Introdução - O baixo peso ao nascer (BPN) é considerado um dos mais importantes problemas de saúde pública em todo o mundo, contribuindo, substancialmente, para a morbi-mortalidade infantil. Objetivos Estimar a proporção de baixo peso ao nascer e identificar a presença de associações entre o baixo peso ao nascer e fatores relacionados à gestação, ao parto, ao recém-nascido e a características sócio-demográficas maternas. Métodos Estudo transversal onde se analisaram 3220 declarações de nascidos vivos referentes aos partos ocorridos no município de Cruzeiro do Sul, Estado do Acre, no período de 2006 e 2007, de mães residentes nesta localidade. Na análise, utilizou-se regressão linear generalizada família Poisson ligação logarítmica com variância robusta, simples e múltipla. Adotou-se nível de significância de 0,10. Resultados - A proporção de baixo peso ao nascer foi 9,13%. Os fatores associados ao baixo peso ao nascer foram: prematuridade; nascimento no domicílio; sexo feminino; idades maternas entre 12 e 13 anos, 16 e 17 anos, 18 e 19 anos, 35 e mais anos; realização de 1 a 3 consultas de pré-natal, crianças não brancas, mães sem ocupação fora do lar e mães solteiras. Conclusão São poucos (ou nenhum) os fatores suscetíveis de mudança ou controle com ações isoladas de saúde. Estratégias de ampla abrangência são necessárias para a redução da proporção de BPN em Cruzeiro do Sul, Acre e, uma vez ocorrido baixo peso ao nascer, atenção especial deve ser proporcionada à criança. / Introduction - The low birth weight (LBW) is considered one of the most important public health problems around the world, contributing substantially to infantile morbidity and mortality. Objectives - To estimate the proportion of low birth weight and identify the presence of associations between low birth weight and factors related to pregnancy, chilbirth, newborn baby and maternal socio-demographic characteristics. Methods - Cross-sectional study which examined 3220 statements of births relating to births occurring in the city of Cruzeiro do Sul, Acre, in the period 2006 to 2007, of resident mothers in this locality. In the analysis, was used linear regression generalized with Poisson family logarithmic linking robust variance, simple and multiple. It was used a significance level of 0,10. Results - The proportion of low birth weight was 9,13%. Factors associated with low birth weight were: prematurity, birth at home, female, maternal age between 12 and 13 years, 16 and 17 years, 18 and 19 years, more than 34 years, achieving 1-3 pre-natal consultations, non-white children, mothers with no occupation outside home and single mothers. Conclusion- Few (or none) the factors susceptible to change or control with isolated actions health. Wide variety of strategies are needed to reduce the proportion of LBW in the city of Cruzeiro do Sul, Acre, and once occurred low birth weight, attention should be given to the child.

Submitted by maria oliveira (maria.oliveira@utp.br) on 2018-06-26T13:39:15Z No. of bitstreams: 1 TRIAGEM AUDITIVA.pdf: 1275565 bytes, checksum: 5e787487214016e5fdb2833b8205b18d (MD5) / Made available in DSpace on 2018-06-26T13:39:15Z (GMT). No. of bitstreams: 1 TRIAGEM AUDITIVA.pdf: 1275565 bytes, checksum: 5e787487214016e5fdb2833b8205b18d (MD5) Previous issue date: 2014-11-28 / INTRODUCTION: This paper has as its theme "Newborn Hearing Screening in a Public Maternity Hospital in Curitiba - PR: Determining Factors for non Adherence to Retesting". According to the 2010 IBGE Census, 5.1% of the population experiences some hearing difficulty. Under Law 12.303/10, it became mandatory to carry out the so-called "Newborn Hearing Test", in newborns before hospital discharge, in order to diagnose possible hearing problems by three months of age. When there is a risk indicator for hearing loss, for the mother or baby, auditory monitoring must be carried out through otoacoustic emissions during the 1st year of the baby’s life. It happens that many mothers do not appear for the hearing retest, thereby undermining the monitoring for these children. OBJECTIVE: To identify the determinants for non-adherence to retesting in neonatal hearing screening at a public hospital in the city of Curitiba-PR for mothers of newborns who presented risk factors for deafness but did not attend retesting. METHOD: 60 mothers of babies who missed the mandatory hearing retest for neonatal hearing screening (NHS) were interviewed. The mother's age, education, marital status, level of knowledge about screening, reasons for non-adherence to retest were the variables considered. The responses were entered into a spreadsheet and submitted to Fischer and Chi-squared tests at a significance level of 0.05. RESULTS: The predominant age range of the mothers was 20-29 years (41.67%); 51.67% were educated only to a primary level, and 46.67% to a high school level. Regarding marital status, 70% of the sample lived alone. All respondents reported that infants listened well, but 63.33% were unaware of the NHS. Among the respondents, 90% received no prenatal guidance or explanatory material about the OAE test; only 20% were targeted during hospitalization; 30% of the sample stated that they "forgot" to do the retest. No significant relationship between age, education and marital status for non-adherence to the retest was found. CONCLUSION: Among the reasons identified for non-adherence to the retest, a large number of participants did not see the needed value in retesting, since the mothers forgot the retest date. This fact allows us to infer that the lack of knowledge about neonatal hearing screening interferes with adherence to the program. However, age, education and marital status did not seem to interfere with the decision to retest and monitor the newborn’s hearing health. The concept of adherence to the retest requires greater analysis by multidisciplinary health professionals. These professionals should be sensitized to the problem because it is their responsibility to make mothers aware of the retest’s importance through knowledge, appreciation and participation in the program. Better communication between health care networks and mothers is needed; conducting informational and motivational campaigns for pregnant women; using standard civil media channels for better orientation about early detection of hearing impairment, since there is little knowledge about the subject. / INTRODUÇÃO: Esta dissertação tem como tema a “Triagem Auditiva Neonatal em uma Maternidade Pública de Curitiba - PR: Fatores Determinantes para a não Adesão ao Reteste”. Segundo o Censo de 2010 do IBGE, 5,1% da população brasileira apresenta alguma dificuldade auditiva. A Lei 12.303/10 tornou obrigatória a realização do denominado “Teste Auditivo Neonatal”, nos recém-nascidos antes da alta hospitalar, para diagnosticar possíveis problemas auditivos até os três meses de idade. Quando houver indicador de risco para deficiência auditiva, na mãe ou no bebê, ele deve realizar o monitoramento auditivo, por meio das emissões otoacústicas, durante o 1º ano de vida. Ocorre que muitas mães não comparecem para o reteste auditivo, o que compromete o seguimento destas crianças. OBJETIVO: Identificar os fatores determinantes para a não adesão ao reteste na triagem auditiva neonatal, em mães de recém-nascidos em maternidade pública da cidade de Curitiba-PR, que apresentaram fatores de risco para surdez e não compareceram ao reteste. MÉTODO: Foram entrevistadas 60 mães de bebês que faltaram ao reteste auditivo obrigatório da triagem auditiva neonatal. Foram consideradas as seguintes variáveis: idade da mãe, escolaridade, estado civil, nível de conhecimento sobre a triagem, motivos que justificaram a não adesão ao reteste. As respostas obtidas foram digitadas em planilha eletrônica e submetidas aos testes estatísticos de Fischer e Qui-quadrado ao nível de significância de 0,05. RESULTADOS: a faixa etária predominante das mães foi de 20 a 29 anos (41,67%); 51,67% apresentaram escolaridade apenas ao nível fundamental e 46,67%, do ensino médio. Quanto ao estado civil, 70% da amostra, viviam sós. Todas as respondentes referiram que os recém-nascidos escutavam bem, mas 63,33% desconheciam a TAN. Dentre as entrevistadas, 90% não receberam orientação no pré-natal, nem material explicativo quanto ao teste da orelhinha; somente 20% foram orientadas durante o internamento; 30% da amostra refere que “esqueceu” a consulta. Não foi encontrada relação significativa entre idade, escolaridade e estado civil para a não adesão ao reteste. CONCLUSÃO: Identificados os motivos para não adesão ao reteste, observa-se que grande parte da amostra não deu o valor necessário ao procedimento de reteste, uma vez que as mães esqueceram a data da consulta. Tal fato permite inferir que a falta de conhecimento sobre a triagem auditiva neonatal interfere na adesão ao programa. Porém, a idade, a escolaridade e o estado civil não parecem interferir sobre a decisão de retornar ao serviço e monitorar o desempenho da saúde auditiva do recém-nascido. O conceito de adesão ao teste requer maior análise multidisciplinar dos profissionais da saúde, que devem estar sensibilizados ao problema, pois lhes cabe a conscientização das mães para que haja conhecimento, valorização e participação no programa. É necessária melhor comunicação entre as redes de assistência à saúde e as mães; a realização de campanhas informativas e motivadoras para gestantes; a utilização dos meios de comunicação da sociedade civil, para orientar melhor quanto à detecção precoce da deficiência auditiva, uma vez que há pouco conhecimento acerca do tema.

Introdução: Recém-nascidos (RN) pré-termo tardios são submetidos repetidamente a lancetagem de calcâneo para controle glicêmico nas primeiras horas de vida. A lancetagem, embora dolorosa, raramente é acompanhada de medida analgésica. Objetivo: Comparar a eficácia do leite materno ordenhado com glicose 25% nos escores da dor em recém-nascidos pré-termo tardios, submetidos à lancetagem de calcâneo. Método: Ensaio clínico randomizado, de não inferioridade, conduzido no Berçário Anexo à Maternidade do Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo (BAM-ICrFMUSP) no período de agosto de 2009 a maio de 2010. A amostra foi de 113 RN, dos quais 56 randomizados no grupo experimental (GE) e 57, no grupo controle (GC). Dois minutos antes de serem submetidos à lancetagem de calcâneo, o GE recebeu 2mL de leite materno ordenhado (LMO) por via oral e os do GC, 2mL de glicose 25% por via oral. O desfecho primário foi o escore da dor obtido com a escala Premature Infant Pain Profile (PIPP) nos primeiros 180 segundos após a lancetagem (T30, T60, T90, T120, T150 e T180). Os desfechos secundários foram alterações relacionadas à mímica facial (sobrancelhas salientes, olhos espremidos, sulco nasolabial), frequência cardíaca (FC), saturação de oxigênio (SatO2), choro e eventos adversos. O projeto de pesquisa recebeu aprovação do comitê de ética da instituição, local do estudo, e foi registrado no Australian and New Zealand Clinical Trials Registry. Resultados: Pela ausência ou volume insuficiente de LMO, 25 neonatos não receberam a intervenção, mas foram incluídos na análise por intenção de tratar. Os grupos foram homogêneos em relação ao tipo de parto, Apgar no 5º minuto de vida, sexo, idade gestacional, idade em horas, intervalo entre a última mamada e a coleta de dados e glicemia capilar. Observou-se diferença estatística significante quanto ao peso do nascimento (p=0,013) e peso na data do procedimento (p=0,017). A análise de variância (ANOVA) indicou escores de dor inferiores no GC: houve diferença significativa entre os grupos de alocação, independente do tempo (p<0,001) e, ao longo do tempo, independente da intervenção (p<0,001). O GC apresentou maior freqüência de escores PIPP indicativos de dor mínima ou ausência de dor (p=0,002 e, na análise por intenção de tratar, p=0,003). A avaliação da mímica facial demonstrou menor porcentagem média de tempo de ocorrência de sobrancelhas salientes, olhos espremidos e sulco nasolabial para o GC em relação ao GE. Para sobrancelhas salientes, observou-se diferença estatisticamente significante entre os grupos (p<0,001) e ao longo do tempo (p<0,001). Com relação ao olhos espremidos, a ANOVA indicou interação (p=0,001). Para os neonatos que receberam leite materno, houve diferença significativa na ocorrência de olhos espremidos no T30 e nos demais intervalos, com redução da ocorrência da mímica ao longo do tempo (p_0,0014). No GC, foi observada redução significativa na ocorrência de olhos espremidos, em relação ao T30, no T90 (p=0,0155), no T150 (p=0,0261) e no T180 (p=0,0122). Quanto ao sulco nasolabial, observou-se interação (p<0,001). No GE, houve diferença estatisticamente significativa entre o T30 e todos os demais períodos de avaliação (p<0,001), exceto entre o T30 e T60. Para o GC, observou-se redução significativa só entre T30 e T90 (p=0,022) e entre T30 e T180 (p=0,0175). Houve interação entre as intervenções e ao longo do tempo na avaliação da FC (p=0,027). Não se observou diferença estatisticamente significante na FC ao longo do tempo para o GE (p=0,563) e para o GC (p=0,955). Para SatO2, observou-se diferença significativa entre os grupos (p=0,004) e ao longo do tempo (p=0,017). Foi observado choro pós-procedimento em 33 neonatos no GE e em 19 no GC (p=0,001 e na análise por intenção de tratar, p=0,001). A porcentagem média de tempo de choro foi maior no GE (p=0,014). Os eventos adversos foram benignos e autolimitados, sem diferença estatisticamente significante entre os grupos (p=0,736 e na análise por intenção de tratar, p=0,637). A margem de não inferioridade estabelecida foi de 2 pontos e, para o teste da hipótese, o intervalo de confiança de 95% foi de 1,507 a 4,483. Conclusão: O teste da hipótese de não inferioridade do efeito do LMO em relação ao efeito da solução de glicose 25% no escore da dor PIPP em neonatos pré-termo tardios submetidos à punção capilar em calcâneo foi inconclusivo. / Background: Late preterm neonates undergo repeated heel lancing during their first hours of life due to capillary blood glucose monitoring. Heel lancing is a painful procedure however pain relief strategies are rarely implemented prior to the lances. Aim: To compare the efficacy of expressed breast milk and 25% glucose on pain scores of late preterm infants during heel lancing. Methods: This is a noninferiority randomized controlled trial, conducted at the Berçário Anexo à Maternidade do Instituto da Criança da Faculdade de Medicina da Universidade de São Paulo (BAM-ICrFMUSP) between August 2009 and May 2010. A total of 113 newborns were randomized: 56 comprised the experimental group (EG) and 57, the control group (CG). Two minutes before heel lancing, EG received 2mL of expressed breast milk (EBM) orally and CG received 2mL of 25% glucose orally. The Premature Infant Pain Profile (PIPP) score was the primary outcome and it was assessed within 180 seconds after lancing (T30, T60, T90, T120, T150 and T180). Secondary outcomes were: grimacing (brow bulging, eye squeezing, nasolabial furrowing), changes in heart rate (HR), and oxygen saturation (SpO2), crying, and adverse events. The research project was approved by the local ethics committee and was registered at the Australian and New Zealand Clinical Trials Registry. Results: Due to absence or insufficient volume of EBM, 25 neonates did not receive the intervention, but were included in the intention to treat analysis. The groups were similar with respect to type of delivery, Apgar score at 5 minutes, sex, gestational age, postnatal age in hours, interval between last feeding and data collection, and capillary blood glucose. There were statistically significant differences amongst the groups regarding birth weight (p=0.013) and weight at the time of the procedure (p=0.017). The analysis of variance (ANOVA) indicated lower pain scores in the CG: there was a significant difference between the interventions, regardless time (p<0.001), and main effect of the time, independent of the intervention (p<0.001). The CG had a higher frequency of PIPP scores indicative of minimal pain or absence of pain (p= 0.002 and p=0.003 on intention to treat analysis). Lower mean percentage of time of brow bulging occurrence, eye squeezing and nasolabial furrowing was observed for CG in comparison to EG. There was a statistically significant difference on brow bulging occurrence amongst the groups (p<0.001) and over the time (p<0.001). ANOVA indicated interaction between interventions and time (p=0.001) for eye squeezing. Infants who received breast milk demonstrated significant reduction on eye squeezing occurrence when comparing T30 and the remaining intervals (p_0.0014). In the CG, a significant reduction on eye squeezing were observed when comparing T30 to T90 (p=0.0155), to T150 (p=0.0261) and to T180 (p=0.0122). As for nasolabial furrowing, there was interaction (p<0.001). Statistically significant differences between the T30 and all other periods (p<0.001) were observed for EG, except when comparing T30 and T60. For neonates who received glucose, there were significant reductions in nasolabial furrowing occurrence between T30 and T90 (p=0.022) and T30 and T180 (p=0.0175). There was interaction in the evaluation of HR (p=0.027). No statistically significant differences were observed in HR over time for EG (p=0.563) and CG (p=0.955). Regarding SpO2, there were significant differences between intervention groups (p=0.004) and over the time (p=0.017). Of the infants who received EBM, 33 cried after lancing; in the CG, 19 neonates cried (p=0.001 and p=0.001 on intention to treat analysis). Longer mean percentage of duration of crying was observed in EG (p=0.014). Adverse events were benign and self-limited and there was no statistically significant difference among the groups (p=0.736 and p=0.637 on intention to treat analysis). Noninferiority margin was established in 2 points and the hypothesis test indicated a 95% confidence interval 1.507 to 4.483. Conclusion: The hypothesis test of noninferiority of EBM as compared to 25% glucose solution on reducing PIPP score in late preterm neonates undergoing heel lancing in was inconclusive.

Submitted by Silvana Teresinha Dornelles Studzinski (sstudzinski) on 2016-12-22T11:39:50Z No. of bitstreams: 1 Silvana Mara Janning Prazeres_.pdf: 8729770 bytes, checksum: 3fc520ee401ed119bf5220fd27c4390e (MD5) / Made available in DSpace on 2016-12-22T11:39:50Z (GMT). No. of bitstreams: 1 Silvana Mara Janning Prazeres_.pdf: 8729770 bytes, checksum: 3fc520ee401ed119bf5220fd27c4390e (MD5) Previous issue date: 2016-10-05 / Nenhuma / A epidermólise bolhosa (EB) hereditária é uma genodermatose, ou seja, doença de pele transmitida geneticamente. É uma doença rara, a qual se caracteriza pelo aparecimento de bolhas, ulcerações ou feridas em qualquer local da superfície corporal em resposta a mínimos traumas ou desencadeadas espontaneamente. Os objetivos deste estudo foram elaborar uma cartilha para o cuidado, no âmbito hospitalar, de neonato com epidermólise bolhosa. Investigar como os profissionais de saúde que atuam em UTI neonatal enfrentam o nascimento e os cuidados a serem dispensados com o neonato em EB, visando subsidiar a elaboração da cartilha. Trata-se de um estudo de natureza qualitativa, exploratória e descritiva, realizado em instituições de saúde que já tiveram casos da doença em neonatos hospitalizados na UTI neonatal na cidade de Porto Alegre/RS. A pesquisa seguiu a resolução 466/12 do Conselho Nacional de Saúde, sendo o projeto aprovado pelo Comitê de Ética e Pesquisa da UNISINOS (parecer 780.693 de 08/09/2014) e das instituições coparticipantes (pareceres: 837.816 de 17/09/2014 e 14171 de 22/10/2014). Participaram 14 profissionais da saúde, que durante sua trajetória haviam cuidado de recém-nascidos com EB. Oito são enfermeiros, três técnicos de enfermagem e três médicos. A coleta dos dados foi realizada por meio de entrevista em profundidade, composta por duas questões abertas: descreva suas experiências no cuidado, tratamento e acompanhamento aos pacientes com EB, que estão ou que ficaram sob seus cuidados durante a internação hospitalar? e Diga como foi para você cuidar de uma criança com EB? A análise dos dados foi constituída pela análise temática. Emergiram três categorias: experimentação do cuidado, família, e equipe de saúde. Os resultados apontaram que o nascimento de uma criança com EB acarreta sofrimento tanto pela insegurança na condução do caso, quanto pela gravidade da doença e seu enfrentamento durante a vida do paciente assistido e seus familiares. Considera-se que a elaboração desta cartilha poderá subsidiar o cuidado de neonatos com EB, contribuindo para a qualificação do cuidado também intra-hospitalar, bem como, para qualificar a orientação aos pais de neonatos com EB, acerca do cuidado domiciliar. / The Epidermolysis Bullosa (EB) is a hereditary genodermatosis. In other words, it is a genetically transmitted skin disease. It’s a rare disease, which is characterized by the manifestation of blisters, ulcerations or wounds anywhere on the body surface either in response to the smallest traumas or spontaneously triggered. The objectives of this study were the elaboration of a practical guide for the handling of newborn babies who are of Epidermolysis Bullosa (EB); investigate how health professionals who work in neonatal intensive care units (ICUs) face the birth and the necessary care of newborn EB carriers, aiming to support the elaboration of the practical guide. This study has a qualitative, exploratory and descriptive nature and it was carried out in health institutions, which have already had cases of the disease in ICUs in the city of Porto Alegre/RS. The research followed the 466/12 resolution of the National Health Council. The project was approved by the UNISINOS Ethical and Research Committee (technical opinion 780.693 on September 8th 2014) and by the coparticipating institutions (technical opinions 837.816 on September 9th 2014 and 14171 on October 22nd 2014) Ethical and Research Committees. A total of 14 health professionals who had taken care of newborns with EB during their trajectory participated in this research. Eight of them are nurses, plus three nurse technicians and three physicians. The data collection was carried out by in-depth interviews, composed by two open questions: describe your experience concerning the care, treatment and monitoring of EB patients who are or have been under your care during hospitalization. And they were asked to tell what it was like to them. The data analysis was constituted by thematic analysis. This resulted in three categories: care experimentation, family and health team. The results indicated that the birth of an EB child leads to suffering due to the insecurity in terms of handling the case as much as to the gravity of the disease and its confrontation during the lives of the assisted patient and their family members. It is considered that the elaboration of this guide can support the assistance of EB newborns, contributing to the care qualification, including in-hospital assistance, and to a better home care orientation to the children’s parents.

INTRODUÇÃO: Os resultados da triagem auditiva neonatal podem ser afetados por condições transientes no meato acústico externo e na orelha média. A reflectância de banda larga (RBL) surge como um instrumento de diagnóstico que fornece medidas objetivas do estado da orelha média e pode explicar variações na forma de como a orelha média recebe, absorve e transmite a energia sonora. Dessa forma, a RBL apresenta um grande potencial para a detecção de alterações de orelha média em recém-nascidos. OBJETIVO: Verificar a correlação entre as medidas de reflectância da energia de banda larga com as medidas das emissões otoacústicas e as imitanciométricas em recém-nascidos. MÉTODO: Estudo de casos. Para este estudo foram avaliados 77 recém-nascidos (40 do sexo masculino e 37 do feminino) de idades entre 27 e 78h sem riscos para perda auditiva segundo o JCHI (2007), e com emissões otoacústicas presentes por estímulo transiente (EOAT). Foram submetidos ao teste das mediadas de EOAT, da reflectância da energia com os estímulos chirp e tom puro numa faixa de 0.2 a 6 kHz, e da timpanometria e reflexo acústico ipsilateral com as frequências da sonda de 226 e 1000 Hz. Os estímulos ativadores de 1000 e 2000 Hz e ruído de banda larga foram usados no reflexo acústico. RESULTADOS: Os resultados apontaram que os recém-nascidos com EAOT presentes revelaram uma configuração de curva da reflectância com característica peculiar da idade, ou seja, baixa reflectância na frequência de 6000 Hz. O timpanograma de curva do tipo A foi obtido em 90,2% das orelhas com a sonda de 1000 Hz, e com a sonda de 226 Hz a maioria (89%) das orelhas apresentaram curva do tipo pico duplo. A configuração da curva 3B/3G foi apresentada em 69,8% das orelhas na sonda de 226 Hz, e as configurações 1B/1G (43%) e 1B/1G S (27%) juntas foram obtidas em 70% das orelhas. Na sonda de 1000 Hz os recém-nascidos avaliados apresentaram 100% de presença dos reflexos acústicos ipsilaterais para estímulos ativadores de 2000 Hz e ruído branco. Não houve diferença significativa entre os resultados do sexo masculino e do feminino. CONCLUSÃO: Este estudo demonstrou que a inter-relação entre o nível de amplitude das EOAT, a configuração timpanométrica B/G e a reflectância apresentou diferenças no comportamento por orelha. Algumas frequências e configurações B/G indicaram uma tendência da diminuição de EOAT com o aumento da reflectância. Dada a equivalência entre os estímulos chirp e tom puro, qualquer um pode ser usado para avaliação da orelha média em recém-nascidos / INTRODUCTION: Newborn hearing screening test outcomes can be influenced by transient conditions in the ear canal and middle ear. Wideband reflectance (WBR) emerges as a diagnostic tool that provides objective measures of the status of the middle ear and can explain variations in how the middle ear receives, absorbs and transmits sound energy. Thus, the WRL has a great potential for the detection of middle ear disorders in newborns. OBJECTIVE: To verify the correlation between wideband reflectance power measurement with otoacoustic emissions and immittance measurement in newborns. METHOD: Case studies. This study evaluated 77 newborns (40 males and 37 females) aged from 27 to 78 hours without risk of hearing loss according to JCHI (2007), and transient evoked otoacoustic emissions present (TEOAE). The newborns underwent the test of TEOAE measurement, the power reflectance using both tone and chirp stimuli from 0.2 to 6 kHz, and 226 and 1000 Hz admittance probe-tone tympanometry and ipsilateral acoustic reflex. The stimuli triggers 1000 and 2000 Hz and broadband noise were used in the acoustic reflex. RESULTS: Results showed that newborns with EAOT present revealed a configuration of the reflectance curve, peculiar feature of the age, i.e., low reflectance in the frequency of 6000 Hz. Single-peaked tympanogram was obtained in 90.2% of ears using a 1000 Hz probe tone, and double-peaked tympanogram was found in 89% of the ears using a 226 Hz probe tone. The 3B/3G tympanograms were found in 69.8% of the ears at 226 Hz probe tone, and the tympanograms 1B/1G (43%) and 1B/1G S (27%) together were obtained in 70% of the ears. In the 1000 Hz probe tone newborns evaluated showed 100% presence of ipsilateral acoustic reflexes to activating stimuli of 2000 Hz and white noise. No significant differences were obtained across gender considering the results of all test evaluated in newborns. CONCLUSION: This study demonstrated that the inter-relationship between the level of TEOAE amplitude, tympanometric configuration B/G and reflectance showed differences according in the ear. Some frequencies and configurations B/G indicated a trend of TEOAE decreasing of TEOAE with reflectance increasing. Given the equivalence between the tone and chirp stimuli, any of them can be used to evaluate the middle ear in newborns

Purpose In recent years, there has been a significant increase in opioid-related drug use among pregnant mothers, specifically Methadone, Subutex (Buprenorphine) and Suboxone (Buprenorphine and Naloxone) resulting in increased neonatal intensive care unit (NICU) admissions for treatment of neonatal abstinence syndrome (NAS). Standard tests such as urine, meconium, and cord stat blood samples have not been shown to accurately demonstrate maternal abuse of these medications or predict the clinical course of NAS. This study aims to correlate and compare clinical symptoms of NAS with cord/ placental blood concentrations of Buprenorphine, Methadone and their metabolites. Another goal is to demonstrate the ability to correctly identify maternal abuse and concentrations of these medications. Methods The design was an observational study where cord/placental blood samples were obtained from eligible subjects. In addition to the standard cord stat test done by state, samples were analyzed using liquid chromatography mass spectrometry (LC-MS/MS) to quantify the metabolites of Buprenorphine, Norbuprenorphine and Methadone. Investigators performing the LC-MS/MS were blinded. Infants were treated on attending physician’s discretion according to clinical course. All infants were followed until discharge. Demographics and clinical course, including NICU stay, were recorded. Results A total of 19 mothers were enrolled, out of which, 15 (78.9%) mothers were on Subutex, 2 (10.5%) on Suboxone and 2 (10.5%) on Methadone. Data analysis was performed only on subjects with exposure to Subutex due to low sample size for Suboxone and Methadone subjects. Cord stat performed by the state lab was negative in 33.3% of subjects; however, 100% of the cord blood samples tested by LC-/MSMS were positive. The percentage of neonates transferred to NICU for NAS was 60% of which 67% received replacement therapy. Length of stay in NICU for treatment of NAS did not have any correlation to the concentration of the metabolites in cord blood. Pearson’s correlation coefficient (r) between duration of NICU stay and Norbuprenorhine concentration was r = -0.07 (p-value = 0.40); Buprenorphine concentration was r = -0.30 (p-value = 0.14); Norbuprenorphine-glucoronate concentration was r = -0.05 (p-value = 0.43); Buprenorphine-glucoronate concentration was r = -0.31 (p-value = 0.13). No correlation was found after adding the concentrations of all the above metabolites with NICU stay r = -0.24 (p-value = 0.19). Conclusion The cord stat result is inferior to cord/placental blood levels of drug metabolites using LC-MS/MS for diagnosing maternal substance abuse in at risk infants. No correlation was found between the concentrations of metabolites and length of stay in NICU or duration of replacement therapy. This study was limited by a small sample size.

No description available.

Orientador: Cátia Regina Branco da Fonseca / Resumo: A Doença Periodontal na gestação desencadeia uma resposta imunológica exacerbada com altas concentrações locais e sistêmicas de marcadores inflamatórios. Objetivo: Investigar a repercussão da Doença Periodontal (DP) na gestante e suas complicações na gestação e no momento do parto, bem como desfechos negativos para o recém-nascido (RN) (infecção, prematuridade, baixo peso, restrição de crescimento fetal). Método: Estudo de coorte retrospectiva, a partir de registros de prontuários médicos de 142 gestantes atendidas em serviço de pré-natal de risco habitual entre 2012-2014, com avaliação odontológica para DP. Foram analisadas variáveis maternas gestacionais, do parto e do recém-nascido. Os RN foram estratificados em dois grupos: filhos de mães com DP (subdividido para Doença Periodontal grave -DPG) e, filhos de mães sem DP. Cada desfecho foi ajustado por um modelo de regressão logística múltipla, com significância se p<0,05, considerando todos os potenciais confundidores. Resultados: Observou-se entre as mulheres com diagnóstico de DPG o aumento de chance de vulvovaginite 3,45 vezes maior (OR=3,45; p=0,050) e de RPM 5,59 vezes maior (OR=5,59; p=0,017). Nos recém-nascidos, a chance de haver restrição de crescimento fetal foi 11,53 vezes maior nas gestantes com DPG (OR = 11,53; p=0,041). Conclusão: A Doença Periodontal aumentou a chance para desfechos neonatais e maternos negativos, sendo estes o recém-nascido nascer com restrição de crescimento fetal e a gestante apresentar vul... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The Periodontal Disease on pregnancy triggers an intense immunological response with high levels of local and systemic concentration of stress biomarkers. Objective: To investigate the repercussion of periodontal disease (PD) on the pregnant woman and complications during pregnancy and delivery as well, negative outcomes for the newborn (infection, prematurity, low weight, fetal growth restriction). Method: Retrospective cohort study, based on records of medical records of 142 pregnant women attended at prenatal service at usual risk between 2012-2014, with odontological evaluation for PD. Gestational maternal, labor and newborn variables were analyzed. The newborns were stratified into two groups: newborns mothers with PD (subdivided for severe periodontal disease - SPD) and newborns mothers without PD. Each outcome was adjusted by a multiple logistic regression model, with significance if p <0.05, considering all potential confounders. Results: Was increased among women exposed the SPD the odds of vulvovaginitis was 3.45 times higher (OR = 3.45; p=0.050) and of PMR was 5.59 times higher (OR=5.59; p=0.017). In the newborn of mothers exposed the SPD, the increase in odds of the fetal growth restriction was 11.53 times higher (OR=11.53; p= 0.041). Conclusion: Periodontal disease increased the chance for neonatal and maternal negative outcomes, such as fetal growth restriction in the newborn and vulvovaginitis and premature rupture of the membrane in the pregnant woman in the p... (Complete abstract click electronic access below) / Mestre

Parents are the first source of a child's learning of her or his gender. In fact, sex-role stereotyping of infants by parents may occur within the first 24 hours of birth. This study examined the nature of parental stereotyping on the basis of their infant's sex by obtaining parents' descriptions of their newborn and toy and clothing preferences for their newborn. In 1974, Rubin found that parents responded stereotypically to their infants on the basis of sex. Following Rubin's interview approach, 50 parent pairs from two urban hospitals were asked to participate in a parent-infant study and were subsequently interviewed 24 hours postpartum. Parents were asked open-ended descriptive questions about their newborn, given a semantic differential scale of 18 bi-polar objectives, asked about the importance of others recognizing their baby's sex, and asked a set of questions relating to the preference of clothing and toy choices for their newborn. Findings suggest that parents do stereotype their infants on the basis of biological sex. Sons were more likely to be described as strong, perfect, big or big-featured and energetic,--while daughters received more descriptions that mentioned their eyes, skin, or facial features and were also more likely to be described as small, tiny, or weak. Parents of boys were also more likely to state a preference for gender-specific toys and clothing. Infant sex did not make a notable difference on the importance that parents attributed to others recognizing their baby's sex. Fathers were more likely to perceive and describe their daughters more stereotypically than were mothers of either daughters or sons. Further studies to investigate gender stereotyping and its consequences as well as the interplay between the macro and micro levels of gender relations in society are suggested.

Mitochondrial fatty acid �-oxidation disorders are a group of clinically and biochemically heterogeneous defects mainly associated with intolerance to catabolic stress. The diseases are potentially fatal, but treatable and the prognosis for most diagnosed disorders is generally favourable. Early diagnosis is thus important to prevent morbidity and mortality. This project describes an improved and validated quantitative fibroblast acylcarnitine profile assay for the investigation of suspected fatty acid �-oxidation disorders. Intact cells were incubated with deuterium-labelled hexadecanoate and L-carnitine, and the accumulated acylcarnitines in the medium analysed using electrospray tandem mass spectrometry. This modified procedure is less demanding technically, requires fewer cells and better reflects the in vivo acylcarnitine status than previously published methods. Mitochondrial fatty acid �-oxidation is coupled to the respiratory chain. Functional defects of one pathway may lead to secondary alterations in flux through the other. The diagnostic specificity and the prognostic potential of the in vitro acylcarnitine profile assay were investigated in fibroblasts from 14 normal controls, 38 patients with eight enzyme deficiencies of fatty acid �-oxidation presenting with various phenotypes, and 16 patients with primary respiratory chain defects including both isolated and multiple enzyme complex defects. All fatty acid �-oxidation deficient cell lines revealed disease-specific acylcarnitine profiles related to the sites of defects irrespective of the severity of symptoms or of different mutation. Preliminary studies suggested a correlation between severity of symptoms and higher concentrations of long-chain acylcarnitine species. However, the fibroblast acylcarnitine profiles from some patients with respiratory chain defects were similar to those of controls, whereas others had abnormal profiles resembling those found in fatty acid �-oxidation disorders. In vitro acylcarnitine profiling is useful for the detection of fatty acid �-oxidation deficiencies, and perhaps the prediction of disease severity and prognostic evaluation facilitating decisions of therapeutic intervention and genetic counselling. However, abnormal profiles do not exclusively indicate these disorders, and primary defects of the respiratory chain remain a possibility. Awareness of this diagnostic pitfall will aid in the selection of subsequent confirmatory tests and therapeutic options.