Preterm infants frequently suffer from respiratory distress syndrome (RDS), possibly due to lower expression of epithelial Na+ channels (ENaC). RDS incidence is sex-specific, affecting males almost twice as often. Despite the use of antenatal glucocorticoids (GCs), the sex difference persists. It is still controversial whether both sexes benefit equally from GCs. We previously showed that Na+ transport is higher in female compared with male fetal distal lung epithelial (FDLE) cells. Since GCs increase Na+ transport, we hypothesized that their stimulating effect might be sex-specific. We analyzed FDLE cells with Ussing chambers and RT-qPCR in the presence or absence of fetal serum. In serum-free medium, GCs increased the ENaC activity and mRNA expression, independent of sex. In contrast, GCs did not increase the Na+ transport in serum-supplemented media and abolished the otherwise observed sex difference. Inhibition of the GC receptor in the presence of serum did not equalize Na+ transport between male and female cells. The GC-induced surfactant protein mRNA expression was concentration and sex-specific. In conclusion, female and male FDLE cells exhibit no sex difference in response to GCs with regard to Na+ transport, and GR activity does not contribute to the higher Na+ transport in females.

No description available.

No description available.

Globalt födds varje år 15 miljoner barn prematurt före gestationsvecka 37+0.Barn som födds mellan gestationsvecka 34+0 – 36+6 benämns som sent prematurt födda. Sent prematurt födda barn kan bedömas både som låg vårdkrävande och högvårdkrävande. De kan både vårdas på en neonatalavdelning eller på ett barnbördshus. Mödrar är inte alltid förberedda att ta hand om sitt sent prematurt födda barn eftersom det sker ett avbrott i mödrarnas omställningsprocess från graviditet till moderskap. Amningen har många fördelar för de ammande mödrarna och barnen. Amningsprocessen kan skilja sig vid amning av sent prematurt födda barn i jämförelse med fullgångna barn. Syftet med denna litteraturöversikt är att beskriva mödrars upplevelse vid amning av sent prematurt födda barn under barnets första levnadsår. Metoden som tillämpades var en icke systematisk litteraturöversikt. Databassökningen i databaserna PubMed och Cinahl genererade i 14 artiklar som besvarade arbetets syfte. Även en manuell sökning utfördes, vilket genererade i en artikel. Totalt inkluderades 15 vetenskapliga artiklar av kvalitativt, kvalitativt ansats samt mixed metod. Med hjälp av en kvalitetsbedömningsmall har artiklarnas kvalitet granskats och därefter har en integrerad dataanalys använts för att besvara arbetes syfte. Resultatet presenterar tre huvudkategorier och åtta underkategorier. Resultatet visade att mödrar till sent prematurt födda barn upplevde en önskan och längtan om att få amma sitt barn, de förstod bröstmjölkens betydelse för det prematurt födda barnets utveckling. Amningen upplevdes som en känslomässig period som ingav känsla av glädje, harmoni och avslappning. Men amningen orsakade även känslor av stress, utmattning och ångest främst på grund av utmaningarna som tillkom vid amningen. Fysiska utmaningar både hos barnet och mödrarna var återkommande. Behov av stöd, undervisning och uppmuntran från anhöriga och sjukvårdspersonalen var betydelsefullt för mödrarna och amningsutfallet. Slutsatsen i studien indikerar att mödrar till sent prematurt födda barn upplever amningen som utmanande men betydelsefull. Under amningen upplevs starka känslor. Mödrars anknytning till barnet och barnets bindning till mödrarna stärktes genom amningen. Behov av stöd och undervisning under amningsperioden identifierades som kan underlätta amningsutmaningar och främja fortsatt amning. Arbetet belyser vikten av undervisning och stöd från sjukvårdspersonal, bland annat barnmorskor, som arbetar nära denna patientgrupp. / Globally every year 15 million infants are born prematurely before gestational week 37 + 0. Infants born between gestational week 34 + 0 to 36 + 6 are referred to as late preterm infants. Late preterm infants can be assessed both as low care- requiring or high care-requiring. They may require neonatal care or care in a maternity unit. Mothers are not always prepared to care for their infant due to early interruption in mother´s transition process from pregnancy to motherhood. Breastfeeding has many benefits for both the breastfeeding mother and the infant. The breastfeeding process may differ when breastfeeding late preterm infants compared to full-term infants.  This study aims to describe mothers' experience of breastfeeding late preterm infants during the infants first year of live.  The method applied was non-systematic literature review was. The databases PubMed and Cinahl generated 14 articles. A manual literature search was conducted, which generated one more article. A total of 15 scientific articles of quantitative, qualitative approach and mixed method were included. Using a quality assessment templet of the articles and an intergrade analysis, the quality and results of the articles have been analyzed. The result presents three main categories and eight subcategories. The results of this study showed that mothers of late preterm infants experienced a desire and longing to breastfeed their infants because the mothers were aware of the importance of breast milk for their late preterm infant for the infants’ development. Breastfeeding was considered as an emotional period which was experienced as joyful, gave harmony and a feeling of relaxation but also feelings of stress, exhaustion and anxiety was experienced mainly due to the challenges that emerged during breastfeeding the late preterm infant. Physical challenges for both the infant and the breastfeeding mother were recurring. The need for support, education and encouragement from relatives and healthcare staff was significant for the mothers and the outcome of breastfeeding.   The conclusion of this study showed that mothers of late preterm infants experienced breastfeeding as challenging but significant. Strong emotions were recurring during breastfeeding. Mothers’ attachment to their infants were strengthened through breastfeeding. The need for support and education during the breastfeeding period was identified to facilitate breastfeeding challenges and promote continued breastfeeding. It is essential for healthcare professionals, as midwives, to have an understanding of breastfeeding experience of mother of late preterm in order to offer adequate care and support.

The present study examined the relationships of depression, social support, and socio-demographic factors on health behaviors of mothers with preterm infants hospitalized in the neonatal intensive care unit (NICU). In addition, the study also assessed the moderation effect of social support on the relationship between depression and health behaviors. Eighty-nine mothers with hospitalized infants in the central Richmond area participated in the study. Analyses found that mother’s education level and her marital status to be significantly associated with her health behaviors. Mothers with a higher level of education and those who were married, were less likely to smoke and more likely to incorporate high fiber foods in their diet. In addition, the more support a mother perceived from family and friends, the less likely she was to smoke cigarettes. Neither depression nor social support from the father was significantly related to health behaviors. This study did not find social support to be a moderator between depression and health behaviors. However, the study found direct effects of socio-demographic factors and certain types of support on health behaviors. Assessing a mother’s personal and interpersonal factors will inform clinicians of possible areas of interventions for mothers during the postpartum period.

Introdução: Recém-nascidos prematuros são considerados vulneráveis às complicações da prematuridade, incluindo o insulto neurológico e os déficits a longo prazo no crescimento e no desenvolvimento. Objetivo: Investigar o desenvolvimento psicomotor e o crescimento de crianças prematuras, nascidas com muito baixo peso, aos 8 e 18 meses de idade corrigida, comparando com seus pares nascidos de termo; e verificar a relação do crescimento com os resultados do desenvolvimento. Método: Estudo de coorte prospectivo, incluindo 83 recém-nascidos com peso de nascimento≤1500g e idade gestacional≤32 semanas, e um grupo controle de 52 crianças nascidas de termo saudáveis. A Alberta Infant Motor Scale (AIMS) e a Escala Brunet-Lèzini (EBL) foram utilizadas para avaliar o desenvolvimento aos 8 e 18 meses de idade (corrigida para a prematuridade - ICo). Medidas antropométricas foram coletadas para avaliar o crescimento nas duas faixas etárias. Resultados: Aos 8 meses de ICo, os prematuros pontuaram significativamente inferior no escore bruto da AIMS (p=0,001). Aos 18 meses, pontuaram significativamente inferior na subescala em pé da AIMS (p=0,040) e apresentaram pobre desenvolvimento psicomotor na EBL (p=0,006). O estado nutricional apresentou diferenças significativas entre os grupos, nas duas faixas etárias (p<0,001). Ocorreu correlação positiva do estado nutricional dos prematuros com a AIMS (r=0,395; p<0,001) e com a EBL (r=0,346; p<0,01) aos 8 meses de ICo; e do perímetro cefálico com a AIMS (r=0,282; p<0,05) aos 18 meses de ICo. Conclusões: Crianças prematuras, nascidas com muito baixo peso, aos 8 e 18 meses de ICo, apresentaram diferenças significativas no desenvolvimento e no padrão de crescimento, quando comparadas aos seus pares de termo. Os resultados demonstram o impacto do crescimento junto ao desenvolvimento, reforçando a importância do acompanhamento multidisciplinar dessa população de risco. / Introduction: Preterm infants are considered vulnerable to the prematurity complications, including the neurological insult and the deficits in the long term growth and development. Objective: To investigate the psychomotor development and growth of preterm infants born with very low weight, at 8 and 18 months corrected age, compared with their peers born at term; and to verify the growth relation with the development results. Methods: A prospective cohort study including 83 infants with birth weight≤1500g and gestational age≤32 weeks, and a control group of 52 healthy term born children. Alberta Infant Motor Scale (AIMS) and Brunet-Lèzini scale (EBL) were used to evaluate the development at 8 and 18 months of age (corrected for prematurity-CA). Anthropometric measurements were collected to evaluate the growth in both age groups. Results: At 8 months of CA, premature infants scored significantly lower in gross score of the AIMS (p=0.001). At 18 months, they scored significantly lower on the standing up subscale from AIMS (p=0.040) and exhibited poor psychomotor development in the EBL (p=0.006). The nutritional status showed significant differences between the groups, in both age groups (p<0.001). There was a positive correlation of nutritional status of preterm infants with the AIMS (r=0.395; p<0.001) and with the EBL (r=0.346; p<0.01) at 8 months of CA; and the head circumference at birth with the AIMS (r=0.282; p<0.05) at 18 months of CA. Conclusions: Preterm infants born with very low birth weight, at 8 and 18 months of CA, showed significant differences in the development and growth pattern, when compared with their peers born at full term. The results demonstrate the impact of growth on the development, reinforcing the importance of monitoring this at risk population.

Na assistência ao prematuro e sua família, em unidades neonatais, há carência de material educativo para orientação das mães acerca dos cuidados domiciliares do filho, com vistas a alta hospitalar. A revisão da literatura sobre o impacto na família do nascimento prematuro e da hospitalização do bebê na UTIN revela que não só a criança, mas também, sua família têm necessidades especiais. Desta forma, é importante elaborar estratégias e instrumentos para dar conta das novas necessidades que se apresentam no trabalho dirigido a estas famílias, reintegrando a criança à família e inserindo a mãe, gradativamente, no cuidado da criança. Também é importante elaborar um plano de treinamento e preparo materno para a alta hospitalar da criança, em atividades de Educação em Saúde, que favoreçam e estimulem a participação responsável, criativa e produtiva da clientela. Assim, o objetivo do presente estudo é desenvolver material didático-instrucional dirigido ao treinamento materno para a alta hospitalar do bebê prematuro, utilizando metodologia participativa. Participaram do estudo 2 enfermeiras, 2 auxiliares de enfermagem e 4 mães de bebês prematuros internados na unidade de cuidados intermediários de um hospital universitário de Ribeirão Preto-SP. Os participantes trouxeram, através de círculos de discussão, um material educativo que direciona as orientações e auxilia as mães na memorização dos conteúdos a serem apreendidos. Indicaram os assuntos de interesse para o processo ensino-aprendizagem, os quais foram agrupados em cuidados diários, alimentação, higiene, cuidados especiais e relacionamento familiar; estes assuntos são voltados para as práticas cotidianas, de cuidados simplificados. Decidiram pela confecção de uma cartilha educativa ilustrada com figuras, que pudesse ser levada para o domicílio. O conteúdo desse material didático instrucional foi feito pela pesquisadora tendo por base a literatura, experiência profissional e assessoria técnico-científica de outros profissionais. A versão final da cartilha educativa foi validada pelos participantes e constitui instrumento criativo para auxiliar nas atividades de educação em saúde dirigida a esta clientela, que participativamente desejarem utilizá-lo. / During care to premature infants and their families, neonatal units lack educational material for maternal advice concerning the care to be given to the child at home after hospital discharge. A literature review concerning the impact on the family of a preterm birth and of the infant's hospitalization in a Neonatal Intensive Care Unit shows that not only the child, but also its family have special needs. Therefore, it is important to elaborate strategies and instruments in order to meet the new needs arising in the work directed to such families, thus integrating the child to the family and gradually including the mother in the child's care through a maternal training and preparation plan for hospital discharge. This plan should include health education activities which will favor and stimulate clients' participation, knowledge exchange and the development of a critical awareness that can provide the necessary instruments for responsible, creative and productive participation. Therefore, this work aims at developing educational and instructional material in order to train mothers for their preterm infants' discharge from hospital using a participative methodology. Two nurses, 2 nursing auxiliaries and 4 mothers of preterm babies participated in the study. The babies were hospitalized in the Intermediate Care Unit of a university hospital in the City of Ribeirão Preto-SP, Brazil. Through discussions panels, the participants expressed that educational materials could direct guidance and help mothers to memorize the contents to be learned. They indicated the subjects of interest for the teaching-learning process, which were grouped in the categories: daily care, feeding, hygiene. special care and family relationship; these subjects were linked to daily practices and simplified care delivery. Following, the participants decided to produce an educational guide in the form of a textbook illustrated with figures which could be taken home. Such educational and instructional material was produced by the researcher based on the literature, her professional experience as well as on the technical and scientific assistance from other professionals. The final version of the guide has been validated by the participants and now constitutes a creative instrument that can be used to help with health education activities directed to the clients who wish to participatively use it.

Preterm infants exhibit clinical distress markers during bottle-feeding due to underdevelopment. Simulation training provides effective means for learners. Twenty-two SLP students split into two groups, video-simulation(VT) and in-vivo-simulation training(IT). Results revealed VT had higher clinical judgment and lower anxiety levels than IT group. Both groups significantly improved distress markers identification.

To coordinate visual perception and motor control in daily life where we are constantly surrounded by motion, we are dependent on normal visuomotor capacity. One essential prerequisite for normal visuomotor capacity is smooth pursuit eye movements (SP). Infants born very preterm (VPT = born &lt;32 gestational weeks) are at high risk of developing disabilities in higher brain functions i.e. perception, cognition, concentration and coordination. In this thesis visuomotor capacity was investigated in a cohort of VPT infants (n = 113) and compared to control groups of full term (FT) infants. Levels of SP were measured at 2 and 4 months’ corrected age (CA). At 8 months’ CA reaching capacity toward a moving object was evaluated as this represents an executive activity guided by vision that develops at an early age. Lower levels of SP were found in the VPT infants compared to FT controls. The VPT boys showed higher levels of SP compared to the VPT girls. In VPT infants without major neonatal morbidities lower levels of SP was found compared to the FT controls. No difference in total capacity of gaze tracking was found, although the VPT infants lagged the object more at 4 months’ CA and used more saccades at 2 months’ CA. With age the VPT infants’ SP levels increased, but with a wider dispersion compared to the FT controls, and the levels of SP at 4 months’ CA corresponded to the levels of the FT infants at 2 months.  A number of perinatal risk factors were found to be negatively associated to lower levels of SP, and this effect was more pronounced in VPT infants with multiple risk factors,.  When evaluating the capacity to reach a moving object at 8 months’ CA, the VPT infants showed significantly more bimanual reach and more curved reaching paths to catch the object as compared to the FT control group. In conclusion, a delayed visuomotor capacity was found in VPT infants compared to FT control infants at 2, 4 and 8 months’ CA. Some VPT infants with perinatal risk factors did not develop in levels of SP between 2 and 4 months’ CA.

Introdução: A Síndrome Metabólica (SM) é um grupo de distúrbios que inclui obesidade, resistência insulínica, dislipidemia e hipertensão. Está associada com o desenvolvimento subsequente de doença cardiovascular e diabete tipo 2. Estudos mostram relação entre baixo peso ao nascer e SM na vida adulta, mas não há estudos sobre a prevalência da SM em pré-termos já na infância precoce. Objetivo: Medir a prevalência da SM aos dois anos de idade corrigida de pré-termos com peso de nascimento inferior ou igual a 1.500 gramas e os fatores associados. Metodologia: Estudo transversal aninhado em uma coorte já existente que incluiu crianças em acompanhamento regular no ambulatório de seguimento de prematuros de hospital terciário aos dois anos de idade corrigida. O diagnóstico de SM foi feito com a presença de três ou mais dos critérios de Cook e colaboradores: circunferência abdominal ≥ percentil 90, glicemia de jejum ≥ 100mg/dl, triglicerídeos ≥ 110mg/dl, HDL colesterol ≤ 40mg/dl e pressão arterial ≥ percentil 90. Estudo aprovado pelo CEP da instituição: 09226. Testes empregados: Qui-quadrado, t de Student, Mann-Whitney e Regressão Logística. Resultados: 235 pré-termos de muito baixo peso foram elegíveis ao programa de seguimento. Destes, 9,4% falharam ao seguimento. A prevalência de SM foi de 15,1%. Doença hipertensiva materna, diabetes gestacional, sexo, idade gestacional, ser pequeno para idade gestacional, sepse precoce e tardia, displasia broncopulmonar, nutrição parenteral com aminoácidos nas primeiras 24 horas de vida, enterocolite necrosante, hemorragia e leucomalácia periventricular, persistência do canal arterial, alimentação no primeiro ano de vida, catch-up de peso, renda e escolaridade materna foram semelhantes entre os grupos. Crianças filhas de mães que tiveram infecção urinária ou ovular e a presença de sobrepeso ou obesidade aos dois anos de idade corrigida apresentaram uma maior prevalência de SM em análises univariadas. Usando a Regressão Logística, apenas sobrepeso ou obesidade aos dois anos de idade corrigida tiveram associação independente com a presença precoce de SM em pré-termos de muito baixo peso. Conclusão: A SM já se encontra presente em pré-termos de muito baixo peso aos dois anos de idade e é muito mais frequente do que o esperado. Na análise univariada, encontramos uma associação positiva da SM com fatores intrauterinos como infecção materna. Provavelmente esta situação aumenta o cortisol fetal, programando a SM. Além do mais, a presença de sobrepeso e/ou obesidade é um fator independente para maior prevalência da SM. / Background: Metabolic syndrome (MS) is a group of disorders which includes obesity, insulin resistance, dyslipidemia and hypertension. It is associated with subsequent development of cardiovascular disease and type 2 diabetes. Some studies suggest a relationship between low birth weight and onset of MS in adulthood, however there is no study showing MS prevalence in preterm, even in early childhood. Aim: To assess the prevalence of MS in very low birth weight preterm infants at two years corrected age and identify factors possibly associated with a higher occurrence of MS. Methods: A prospective cohort study of very low birth weight infants at two years corrected age who attended to a preterm follow up clinic of a tertiary hospital. To define Metabolic syndrome we considered the criteria of Cook et al.: Waist circumference ≥ 90th percentile, fasting glucose ≥ 100mg/dl, triglycerides ≥ 110mg/dL, HDL cholesterol ≤ 40 mg/dl and blood pressure ≥ 90th percentile. The presence of three or more of these criteria defines the MS diagnosis. This study was approved by ethics committee of the institution (09226). Chi-square, Student t, Mann-Whitney tests and Logistic Regression were used. Results: 235 very low birth weight preterm infants were eligible to follow up program. Of these, 9.4% failed. MS prevalence was 15.1%. Maternal hypertensive disorders, gestational diabetes, gender, gestational age, small for gestational age, early and late sepsis, bronchopulmonary dysplasia, parenteral nutrition with amino acids in the first 24 hours of life, necrotizing enterocolitis, hemorrhage and periventricular leukomalacia, patent ductus arteriosus, feeding at discharge and during the first year of life, income and maternal education were similar between groups. Children of mothers who had urinary tract infection or chorioamnionitis and presence of overweight / obesity at 2 years CA showed a higher MS prevalence in univariate analyses. Using Logistic Regression, only overweight / obesity at 2 years CA was independently associated with the early presence of MS in very low birth weight infants. Conclusion: MS is already present in preterm of very low birth weight at 2 years corrected age and is higher than expected. In the univariate analysis MS was associated with intrauterine factors such as maternal infection. This situation would lead to an increase in fetal cortisol, programming MS. Furthermore, the early-onset overweight and obesity is an independent risk factor to MS in those newborns.