6%) foram hospitalizados por pneumonia. A cobertura vacinal e o aleitamento materno foram os componentes da assistência materno-infantil que apresentaram melhor resposta às ações realizadas pela equipe do PSF. Em relação aos atendimentos, tem-se que a maioria dos RNs foi visitada por Agentes Comunitários de Saúde (ACSs), no período neonatal precoce e uma parcela relativamente pequena compareceu à unidade no período neonatal para 8 atendimento pelo médico e/ou pela enfermeira, sendo que esse atendimento está centrado na demanda espontânea. A partir da descrição da forma de captação da clientela e da verificação dos atendimentos realizados, foi possível construir um fluxograma de atendimento ao recém-nascido. Depreendeu-se que o fluxograma representa uma forma adequada de identificar o tipo de demanda, o atendimento de cada profissional, os procedimentos, encaminhamentos, retornos, assim como as lacunas. Permitiu, ainda, visualizar o período neonatal esquematicamente, possibilitando contribuir na organização da assistência ao recém-nascido em unidades de PSF. / The goal of this survey is to describe the assistance given to newborn children in the neonatal period. It was carried out at a Unit of the Hea1th of the Fami1y Programme (PSF) in the City of Guarapuava (PR) with the specific aim of subsidizing the organization that cares for children’s health in the context of the family. It is a descriptive study and was conducted from the registered data in the certificate of live birth and medical records. The research was done with children born between 01/OCT/2003 and 30/SEP/2004 adding up 90 newborn babies. We have noticed that a lot of birth certificates showed a 9/10 Apgar and that despite a large number of born children who were of average weight; there was also a significant number of underweight and premature babies. Concerning women, about half of them got prenatal care with 7 or more appointments, but the number of mothers who didn't go to the doctor as it was recommended is considered very large too. The main delivery procedure was the Cesarian section. Half of the women were between 20 and 29 years old, the number of teenagers (between 15 and 19 years old) and women over-30s being significant. It was discovered that many of the pregnant women were at a maternal age risk (under 19 and upper 35 years old) and some of them had a level of education lower than 8 years. Our survey revealed that most of the newborn babies had exclusive breastfeeding and complete vaccination at the neonatal period, 6 of them (6,6%) having been taken to hospital due to pneumonia. The covering of the children who were being vaccinated and breastfed was the part of the maternal-infant assistance that has showed the best answer to the actions taken by the PSF team. With regard to the service, it was provided mainly by spontaneous request. We discovered that the 10 majority of children was visited by ACS in the premature neonatal period having been attended by a doctor and/or a nurse. From the description of the way of attracting clients and from the verification of the taken services, it was possible to create a flow chart containing information on the assistance given to newborn children. It was deduced that the flow chart represents a right way of identifying the type of request, the service taken by each professional, the procedures, the requirements of further visits to specialists, returns, as well as the omissions. It has allowed us to see the neonatal period schematically and contributed to an organization of the aid to newborn children in Units of the PSF.

The attempt to identify risk factors or correlates of intraventricular hemorrhage (IVH) has been constrained by conflicting research findings, changing hypotheses about the etiology of IVH, and by the exceedingly complex nature of this neurological disorder. In addition, few studies have investigated the possibility that antenatal factors might predispose the infant to IVH. Thus, research aimed at identifying IVH correlates from all time periods in which stress could occur to the neonate needs to be undertaken. This study was conducted for the purpose of identifying and quantifying correlates of IVH by constructing an interactive statistical model to predict the occurrence, severity, and onset of IVH. The study sample was composed of inborn neonates admitted to the University of Utah Medical Center's Neonatal Intensive Care Unit from July 1985 to June 1987. Ultrasound brain scans were used to assigned 150 infants into two groups of equal numbers: an IVH group and a nonIVH group. Forty-three maternal, 17 obstetric, and 35 neonatal variables were collected from the infants' and infants' mothers' medical records and included demographic, medical, and behavioral data. The mean birthweights and gestational ages for the IVH and non-IVH groups were 1413 g, 29.9 weeks, and 1573 g 31.3 weeks, respectively. Factors found to be associated with IVH were neonatal hypotension, bronchopulmonary dysplasia, lower hematocrit percent, pulmonary interstitial emphysema, severe respiratory distress syndrome, shorter gestational ages, lower 5-minute Apgar score, pneumothorax, shorter umbilical cord lengths, and lower maternal hemoglobin concentrations. No obstetric factors were found to be related to IVH. A second-order, interactive model used to predict IVH occurrence and severity explained 90.9% of the total variability. The attempt to predict the onset time of IVH was unsuccessful. While the condition of the neonate immediately following birth is the best predictor of IVH, maternal or antenatal factors may interact to contribute to the development of this neurological disorder.

Background To date, the vast majority of studies on infant feeding behavior of Chinese population have been conducted in Asian and some western countries but not the U.S. As the fastest growing Asian subgroup and with the largest Chinese community outside of Asia, studies that focus on their health choices in the U.S. are long overdue. Where studies are available, the overseas Chinese population is often regarded as high formula feeding and low breastfeeding. Chinese mothers often cite family, cultural, and social expectations as the determining factors for their choice of infant feeding. Given the cultural beliefs and traditions of Chinese immigrant population in the U.S., this study argues for the importance of including the input of the overall community, as opposed to only mothers, as a more data-based explanation of the prevalence of formula feeding among the Chinese community in New York City, and in addition, why this community continues to accept formula feeding as the norm. Methods Guided by Theory of Planned Behavior, this study incorporated both quantitative and qualitative components. A total of 434 surveys and 20 in-person interviews were collected in Chinese populated areas in New York City. Results In examining the prevalence of formula feeding in the Chinese community, both quantitative and qualitative findings consistently identified the central role friends and family played in motivating certain groups to use formula. These less acculturated, educated, and China-born subgroups are likely to conform to the idea that breast milk supplemented by infant formula is necessary in order to meet the nutritional demand of a growing infant. For the first-generation immigrants who breastfeed for health benefits and tradition, their attitudes towards infant feeding shifted after seeing other formula-fed children in populated Chinese communities as evident by shorter breastfeeding durations for the child born in the U.S. as compared to previous child born in China. As for the second-generation, who are more acculturated and educated, although they are aware of the benefits of breastfeeding and intend to breastfeed, they are expected by the older generation to continue the formula feeding tradition in the family. Conclusion When investigating why infant formula remained as the popular choice of feeding and is often perceived as the norm by this community, the current study identified the psychosocial variables that motivated individual subgroups and the context underlay. The findings provided new insights to the current literature and are intended to help guide future studies and to develop educational policy interventions to improve the overall infant feeding experiences for the Chinese community in New York City.

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

This thesis has outlined a reliable and practical method for auditory screening in the newborn. Validation of the assumption that the Denver test kit bell could be used as a standardized stimulus was accomplished by electronic analysis. The experimental stimulus, then, was matched against a standardized commercial device for auditory screening with the hypothesis that there would be no differences in response patterns elicited by the two instruments. Newborns in a hospital nursery served as subjects.No significant differences existed between the two groups with respect to the number judged as hearing infants. However, there was a significant difference between the two groups with respect to the number judged as nonhearing infants.In addition, a discussion is presented to illustrate the meaning of the findings, the usefulness of this study, and a method for continuing the auditory evaluation of newborns.Ball State UniversityMuncie, IN 47306

There is uncertainty regarding how much intravenous fluid should be given to women in the intrapartum period. There are no published protocols or guidelines available to address fluid management in labour to optimize care for women and their infants. The absence of an evidence-based approach to intrapartum fluid management may result in fluid overload, with consequent maternal and newborn morbidity. The FILL Trial sought to answer the question, for low risk women receiving epidural analgesia in labour, ‘what is the effect of a conservative protocol for fluid management versus usual care on breastfed newborns’ weight loss prior to hospital discharge? The FILL Trial was a single site randomized controlled trial comparing a conservative protocol of fluid management with usual care for low risk women receiving epidural analgesia in labour. Women in the conservative care group received an IV volume prior to epidural analgesia initiation of < 500 ml and an IV infusion rate of 110 ml per hour. Women in the usual care group received an IV volume prior to epidural analgesia initiation of >500 ml and an IV infusion rate of 200 ml per hour. The primary outcome of interest was the proportion of breastfed infants who lost > 7% of their birth weight prior to discharge. Two hundred women participated, 100 in the conservative care group and 100 in the usual care group. Forty-four infants in the conservative care group and 48 infants in the usual care group lost > 7% of their birth weight, p=0.57. There were no statistically significant differences between groups for breastfeeding outcomes or measures of newborn well being. More babies in the conservative care group required initial admission to the neonatal intensive care unit for septic work up for maternal fever. No septic work ups of the babies yielded positive results. More instrumental vaginal deliveries occurred in the conservative care group. No change in current practice is warranted for intrapartum intravenous fluid volumes < 2500 ml. Future research should focus on the creation of more evidence regarding safe volumes of intravenous fluid during labour.

Fever in infants younger than 2 months of age causes a significant number of emergency department visits and is particularly worrisome because of the potential for serious infection. Management of febrile infants is problematic because clinical observation is not a reliable indicator of serious bacterial illness (SBI), such as bacteremia, meningitis, and urinary tract infection (UTI). Numerous investigators have proposed methods of screening laboratory tests to ascertain the risk of SBI in febrile infants. These screening tests could potentially avoid the invasive and costly sepsis work-up, which usually includes complete blood count (CBC), blood culture, urinalysis, urine culture, and lumbar puncture. We conducted a prospective, cross-sectional study that examined the prevalence of rhinovirus (RV) and coronavirus (CoV), which are two of the most common causes of upper respiratory infections in the first year of life, and human metapneumovirus (hMPV), which is a common cause of bronchiolitis, in infants younger than 2 months of age. This study also examined whether febrile infants with RV were more or less likely to also have a SBI than infants without a viral respiratory infection. Methodology: Fever was defined as rectal temperatures greater than 37.9C or a historical fever greater than 100.3F. Nasal swabs were tested with reverse transcriptase polymerase chain reaction (rt-PCR) techniques for rhinoviruses (RV), human metapneumovirus (hMPV) and coronaviruses (CoV). Nasal samples were also tested for RSV, influenza A and B, parainfluenza types 1, 2 and 3, and adenovirus via direct fluorescent antibody (DFA). Conclusion: Rhinovirus (RV) was the most commonly detected respiratory viral pathogen in our cohort (14% out of 98 total enrolled patients). Coronovirus (CoV) and human metapneumovirus (hMPV) were both detected but in only one patient (1%) each. RV occurred predominantly in the summer (79%). This cohort of patients showed no difference between the incidence of serious bacterial illness (SBI) with and without RV infection (p=0.84).

Thesis (M.S.)--Florida State University, 2004. / Advisor: Dr. Deborah Frank, Florida State University, School of Nursing. Title and description from dissertation home page (viewed June 17, 2004). Includes bibliographical references.

published_or_final_version / Public Health / Master / Master of Public Health

In healthcare environments, elements like nature, daylight and sound have been found to significantly influence the healing process of patients, by enhancing the quality of their recovery, shortening their hospital stay and consequently reducing hospital costs. For instance, it has been shown that exposure to nature triggers positive responses in people, daylight affects human psychology, and different sounds have varying behavioral effects on different groups of people. But, while these effects have been carefully studied in adult patients, leading to clear design standards, less is known about their impact on premature infants. Interestingly, the care that many newborns receive in Neonatal Intensive Care Units provides countless benefits, but there are also many aspects of it that can cause stress to babies, staff and families. Exposure to continuous light, high levels of noise, separation from their mothers, minimal physical contact and painful procedures are all stressful factors that can have tremendous effects on a baby's recovery. So, while highly specialized treatments can greatly improve a newborn's medical condition, physical surroundings are rarely regarded as influential in his or her care. This thesis exploration focuses on the design of a Women's and Infant's Medical Center prototype where the emphasis will be to promote well-being and healthy development through the physical environment. Attention will be given to the controversial effects of natural light on babies and its benefit will be determined through analysis of collected evidence. Equally, noise sources and methods to control it will be explored in order to minimize stress and discomfort in newborns. Finally, the importance of access to the natural environment will be studied, and even though this would normally not be directly associated with a baby's healing process, it could be an essential factor in the well-being of mothers and caregivers, which in turn will benefit the baby. Through evidence, research, analysis and a prototype design various strategies will be developed to demonstrate how the proposed elements (access to nature, daylight, and noise control) could successfully be integrated into a NICU setting. The resulting environment should promote faster recovery and healthier development of babies, both directly and via their caregivers (parents and medical staff).