CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A pele do bebà quando internado em uma Unidade de Terapia Intensiva Neonatal (UTIN), apresenta predisposiÃÃo a ser lesionada, diante da necessidade de muitos procedimentos especÃficos, acabando por expÃ-lo a manipulaÃÃes necessÃrias, mas um tanto desgastantes para o mesmo. Objetivou-se avaliar as lesÃes de pele que acometem recÃm-nascidos internados em uma UTIN. Estudo prospectivo, quantitativo, exploratÃrio descritivo, realizado no perÃodo de marÃo a maio/2007, numa instituiÃÃo pÃblica em Fortaleza-CE. ConstituÃram o universo e a amostra 137 recÃm-nascidos, que estiveram internados nas UTIN, os quais todos foram autorizados à participaÃÃo nesta pesquisa pelos pais. Destes, 36 apresentaram lesÃes de pele. Na coleta de dados, utilizou-se um instrumento que permitiu o registro das lesÃes atravÃs da observaÃÃo direta dos recÃm-nascidos durante a higiene corporal, trocas: de fralda, de sonda, de venda ocular; retiradas: de membrana semipermeÃvel, bandagem adesiva elÃstica e/ou micropore, eletrodos, hidrocolÃide que estavam fixados diretamente na pele destes, durante as punÃÃes, dentre outros procedimentos. Investigou-se 137 recÃm-nascidos, a maioria prematuro (80%), sexo masculino (63%), nascido de parto abdominal (61%), apgar de 7 a 10 no 1 minuto (40%), diagnosticados com prematuridade moderada (49%), baixo peso ao nascer (39%), adequado para a idade gestacional (74%), medindo entre 41 e 47cm (44%). Destes, 36 recÃm-nascidos (26%) apresentaram lesÃes de pele, totalizando 51 lesÃes. Foram identificadas: hematomas (46%), eritemas (18%), escoriaÃÃes (12%), equimoses (10%), pÃstulas (6%), descamaÃÃes (4%), mielomeningocele (2%) e gastrosquise (2%). Quando ocorreram as lesÃes, os recÃm-nascidos estavam em uso de hidrataÃÃo venosa (84%), antibiÃtico (78%), ventilaÃÃo mecÃnica (53%), fototerapia (33%), nutriÃÃo parenteral (27%), hemotransfusÃo (8%), oxihood (8%), cpap nasal (6%) e O2 circulante (4%); acomodados em incubadora aquecida (86%), incubadora de transporte (10%) e em berÃo de calor radiante (4%). Predominaram lesÃes nos membros (52%), no tronco (24%), na cabeÃa (16%) e em outros (8%). As associaÃÃes realizadas foram: punÃÃo arterial (32%), extravasamento (14%), assadura (14%), punÃÃo venosa (8%), impetigo (4%), indeterminada (4%), mà formaÃÃo congÃnita (4%), retirada da membrana transparente (4%), retirada da bandagem adesiva (4%), ressecamento da pele (4%), infecÃÃo (2%), retirada da fita hipoalergÃnica (2%) e tocotraumatismo (2%). Quanto a Ãrea da lesÃo (40%) eram < 1cm2, no tamanho 68% eram lesÃes entre 1 e 2cm. A maioria tinha a forma geogrÃfica (38%) e distribuiÃÃo localizada (92%). Os recÃm-nascidos que desenvolveram lesÃes tinham diagnÃsticos de âprematuridadeâ (92%), âsÃndrome do desconforto respiratÃrioâ (43%), âasfixiaâ (24%), ârecÃm-nascido a termoâ (8%); ârisco de infecÃÃoâ (6%), ârisco de hipoglicemiaâ (6%), âgastrosquiseâ (2%) e âmielomeningoceleâ (2%). A maioria nasceu com peso entre 550 - 999g, (47%), sendo o peso destes no dia em que ocorreu a lesÃo entre 455 - 999g, (47%). A maioria eram neonatos (84%) e as lesÃes (47%) surgidas antes do 7 dia de vida. Ao associar: tipos de lesÃes, diagnÃsticos, PN e IG dos RNâs, somente o diagnÃstico âprematuridadeâ apresentou associaÃÃo estatÃstica significante: âp de Fisher-Freeman-Halton = 0,496â. Consagra-se na trajetÃria deste estudo o cuidado de enfermagem ao RN que, indiscutivelmente, deve ser holÃstico e diferenciado, considerando suas peculiaridades. / Infants in the Neonatal Intensive Care Unit (NICU) often get skin lesions on account of the many stressful procedures they are exposed to. This prospective, quantitative and descriptive study was carried out at a public health facility in Fortaleza (Northeastern Brazil) from March to May 2007, in order to investigate skin lesion patterns in infants in the NICU setting. The study population consisted of 137 hospitalized infants. Informed written consent was obtained from the infantsâ caretakers. The data collection instrument registered skin lesions through direct observation during bathing, change of diapers, catheters and eye patches and during removal of semi-permeable membranes, elastic adhesive bandages and/or micropores, electrodes and hydrocolloid dressings applied to the skin during punction, among other procedures. Eighty percent of the infants were premature, 63% were male, 61% were caesarean births, 40% presented first-minute apgar scores of 7-10, 49% were diagnosed with moderate prematurity, 74% were full-term, 39% had low birth weight and 44% measured 41â47cm. Thirty-six infants had skin lesions (total 51 lesions) in the form of bruises (46%), erythema (18%), excoriation (12%), ecchymosis (10), pustulas (6%), scaling (4%), myelomeningocele (2%) or gastroschisis (2%). The lesions were inflicted while the infants were being treated with intravenous hydration (84%), antibiotics (78%), mechanical ventilation (53%), phototherapy (33%), parenteral nutrition (27%), blood transfusion (8%), oxygen hood (8%), nasal cpap (6%) or circulating oxygen (4%), or were in a heated incubator (86%), transport incubator (10%) or heated crib (4%). Lesions were observed most often on limbs (52%), torso (24%), head (16%) and other sites (8%). The causes identified were arterial puncture (32%), leaking (14%), contact dermatitis (14%), vein puncture (8%), impetigo (4%), undetermined (4%), congenital malformation (4%), removal of the caul (4%), removal of adhesive bandage (4%), skin dryness (4%), infection (2%), removal of hypoallergenic tape (2%) and birth traumatism (2%). Forty percent of lesions measured < 1cm2 and 68% measured 1-2cm. Most were well defined (38%) and/or localized (92%). Infants with lesions presented prematurity (92%), syndrome of respiratory distress (43%), asphyxia (24%), full-term delivery (8%); risk of infection (6%), risk of hypoglycemia (6%), gastroschisis (2%) or myelomeningocele (2%). Most (47%) weighed 550-999g at birth, with lesions occurring at 455-999g in 47%. Most were newborn (84%) and lesions appeared before the seventh day of life in 47% of cases. Among the parameters lesion type, diagnosis, PN, IG and prematurity, only the latter presented a statistically significant association (p=0.496, by the Fisher-Freeman-Halton test). The study shows the importance of providing the newborn with good-quality holistic nursing care with a view to the special needs of this patient population.

Bakgrund: Att bli mamma till ett för tidigt fött barn (&lt;37 gestationsveckor) innebär en oväntad stress vilket påverkar hela familjen. Under de senaste årtionden har stora förbättringar skett inom perinatal vård och numera är chansen till överlevnad stor. Att barnet efter födseln vårdas på neonatal intensivvårdsavdelning (NICU) får konsekvenser för mamman både känslomässigt och i omvårdnaden av barnet. Syfte: Att undersöka föräldrastress och beskriva faktorer som påverkar tidig föräldrastress hos mammor till för tidigt födda barn när barnet är två månader i korrigerad ålder. Metod: Studien utfördes på fyra NICU i Sverige. Inklusionskriterierna för studien var att barnet var för tidigt fött samt vårdades på neonatalavdelning i minst 72 timmar. För att mäta upplevd föräldrastress fick mammorna (n=276) svara på enkäten Swedish Parental Stress Questionnaire (SPSQ) när barnet var två månader i korrigerad ålder. Resultat: Mammor vars barn inte vårdades på en samvårdsavdelning, som hade barn i kuvös, mammor till barn med äldre syskon, var äldre, rökte och/eller ammade helt upplevde mer föräldrastress än övriga mammor. Slutsats: Studien visar att faktorer i framför allt i miljön samt hos mamman har betydelse för upplevd föräldrastress. Våra resultat innebär att omhändertagandet bör bli bättre, både under tiden på neonatalavdelning men även efter utskrivning. Då studien också påvisar vikten av samvårdsavdelning bör förbättringar ske i den fysiska vårdmiljön för att minimera upplevelsen av föräldrastress. / Background: When an infant is born preterm (&lt;37 gestational weeks) unexpected stresses affect the whole family. Significant improvements in the perinatal care has been made in the recent decades and now the chance of survival is high. To become a mother in a Neonatal Intensive Care Unit (NICU) entail consequences for the mother emotionally and in her care for her infant. Aim: To investigate parental stress and describe factors associated to early parenting stress in mothers of preterm infants at two months of corrected age. Method: The study was conducted in four NICUs in Sweden. The inclusion criteria were that the infant was born prematurely and had a hospital stay for at least 72 hours. To measure perceived parental stress, the mothers (n=276) answered the Swedish Parental Stress Questionnaire (SPSQ) at two months of corrected age. Results: Mothers whose infants were not cared for in a NICU with co-care, whose infants were cared for in an incubator, who were multiparous, older, who smoked and/or who were breastfeeding exclusively, experienced more stress than their counterparts in various dimensions explored. Conclusion: The study shows that factors relating to the environment and the mother are associated to parental stress among mothers’ of preterm infants. These findings show the need for improved support, both during the NICU stay and after discharge. These findings also highlight the need for improvements in the physical environment of the NICUs to reduce the risk for parental stress.

The birth of a child diagnosed with congenital diaphragmatic hernia (CDH) involves significant intensive care at the beginning of life and the need for surgery. Parents’ experiences during the acute phase of hospitalization for a critically ill infant not born premature is currently limited in the literature; in particular, there is no literature describing parents’ experiences of nursing care for having a infant with CDH in the Neonatal Intensive Care Unit (NICU). Using narrative inquiry this study explores stories of parents’ early experiences of nursing care in the NICU for an infant born with CDH. A thematic analysis revealed a main overarching theme of “not knowing” with three interrelated subthemes related to parents’ need for information and open communication; participation, power and partnership; and nursing presence to transition from not knowing to knowing their infant. The findings from this study suggest that parents want to be recognized as key members within the multidisciplinary team and that the nurse has the ability to facilitate aspects of care to impact parents positively or negatively. Implications for practice focus on supporting parents through evolving empowerment and participation in the care of their infant. / Graduate / 0569

This thesis presents the development and evaluation of a computerized physician-parent decision support tool for a neonatal intensive care unit (NICU), known as Physician and Parent Decision Support (PPADS). The NICU is a specialized hospital unit that treats very-ill neonates. Many difficult care decisions are made daily for this vulnerable population. The PPADS tool aims to augment current NICU decision-making by helping parents and physicians make more informed decisions, improving physician-parent communication, increasing parent decision-making satisfaction, decreasing conflict, and increasing decision efficiency. The development of the PPADS tool followed a five-step methodology: assessing the clinical environment, establishing the design criteria, developing the system design, implementing the system, and performing usability testing. Usability testing of the PPADS tool was performed on neonatologists and on parents of neonates who have graduated (survived) from a tertiary level NICU. The usability testing demonstrated the usefulness and ease of use of the tool.

This research study seeks to better understand the experience of South Asian immigrant women in the Neonatal Intensive Care Unit (NICU). The information gathered cannot be generalized to all South Asian and other immigrant populations nor is it the intent of this study. Instead, by examining the individual NICU experiences and challenges faced during this experience, themes emerge that can prompt neonatal nurses to examine their own practice with immigrant families. The main, overall theme identified in all participant responses was, Fear of the Unknown. Three subthemes that emerged from discussions regarding how participants experience nursing care were Trust, Teaching and Advocating. In terms of what participants identified as their most critical concerns while their infant was in the NICU, the three subthemes that arose were Language Barriers, Lack of Knowledge about the NICU and A More Comfortable NICU. On a broader scale, it is hoped that this research study will inspire all nurses to examine their interactions with all immigrant families in order to provide care that is holistic and individualized to the needs of their immigrant patient. / Graduate

Kangaroo Mother Care (KMC) is an alternative model of care that prevents parent-infant separation when preterm infants need neonatal intensive care by skin-to-skin contact between infants and their parents. KMC is also a strategy that involves parents in their infants’ care and enables them to assume the responsibility for the care. Furthermore, KMC promotes parent-infant bonding and attachment. The overall aim of this thesis was to gain a deeper understanding and knowledge about parents’ capacity, willingness, and experiences of KMC and to which extent parents choose to use KMC throughout their infants' hospital stay. These studies were conducted in the NICUs at two Swedish university hospitals (NICU A and NICU B). Mothers of infants cared for at NICU A (n=17) answered a questionnaire about their experiences of KMC (Paper I). Twenty parents of infants cared for at NICU A recorded the duration of each KMC session during a period of 24 hours and the identity the KMC provider (Paper II). Seven fathers were interviewed about their experiences of KMC (Paper III) and 76 mothers and 74 fathers completed a questionnaire about what facilitated or rendered it difficult to perform KMC (Paper IV). The time of initiation of KMC and duration in minutes, and the identity of the KMC providers was recorded continuously during the infants’ (n=104) hospital stay: 83 mothers and 80 fathers also completed a questionnaire during their infants’ hospital stay (Paper V). This thesis provides new knowledge about parents’ practice of KMC, also continuously day and night, in a high tech NICU in an affluent society, with good resources for infant care in an incubator by trained staff. The accuracy of parents’ records of KMC were comparable to nurses’ records. The results indicate that parents want to be together with their infant in the NICU and be actively involved in the infants’ care. Although parents may experience KMC as exhausting and uncomfortable, they still prefer KMC to conventional neonatal intensive care as it supports their parental role. Early initiation of KMC after birth appears to result in a longer total duration of KMC during the infants’ hospital stay.

O estudo das interações iniciais entre mãe e bebê é fundamental para a compreensão da ontogênese humana (Seidl-de-Moura, et al., 2008) e para ajudar a promover a saúde relacional da díade. Nos estudos sobre as interações inicias entre mãe e bebê prematuro, ainda há um questionamento sobre se o nascimento prematuro e a internação em uma UTI-Neonatal fortalecem ou enfraquecem as trocas entre os membros da díade. Assim, neste estudo observou-se e analisou-se as interações iniciais entre mãe e bebê prematuro na UTI-Neonatal, observou o desenvolvimento das interações ao longo de dois meses, e comparou com interações de um grupo de mães-bebês nascidos a termo, de acordo com categorias predefinidas para a análise de vídeos. Também analisou, através de entrevistas, as características que as mães de cada tipo de díade relataram sobre seus filhos, bem como as metas de desenvolvimento apontadas e as emoções que expressaram em relação ao bebê. Participaram da pesquisa 20 díades mãe-bebê de nascidos a termo, e 20 díades de mãebebê de prematuros, nascidos entre 28 e 36 semanas de idade gestacional. Entre outras evidências, enquanto os bebês estavam na UTI-Neonatal, foram encontradas associações significativas entre as características maternas e as do bebê. Após a alta hospitalar, houve associações significativas entre a sincronia da díade e os comportamentos dos bebês. Não houve diferenças significativas entre as características de interações quando a díade estava na UTI-Neonatal e após dois meses. Não foram observadas diferenças significativas entre as díades de mães-bebês prematuros e mães-bebês a termo em relação à sincronia da díade, nem tampouco entre os comportamentos maternos nos dois momentos de observação, mas uma diferença significativa foi encontrada entre os comportamentos autorregulatórios dos bebês nascidos a termo e os dos prematuros. Verificou-se que para os dois grupos de mães, as emoções mais frequentemente relatadas foram as de amor e apego. As metas de desenvolvimento mais apontadas enquanto as mães estavam com seu bebê na UTI-Neonatal foram voltadas para o desenvolvimento físico do bebê, e quando os bebês estavam com dois meses, as metas eram mais voltadas para o desenvolvimento emocional, da mesma forma como ocorreu com as mães de bebês a termo. As características mais apontadas pelas mães ao pensarem em seus bebês enquanto eles estavam na UTI-Neonatal foram as físicas, enquanto após a alta, foram as pessoais e emocionais, assim como ocorreu com as mães de bebês nascidos a termo. Os resultados se contrapõem a afirmações de que em episódios de interação as mães de prematuros são menos sensitivas, mais intrusivas, e seus bebês, menos atentos e responsivos. Apontaram, ao contrário, para uma certa continuidade entre o que se observou na UTI-Neonatal e aos dois meses. Também não foram identificadas diferenças significativas na maioria das características de interações entre mães e bebês prematuros e mães e bebês nascidos a termo. Assim, tais resultados suavizam possíveis estigmatizações sobre estas mães e apontam a importância de se fortalecer essa relação na UTI-Neonatal através de estratégias de promoção de saúde. / The study of early interactions between mother and baby is fundamental to understanding human ontogeny (Seidl-de-Moura, et al., 2008) and to help promote the health of the relational dyad. In initial studies on the interactions between mothers and premature infants, there is still a question about whether premature birth and hospitalization in a neonatal intensive care unit strengthen or weaken the exchanges between members of the dyad. Thus, in this study we observed and analyzed the initial interactions between mother and premature baby in the neonatal intensive care unit, noted the development of interactions over two months, and compared with interactions of a group of mothers-term infants, according to predefined categories for the analysis of videos. Also examined, through interviews, features that mothers of each type of dyad reported on their children, as well as the development goals outlined and the emotions expressed in relation to the baby. Participants were 20 mother-infant dyads of term infants, and 20 mother-infant dyads in premature babies, born between 28 and 36 weeks gestational age. Among other evidence, while the babies were in the neonatal intensive care unit, significant associations were found between maternal characteristics and the baby. After hospital discharge, there were significant associations between dyadic synchrony and behavior of babies. There were no significant differences between the characteristics of interactions when the dyad was in the neonatal intensive care unit and after two months. There were no significant differences between dyads of mothers-term infants and mothers-preterm infants at term in relation to the timing of the dyad, nor between maternal behaviors in the two periods of observation, but a significant difference was found between the behaviors of autorregulatory in infants born at term and preterm infants. It was found that for both groups of mothers, the emotions most frequently reported were those of love and attachment. The goals of developing more pointed while mothers were with their baby in the neonatal intensive care unit were focused on the physical development of the infant, and when the infants were two months, the goals were more focused on emotional development, just as occurred with mothers of term infants. The characteristics most cited by the mothers think about their babies while they were in the neonatal intensive care unit were physical while after discharge, were the personal and emotional, as did mothers of term infants. The findings go against the claims that episodes of interaction in mothers of preterm infants are less sensitive, more intrusive, and their babies, less attentive and responsive. They pointed instead to a certain continuity between what was observed in the neonatal intensive care unit and two months. There were also no significant differences in most characteristics of interactions between mothers and premature babies and mothers and term infants. Thus, these results understate possible stigmatization on these mothers and indicate the importance of strengthening this relationship in the neonatal intensive care unit through health promotion strategies.

Background: According to the World Health Organization, between four to nine million newborns develop birth asphyxia. It is estimated that 1.2 million fatal outcomes and at least the same number develop disabling neurological sequelae and developmental delay. Early neurological evaluation promotes the improvement of the life expectancy of serious asphyxiated babies and It can be incorporated into the routine of neonatal intensive care units. Glasgow Coma Scale adapted for children can be an assessment tool used in high-risk newborns. Objective: To compare the clinical outcome of term infants with perinatal asphyxia (PA) moderate and severe that underwent a neurological neonatal serial evaluation protocol during hospital stay, with those not undergoing evaluation. Method: This is an epidemiologic, observational and analytical study, using a quantitative approach. The study considered two groups, intervention and control. For the control group, at first, it was made a survey data in charts and then the longitudinal, prospective, observational approach was adopted during the period of outpatient care. For the intervention group, a longitudinal approach, prospective, observational was used during the hospital stay and follow-up clinic. We sought to investigate the neurological clinical course of children, the length of stay in hospital and delay presence in the development of neuromotor skills. Results: The sample consisted of 112 newborns, 86 infants in the control group and 26 infants in the intervention group. The intervention group showed a median of less hospital stay (p<0.001) than the control group. Full-term newborns diagnosed with PA, which remained for a shortest time in hospital length and were subjected to a serial neurological evaluation protocol, incorporated into standard clinical procedures in the NICU for the management of PA, did not show disturbances in neuromotor development. Conclusion: The use of serial neurological evaluation protocol influenced significantly, the prevalence of delayed neuromotor development. / Introdução: Segundo a Organização Mundial da Saúde, cerca de quatro a nove milhões de recém-nascidos (RN) desenvolvem asfixia ao nascer. Estima-se que 1,2 milhão evoluem para óbito e, pelo menos, o mesmo número desenvolve sequelas neurológicas incapacitantes e atraso no desenvolvimento. A avaliação neurológica precoce promove melhora da perspectiva de vida dos anoxiados graves, podendo, esta, ser incorporada à rotina das unidades de terapia intensiva neonatal. A escala de coma de Glasgow adaptada para crianças poderá ser utilizada em RN de alto risco. Objetivo: Comparar a evolução clínica neurológica dos RN a termo com asfixia perinatal (AP) moderada e grave que foram submetidos a um protocolo de avaliação neurológica neonatal seriada durante período de internamento hospitalar, com aqueles não submetidos à avaliação. Métodos: Trata-se de um estudo epidemiológico, observacional, analítico, com abordagem quantitativa. O estudo considerou dois grupos, intervenção e controle. Para o grupo controle foi feito um levantamento de dados em prontuários e, em seguida, adotada a abordagem longitudinal, prospectiva, observacional, durante o período de atendimento ambulatorial. Para o grupo intervenção, foi utilizada uma abordagem longitudinal, prospectiva, observacional, durante o período intra-hospitalar e em ambulatório de seguimento. Buscou-se investigar a evolução clínica neurológica da criança, o tempo de permanência no serviço hospitalar e presença de atraso no desenvolvimento das habilidades neuromotoras. Resultados: A amostra foi constituída de 112 RN, sendo 86 RN do grupo controle e 26 RN do grupo intervenção. O grupo intervenção mostrou uma mediana de tempo de internamento hospitalar menor (p<0,001) que o grupo controle. RN a termo, diagnosticados com AP, que permaneceram por menor tempo em internamento hospitalar e foram submetidos a um protocolo de avaliação neurológica seriada, incorporado às condutas clínicas padronizadas na UTIN para a gestão da AP, não apresentaram distúrbios no desenvolvimento neuromotor. Conclusão: A utilização do protocolo de avaliação neurológica seriada influenciou a prevalência de atraso no desenvolvimento neuromotor.

O estudo das interações iniciais entre mãe e bebê é fundamental para a compreensão da ontogênese humana (Seidl-de-Moura, et al., 2008) e para ajudar a promover a saúde relacional da díade. Nos estudos sobre as interações inicias entre mãe e bebê prematuro, ainda há um questionamento sobre se o nascimento prematuro e a internação em uma UTI-Neonatal fortalecem ou enfraquecem as trocas entre os membros da díade. Assim, neste estudo observou-se e analisou-se as interações iniciais entre mãe e bebê prematuro na UTI-Neonatal, observou o desenvolvimento das interações ao longo de dois meses, e comparou com interações de um grupo de mães-bebês nascidos a termo, de acordo com categorias predefinidas para a análise de vídeos. Também analisou, através de entrevistas, as características que as mães de cada tipo de díade relataram sobre seus filhos, bem como as metas de desenvolvimento apontadas e as emoções que expressaram em relação ao bebê. Participaram da pesquisa 20 díades mãe-bebê de nascidos a termo, e 20 díades de mãebebê de prematuros, nascidos entre 28 e 36 semanas de idade gestacional. Entre outras evidências, enquanto os bebês estavam na UTI-Neonatal, foram encontradas associações significativas entre as características maternas e as do bebê. Após a alta hospitalar, houve associações significativas entre a sincronia da díade e os comportamentos dos bebês. Não houve diferenças significativas entre as características de interações quando a díade estava na UTI-Neonatal e após dois meses. Não foram observadas diferenças significativas entre as díades de mães-bebês prematuros e mães-bebês a termo em relação à sincronia da díade, nem tampouco entre os comportamentos maternos nos dois momentos de observação, mas uma diferença significativa foi encontrada entre os comportamentos autorregulatórios dos bebês nascidos a termo e os dos prematuros. Verificou-se que para os dois grupos de mães, as emoções mais frequentemente relatadas foram as de amor e apego. As metas de desenvolvimento mais apontadas enquanto as mães estavam com seu bebê na UTI-Neonatal foram voltadas para o desenvolvimento físico do bebê, e quando os bebês estavam com dois meses, as metas eram mais voltadas para o desenvolvimento emocional, da mesma forma como ocorreu com as mães de bebês a termo. As características mais apontadas pelas mães ao pensarem em seus bebês enquanto eles estavam na UTI-Neonatal foram as físicas, enquanto após a alta, foram as pessoais e emocionais, assim como ocorreu com as mães de bebês nascidos a termo. Os resultados se contrapõem a afirmações de que em episódios de interação as mães de prematuros são menos sensitivas, mais intrusivas, e seus bebês, menos atentos e responsivos. Apontaram, ao contrário, para uma certa continuidade entre o que se observou na UTI-Neonatal e aos dois meses. Também não foram identificadas diferenças significativas na maioria das características de interações entre mães e bebês prematuros e mães e bebês nascidos a termo. Assim, tais resultados suavizam possíveis estigmatizações sobre estas mães e apontam a importância de se fortalecer essa relação na UTI-Neonatal através de estratégias de promoção de saúde. / The study of early interactions between mother and baby is fundamental to understanding human ontogeny (Seidl-de-Moura, et al., 2008) and to help promote the health of the relational dyad. In initial studies on the interactions between mothers and premature infants, there is still a question about whether premature birth and hospitalization in a neonatal intensive care unit strengthen or weaken the exchanges between members of the dyad. Thus, in this study we observed and analyzed the initial interactions between mother and premature baby in the neonatal intensive care unit, noted the development of interactions over two months, and compared with interactions of a group of mothers-term infants, according to predefined categories for the analysis of videos. Also examined, through interviews, features that mothers of each type of dyad reported on their children, as well as the development goals outlined and the emotions expressed in relation to the baby. Participants were 20 mother-infant dyads of term infants, and 20 mother-infant dyads in premature babies, born between 28 and 36 weeks gestational age. Among other evidence, while the babies were in the neonatal intensive care unit, significant associations were found between maternal characteristics and the baby. After hospital discharge, there were significant associations between dyadic synchrony and behavior of babies. There were no significant differences between the characteristics of interactions when the dyad was in the neonatal intensive care unit and after two months. There were no significant differences between dyads of mothers-term infants and mothers-preterm infants at term in relation to the timing of the dyad, nor between maternal behaviors in the two periods of observation, but a significant difference was found between the behaviors of autorregulatory in infants born at term and preterm infants. It was found that for both groups of mothers, the emotions most frequently reported were those of love and attachment. The goals of developing more pointed while mothers were with their baby in the neonatal intensive care unit were focused on the physical development of the infant, and when the infants were two months, the goals were more focused on emotional development, just as occurred with mothers of term infants. The characteristics most cited by the mothers think about their babies while they were in the neonatal intensive care unit were physical while after discharge, were the personal and emotional, as did mothers of term infants. The findings go against the claims that episodes of interaction in mothers of preterm infants are less sensitive, more intrusive, and their babies, less attentive and responsive. They pointed instead to a certain continuity between what was observed in the neonatal intensive care unit and two months. There were also no significant differences in most characteristics of interactions between mothers and premature babies and mothers and term infants. Thus, these results understate possible stigmatization on these mothers and indicate the importance of strengthening this relationship in the neonatal intensive care unit through health promotion strategies.

Este estudo foi motivado pelas inquietações surgidas durante a experiência profissional da pesquisadora, no trabalho com recém-nascidos prematuros e seus familiares. Trata-se de pesquisa do tipo descritivo, com obtenção e tratamento de dados qualitativos, que teve como objetivo identificar a vivência da mãe de recém-nascido prematuro, egresso de Unidade Neonatal, e sobre o cuidado do bebê, no domicílio. O projeto foi aprovado pela Comissão de Ensino e Pesquisa do Hospital Estadual de Sumaré, campo de estudo, e pelo Comitê de Ética em Pesquisa da Universidade Estadual de Campinas (UNICAMP). Foram entrevistadas 12 mães, no retorno ambulatorial do bebê prematuro, após aproximadamente 10 dias da alta da Unidade Neonatal. Os dados foram coletados, no período de julho a outubro de 2008, por meio de entrevistas e tratados pela técnica do Discurso do Sujeito Coletivo (DSC) proposto por Fernando Lefèvre. Dos relatos obtidos, emergiram oito DSCs assim distribuídos: 1-Vivenciando o cuidado do prematuro; 2-Reproduzindo o que aprendeu na unidade neonatal; 3-Tentando atender às necessidades do prematuro; 4-Falando de aleitamento; 5-Recebendo ajuda dos familiares; 6-Expressando sentimentos de satisfação; 7-Citando a Cartilha da Unidade Neonatal e 8-Expressando dificuldade para cuidar do prematuro. Os resultados revelam a importância da Unidade Canguru que possibilita à mãe receber orientações contínuas sobre o cuidado do bebê prematuro, em Unidade Neonatal, de modo a habilitá-la para atender com segurança às demandas do filho, no domicílio. Outro dado de relevância é que as mães consultam a Cartilha de orientação oferecida pelo serviço, apenas diante de alguma dúvida sobre o cuidado a ser oferecido ao bebê prematuro, dispensando sua completa leitura. Os relatos revelam que as estratégias para a capacitação materna para o cuidado do prematuro devem ser adotadas pelas unidades neonatais desde a admissão do recém-nascido, de modo a proporcionar maior segurança no desenvolvimento de habilidades no cuidado do filho e para favorecer a criação do vínculo entre ambos / This study is the result of anxieties brought about the authors professional experience working with premature newborns and their families. This is a descriptive research, with gathering and treatment of qualitative data, aimed at identifying the experience of premature newborns mothers released from Neonatal Units with regards to the babys care at home. The project had approved of the Teaching and Research Commission of the Sumaré State Hospital, field of study, and the State University of Campinas Committee of Ethics in Research. Twelve mothers were interviewed in the follow-up visits of premature babies approximately 10 days after release from the Neonatal Unit. Data were collected between July and October of 2008 through interviews and treated with the technique of the Discourse of the Collective Subject (DCS) proposed by Fernando Lefèvre. From the descriptions emerged 8 DCSs, grouped as follows: 1-Experiencing the care for the premature baby; 2-Reproducing what was learned in the Neonatal Unit; 3-Trying to fulfill the premature babys needs; 4 Speaking about breast feedind; 5-Being helped by family members; 6-Expressing feelings of satisfaction; 7-Quoting the Neonatal Units guide book; and 8-Expressing difficulty to care for the premature baby. The results reveal the importance of the Kangaroo Unit, which makes possible for mothers to receive continuous guidance regarding the care for premature babies in Neonatal Units so as to enable them to securely respond to their childs demands at home. Another relevant piece of information is that mothers check the guide book that the service gives them only if theres a doubt regarding the kind of care that should be given to the premature baby, rather than fully reading it. The narratives show that the strategies to build the capacity of mothers to care for premature babies should be adopted by neonatal units since the newborn is taken in, so as to provide more security in the development of abilities in the care for the child and to encourage the creation of ties between them