Stabilisation and resuscitation in the delivery room is an integral part of the care of extremely premature newborns. The main task is to support essential life functions and to facilitate the adaptation of the immature organism to the extrauterine life. The current recommendations are well defined for the full term and late preterm newborns, but there is a lack of targeted recommendations for the stabilisation and resuscitation of extremely premature newborns. The research part of the submitted thesis summarises the most important results of clinical research performed in 2010-2015 at the Department of Neonatology of the Department of Gynecology and Obstetrics, VFN and First Faculty of Medicine, Charles University in Prague. The research evaluates the efficacy and side effects of the currently recommended methods of stabilisation and resuscitation of extremely premature neonates in the delivery room and presents some new and potentially useful techniques for delivery room care. A significant output of this work is the recommendation for practice, structured according to the gestational age of extremely premature newborns. The proposed guideline is based on our results of partial clinical trials and aims to improve the current level of stabilisation and resuscitation of extremely premature newborns...

Submitted by Neusa Fagundes (neusa.fagundes@unioeste.br) on 2018-07-10T19:46:34Z No. of bitstreams: 2 Joziana_Pastro2018.pdf: 1649555 bytes, checksum: 769cd69a9e879a09907152dd2e64987c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-10T19:46:34Z (GMT). No. of bitstreams: 2 Joziana_Pastro2018.pdf: 1649555 bytes, checksum: 769cd69a9e879a09907152dd2e64987c (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-03-13 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Retinopathy of prematurity (ROP) is a vasoproliferative disease, related to blindness, in Premature Newborns (PN) who, within other factors, used oxygen during hospitalization. Early visual follow-up of preterm newborns by ophthalmologists makes it possible to identify the stage and grade of the disease and the indication of treatment or attendance of its evolution. Nursing orientation is essential to the PN relatives, since ROP is not an easily seen disease, so, parents being aware that the ophthalmologic follow-up is of vital importance for the visual recovery of the baby will make a difference in the child future visual health. Therefore, this study aims to evaluate the prevalence and evolution of ROP in PN, hospitalized in a Neonatal Intensive Care Unit (NICU) and attended at a referral ophthalmologic follow-up service. This is a quantitative, descriptive and exploratory study, carried out in the city of Cascavel. Data collection was done in medical records of PN, born between January 2014 and June 2016, hospitalized in the NICU of the West Paraná University hospital, and followed by the outpatient clinic of Cascavel Eyes Hospital, totaling 181 charts. A quantitative analysis was performed through descriptive and inferential statistic. The prevalence of ROP was 11.31% (n = 50). Relating its characteristics to evolution, the diagnoses prevalent in the PN of the study were respiratory diseases (41.99%) and among comorbidities, sepsis prevailed (63.54%). 80 PN required blood transfusion (44,20%) and 152 (83.98%) used oxygen therapy, with a predominance of mask device (n = 141; 77,90%) and orotracheal tube - TOT (n = 100; 55.25%), on average for 15 days. The highest concentration recorded was hood (45.0%). The time of use and the O2 concentration of TOT, time of mask use and time and concentration of O2 of Continuous Positive Airway Pressure (CPAP), were significant to trigger ROP. Among ROP cases, ten (5.5%) children had severe ROP and required laser treatment. All the PN diagnosed with ROP used oxygen. ROP prevailed in moderate preterm newborns (44%), with ROP grade 3 being the most severe, affecting both extreme and moderate PN. Respiratory diseases, sepsis and procedures such as blood transfusion and oxygen therapy influenced the presence of ROP, with prevalence in moderate preterm newborns. The adoption of ophthalmologic screening for ROP detection, with background examinations of the eyes in the NICU contributed to the early treatment and prevention of severe visual impairment and blindness caused by ROP. Thus, nurses are fundamentally important, from the prevention, the diagnosis until the course of the treatment and for discharge counselling. / A Retinopatia da Prematuridade (ROP) é uma enfermidade vasoproliferativa, relacionada à cegueira, em recém-nascidos prematuros (RNPT) que, dentre outros fatores, utilizaram oxigênio durante a hospitalização. O acompanhamento visual precoce de prematuros por oftalmologistas possibilita a identificação do estágio e do grau da doença, assim como a indicação de tratamento ou de acompanhamento da sua evolução. A orientação da enfermagem é primordial aos familiares dos RNPT, visto que a ROP não é uma doença de fácil visualização; portanto, os pais estarem cientes de que o acompanhamento oftalmológico é de vital importância para a recuperação visual do bebê fará diferença na vida futura da criança. Assim, este estudo objetiva avaliar a prevalência e a evolução da ROP em RNPT internados em uma Unidade de Terapia Intensiva Neonatal (UTIN) e acompanhados em serviço de seguimento oftalmológico de referência. Trata-se de uma pesquisa quantitativa, descritiva e exploratória, realizada no município de Cascavel. A coleta de dados ocorreu em prontuários de RNPT, nascidos entre janeiro de 2014 e junho de 2016, hospitalizados na UTIN do Hospital Universitário do Oeste do Paraná – HUOP, e em seguimento pelo ambulatório do Hospital de Olhos de Cascavel, totalizando 181 prontuários. Realizou-se análise quantitativa, por meio de estatística descritiva e inferencial. A prevalência de ROP foi de 11,31% (n=50). Relacionados às suas características e evolução, os diagnósticos prevalentes nos RNPT do estudo foram as doenças respiratórias (41,99%) e, entre as comorbidades, a sepse prevaleceu (63,54%). Necessitaram de transfusão de sangue 80 RNPT (44,20%), e 152 (83,98%) fizeram uso de oxigenioterapia, com predomínio do dispositivo máscara (n=141; 77,90%) e tubo orotraqueal - TOT (n=100; 55,25%), em média por 15 dias. A maior concentração registrada foi por halo (45%). O tempo de uso e a concentração de O2 de TOT, tempo de uso de máscara e tempo e concentração de O2 do Continuous Positive Airway Pressure (CPAP) foram significativos para desencadear a ROP. Dentre os casos de ROP, dez (5,5%) crianças tiveram ROP grave e necessitaram de tratamento com laser. Todos os RNPT diagnosticados com ROP fizeram uso de oxigênio. A ROP prevaleceu nos prematuros moderados (44%), sendo o grau 3 de ROP o mais grave encontrado, acometendo tanto RNPT extremos quanto moderados. Doenças respiratórias, sepse e procedimentos como a transfusão de sangue e a oxigenioterapia influenciaram na presença da ROP, com prevalência em prematuros moderados. A adoção da triagem oftalmológica para a detecção da ROP, com exames de fundo de olho sistematicamente realizados na UTIN, contribuíram para o tratamento precoce e a prevenção de deficiências visuais graves e cegueira causados pela ROP. Nesse sentido, o enfermeiro é de fundamental importância, desde a prevenção, o diagnóstico até o decorrer do tratamento e a alta.

Le sepsis tardif, défini comme une infection systémique chez les nouveaux nés âgés de plus de 3 jours, survient chez environ 7% à 10% de tous les nouveau-nés et chez plus de 25% des nouveau-nés de très faible poids de naissance qui sont hospitalisés dans les unités de soins intensifs néonatals (USIN). Les apnées et bradycardies (AB) spontanées récurrentes et graves sont parmi les principaux indicateurs précoces cliniques de l'infection systémique chez les prématurés. L'objectif de cette thèse est de déterminer si la variabilité du rythme cardiaque (VRC), la respiration et l'analyse de leurs relations aident au diagnostic de l'infection chez les nouveaux nés prématurés par des moyens non invasifs en USIN. Par conséquent, on a effectué l'analyse Mono-Voie (MV) et Bi-Voies (BV) sur deux groupes sélectionnés de nouveau-nés prématurés: sepsis (S) vs. non-sepsis (NS). (1) Tout d'abord, on a étudié la série RR non seulement par des méthodes de distribution (moy, varn, skew, kurt, med, SpAs), par les méthodes linéaire: le domaine temporel (SD, RMSSD) et dans le domaine fréquentiel (p_VLF, p_LF, p_HF), mais aussi par les méthodes non–linéaires: la théorie du chaos (alphas, alphaF) et la théorie de l'information (AppEn, SamEn, PermEn, Regul). Pour chaque méthode, nous étudions trois tailles de fenêtre 1024/2048/4096, puis nous comparons ces méthodes afin de trouver les meilleures façons de distinguer S de NS. Les résultats montrent que les indices alphaS, alphaF et SamEn sont les paramètres optimaux pour séparer les deux populations. (2) Ensuite, la question du couplage fonctionnel entre la VRC et la respiration nasale est adressée. Des relations linéaires et non-linéaires ont été explorées. Les indices linéaires sont la corrélation (r²), l'indice de la fonction de cohérence (Cohere) et la corrélation temps-fréquence (r2t,f) , tandis que le coefficient de régression non-linéaire (h²) a été utilisé pour analyser des relations non-linéaires. Nous avons calculé les deux directions de couplage pendant l'évaluation de l'indice h2 de régression non-linéaire. Enfin, à partir de l'ensemble du processus d'analyse, il est évident que les trois indices (r2tf_rn_raw_0p2_0p4, h2_rn_raw et h2_nr_raw) sont des moyens complémentaires pour le diagnostic du sepsis de façon non-invasive chez ces patients fragiles. (3) Après, l'étude de faisabilité de la détection du sepsis en USIN est réalisée sur la base des paramètres retenus lors des études MV et BV. Nous avons montré que le test proposé, basé sur la fusion optimale des six indices ci-dessus, conduit à de bonnes performances statistiques. En conclusion, les mesures choisies lors de l'analyse des signaux en MV et BV ont une bonne répétabilité et permettent de mettre en place un test en vue du diagnostic non invasif et précoce du sepsis. Le test proposé peut être utilisé pour fournir une alarme fiable lors de la survenue d'un épisode d'AB tout en exploitant les systèmes de monitoring actuels en USIN. / Late-onset sepsis, defined as a systemic infection in neonates older than 3 days, occurs in approximately 10% of all neonates and in more than 25% of very low birth weight infants who are hospitalized in Neonatal Intensive Care Units (NICU). Recurrent and severe spontaneous apneas and bradycardias (AB) is one of the major clinical early indicators of systemic infection in the premature infant. Various hematological and biochemical markers have been evaluated for this indication but they are invasive procedures that cannot be repeated several times. The objective of this Ph.D dissertation was to determine if heart rate variability (HRV), respiration and the analysis of their relationships help to the diagnosis of infection in premature infants via non-invasive ways in NICU. Therefore, we carried out Mono-Channel (MC) and Bi-Channel (BC) Analysis in two selected groups of premature infants: sepsis (S) vs. non-sepsis (NS). (1) Firstly, we studied the RR series not only by distribution methods (moy, varn, skew, kurt, med, SpAs), by linear methods: time domain (SD, RMSSD) and frequency domain (p_VLF, p_LF, p_HF), but also by non-linear methods: chaos theory (alphaS, alphaF) and information theory (AppEn, SamEn, PermEn, Regul). For each method, we attempt three sizes of window 1024/2048/4096, and then compare these methods in order to find the optimal ways to distinguish S from NS. The results show that alphaS, alphaF and SamEn are optimal parameters to recognize sepsis from the diagnosis of late neonatal infection in premature infants with unusual and recurrent AB. (2) The question about the functional coupling of HRV and nasal respiration is addressed. Linear and non-linear relationships have been explored. Linear indexes were correlation (r²), coherence function (Cohere) and time-frequency index (r2t,f), while a non-linear regression coefficient (h²) was used to analyze non-linear relationships. We calculated two directions during evaluate the index h2 of non-linear regression. Finally, from the entire analysis process, it is obvious that the three indexes (r2tf_rn_raw_0p2_0p4, h2_rn_raw and h2_nr_raw) were complementary ways to diagnosticate sepsis in a non-invasive way, in such delicate patients.(3) Furthermore, feasibility study is carried out on the candidate parameters selected from MC and BC respectively. We discovered that the proposed test based on optimal fusion of 6 features shows good performance with the largest Area Under Curves (AUC) and the least Probability of False Alarm (PFA). As a conclusion, we believe that the selected measures from MC and BC signal analysis have a good repeatability and accuracy to test for the diagnosis of sepsis via non-invasive NICU monitoring system, which can reliably confirm or refute the diagnosis of infection at an early stage.