nÃo hà / MudanÃas que aconteceram no sÃculo XX, permitiram que avanÃos tecnolÃgicos aumentassem a sobrevida diante de doenÃas anteriormente incurÃveis e processos patolÃgicos irreversÃveis. No entanto, a busca incessante pela cura, alÃm de levar ao aumento da sobrevida, tambÃm gerou a obstinaÃÃo terapÃutica, ou seja, medidas terapÃuticas fÃteis diante de evoluÃÃo inexorÃvel para a morte, impactando em indicadores como Ãndice de satisfaÃÃo do cliente e cuidadores, tempo mÃdio de permanÃncia, elevaÃÃo de custos, bem como em prejuÃzo na distribuiÃÃo equitativa de recursos. No inÃcio dos anos 90, a limitaÃÃo do suporte de vida (LSV) comeÃou a ser estudada e considerada, em paÃses da Europa, Estados Unidos, Canadà e Austrlia, como forma de assistir os pacientes nesses casos, uma vez que as medidas terapÃuticas nÃo mais trariam benefÃcios, mas gerariam prolongamento do sofrimento e do processo de morrer. No Brasil, contudo, os estudos sÃo limitados e os dados referentes ao Nordeste do paÃs sÃo ainda muito escassos. O objetivo do estudo foi caracterizar as condutas mÃdicas que antecederam o Ãbito de pacientes em UTI pediÃtrica e neonatal em um hospital de referÃncia do Nordeste Brasileiro. Foram estudados 86 prontuÃrios de pacientes que morreram nas referidas UTIs no perÃodo de dezembro/09 a novembro/10. Apenas 3,5% dos Ãbitos ocorreram apÃs LSV registrada em prontuÃrio, destes 33,7% tinham doenÃa crÃnica associada, sendo as neoplasias as mais comuns. As causas de Ãbito mais comuns foram sepse (23,5%), falÃncia de mÃltiplos ÃrgÃos (18,8%), insuficiÃncia respiratÃria (12,9%), cardiopatias congÃnitas (8,2%) e as outras causas somaram 36,6%. A maior parte dos pacientes morreu apÃs aumento das medidas de suporte avanÃado de vida, considerando as ultimas 24h antes do Ãbito: drogas vasoativas (59,3% 24h antes e 70,9% no momento do Ãbito); VentilaÃÃo mecÃnica (89,5% 24h antes e 95,2% no momento do Ãbito). Enquanto as medidas de cuidados e conforto nÃo tiveram a mesma expressÃo, tendo um aumento irrelevante: sedaÃÃo (39,5% 24h antes e 43% no momento do Ãbito); analgesia (60% 24h antes e 60,5% no momento do Ãbito). As manobras de ressuscitaÃÃo cardiopulmonar foram registradas em 4,7% 48h antes do Ãbito, 29,1% 24h antes e 69,4% no momento do Ãbito. O uso de adrenalina foi registrado em 55,4% antes do Ãbito. Conclui-se que a LSV ainda nÃo à frequentemente considerada como uma alternativa de assistÃncia de final de vida a pacientes pediÃtricos e neonatais no Estado do CearÃ, onde as condutas mais prevalentes incluem o incremento do suporte avanÃado de vida em detrimento das medidas de conforto e cuidados paliativos. Comparando-se com estudos do Sul e Sudeste do paÃs, evidencia-se uma grande diferenÃa, onde se observam uma maior prevalÃncia de LSV e cuidados paliativos para pacientes em fase terminal, o que denota prÃticas mais humanas e de maior qualidade na assistÃncia. / Changes around the world at the XX century allowed new technologies to improve the possibilities of surviving in so many cases of sickness that were incurable before. Besides the benefits it brought, other consequences have come together specially futility, in other words futile therapeutic measures when the cure is impossible and the death is inevitable. These facts have influence in client satisfaction, lengh of stay and costs elevation. Since 1990 life support limitation (LSL) started to be considered in Europe, United States, Canada and Austrlia to assist patients in terminal conditions to whom curative practices wouldnât bring any benefit. In Brazil there is a limited number of studies and the data from the Northeastern are even less. The aim of this study was to describe the medical practices before death in patients in PICU and NICU at a reference pediatric hospital in Brazilian Northeastern. Data were collected from 86 medical charts. Only 3.5% of LSL was registered. 33.7% of patients had some chronic disease and neoplasic ones were more comons. The main causes of death were: sepsis (23.5%), MDOS (18.8%), respiratory failure (12.9%), congenital heart disease (8.2%) and the other causes 36.6% together. Most of patients died after increment in vasoatives administration, considering the final 24 hours before death (59.3% 24h before, 70.9% at the momento of death). Mechanical ventilation (89.5% 24h before, 95.2% at the moment). In the other hand palliative care and pain control were not so frequent as could be expected: sedative (39.5 24h before, 43% at the moment) analgesic (60% 24h before, 60.5% at the moment). CPR was offered in 4.7% of patients 48h before death, 29.1% 24h before and 69.4% at the moment of death. Adrenaline was used in 55.4% at the moment of death. These data show that LSL is not a frequente alternative to assist terminal patients at PICU and NICU in Brazilian Northeastern, where more prevalent practices are to maintain life support instead of offer palliative care and pain control. At Southern and Southeastern practice include LSL and palliative care more frequently, what suggests better practices of the end-of-life care.

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.

Este estudo teve como objetivo descrever o perfil e o padrÃo de prÃticas assistenciais de recÃm-nascidos com distÃrbios respiratÃrios, internados nas unidades de terapia intensiva em Fortaleza e analisar fatores associados ao Ãbito em recÃm-nascidos de muito baixo peso com SÃndrome do Desconforto RespiratÃrio. Trata-se de um estudo de coorte prospectiva de base hospitalar, realizado em 773 recÃm-nascidos em cinco hospitais, de julho a dezembro de 2007. Foram duas etapas uma descritiva e a outra, analÃtica. A maioria era prÃ-termo (80,7%). Entre o primeiro e quinto minuto, houve queda no Apgar de 4-6 e melhora no Apgar maior do que 7. A SÃndrome do Desconforto RespiratÃrio foi a patologia mais freqÃente (73%). Dos recÃm-nascidos de muito baixo peso 62,7% estavam sob ventilaÃÃo mecÃnica, 53,7%, surfactante e 19,9% foram a Ãbito. Os fatores de risco para Ãbito identificados pela anÃlise bivariada e nÃvel de significÃncia de 5% foram a idade materna < 20 anos (p=0,008), Apgar de quinto minuto < 7 (p<0,001), o uso de ventilaÃÃo com pressÃo positiva na sala de parto (p< 0,001), intubaÃÃo na sala de parto (p< 0,001) e o uso de surfactante (p<0,001). O uso de corticÃide antenatal assim como o uso de surfactante foi baixo. Os recÃm-nascidos com peso menor que 1500g necessitaram de maior suporte terapÃutico e tiveram mais elevada taxa de Ãbito. Esse cenÃrio demonstra a necessidade de melhorias na assistÃncia prà e perinatal e particularmente aos recÃm-nascidos de muito baixo peso. / The objectives of this study was to describe the profile and the standards of medical care in newborns with respiratory disorders admitted to intensive care units as well as analyze the risk factors associated to the death in low birth weight newborn with respiratory distress syndrome. It is a prospective cohort study hospitalar-based realized in 773 newborns in five hospitals from July and December 2007. Was two phases a described and the other, analytical. The majotity were premature (80.7%). Between the first and the fifth minute, the number of newborns with Apgar less than 3 decreased and the ones with Apgar above or equal to 7 increased. Respiratory distress syndrome was the most frequent disease (73%). For the newborns with very low weight and respiratory distress syndrome, 62.7% used mechanical ventilation, 53.7% surfactant and 19.9% died. The risk factors for death according to the bivariate analysis were: mother`s age less than 20 years (p=0.008), Apgar less than 7 in the fifth minute (p<0.001), the use of positive pressure ventilation in the delivery room (p<0.001), intubation in the delivery room (p<0,001) and the use of surfactant (p<0.001).The use of antenatal corticosteroids and use of surfactant was low. The newborns weighing less than 1500g needed more medical assistance than others and still presented a high death rate. According to the study, the respiratory disorders of the newborns and the outcome are strongly related to the prenatal factors, to the assistance in the delivery room and to the intensive care.

Submitted by Edineia Teixeira (edineia.teixeira@unioeste.br) on 2017-12-18T14:07:00Z No. of bitstreams: 2 alessandra_santos2017.pdf: 7767565 bytes, checksum: 0e4c6d512fc332357ecb23d4a631cb5b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-12-18T14:07:00Z (GMT). No. of bitstreams: 2 alessandra_santos2017.pdf: 7767565 bytes, checksum: 0e4c6d512fc332357ecb23d4a631cb5b (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-08-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Preterm birth provides modifications for both the life of the Newborn (NB) as family. Among these changes has been hospitalization in Neonatal Intensive Care Units (NICU) due to the immaturity of organs and systems, generating the need for treatment and intensive care. Because of hospitalization, complications may occur or biological, psychological and social changes to the Newborn Preterm (PTN), which can lead to changes in Neuropsychomotor Development (DNPM). One way to minimize these complications is through proper body positioning premature procedure performed during routine care team in a NICU. However, a gap is evident as regards the PTN response during positioning correlating different positions during hospitalization, as well as the comparison between standard protocols and procedures routine in the NICU. Therefore, the main objective of this research was to compare the physiological, behavioral and pain responses presented by PTN subjected to a Standard Operating Procedure (SOP) body position with those in routine positioning of the NICU. Quantitative study, prospective, randomized clinical trial type, conducted from July 2015 to March 2016 with 30 preterm infants admitted to the NICU of a teaching hospital of the West of Paraná. The subjects were randomly separated into Unit Routine Decubitus group (URD) and Intervention Group (GI), on which it was subjected to previously validated positioning protocol and proposed in 2015. The variables analyzed in the study were: physiological characteristics (respiratory rate, heart rate and oxygen saturation); behavior (measured by the Scale of Brazelton Modified - EBM) and pain (scale verified by the Neonatal Infant Pain Scale - NIPS). The study sample consisted of preterm infants with gestational age for both groups predominantly between 28 and 32 weeks and birth weight between 1001 and 1499 grams, characterizing the sample as very premature and very low birth weight. Regarding the physiological variables it was observed throughout the procedure that the heart rate in URD remained lower compared to the values submitted by the IG; Respiratory Rate (RR) in the URD was higher when compared to IG and oxygen peripheral saturation values remained stable in both groups. The PTN behavior, by EBM and pain by NIPS, showed similar scores in both groups before the start of the procedure, however, significantly lower in IG during the intervention. It is pointed out then that the positioning SOP provided decrease in RR in scores of pain and behavior scales, when compared to the URD. It is believed that a standardized position in the long term hospitalization contribute to the proper DNPM. / O nascimento prematuro proporciona modificações tanto para a vida do Recém-Nascido (RN) quanto para a família. Dentre essas modificações tem-se o internamento em Unidades de Terapia Intensiva Neonatal (UTIN) devido à imaturidade de órgãos e sistemas, gerando a necessidade de tratamento e cuidados intensivos. Em virtude da hospitalização, podem ocorrer complicações ou alterações biológicas, psicológicas e sociais para o Recém-nascido Prematuro (RNPT), que podem levar a alterações no Desenvolvimento Neuropsicomotor (DNPM). Uma das maneiras de minimizar estas complicações é por meio do posicionamento corporal adequado do prematuro, procedimento realizado durante a rotina de cuidados da equipe de uma UTIN. Contudo, evidencia-se lacuna no que se refere à resposta do RNPT durante o posicionamento correlacionando os diferentes decúbitos durante a hospitalização, bem como a comparação entre protocolos padronizados e procedimentos de rotina da UTIN. Para tanto, o objetivo principal desta pesquisa foi comparar as respostas fisiológicas, comportamentais e à dor apresentadas pelos RNPT submetidos a um Procedimento Operacional Padrão (POP) de posicionamento corporal com aqueles sob posicionamento de rotina da UTIN. Estudo quantitativo, prospectivo, do tipo ensaio clínico randomizado, realizado no período de julho de 2015 a março de 2016 com 30 RNPT internados na UTIN de um hospital escola do Oeste do Paraná. Os sujeitos foram separados randomicamente em grupo Decúbito de Rotina da Unidade (DRU) e Grupo Intervenção (GI), em que este foi submetido a protocolo de posicionamento previamente validado e proposto no ano de 2015. As variáveis analisadas no estudo foram: características fisiológicas (frequência respiratória, frequência cardíaca e saturação periférica de oxigênio); comportamento (mensurado pela escala de Brazelton modificada - EBM) e dor (verificada pela escala Neonatal Infant Pain Scale - NIPS). A amostra do estudo constituiu-se por RNPT com idade gestacional para ambos os grupos predominantemente entre 28 e 32 semanas e o peso ao nascimento entre 1001 e 1499 gramas, caracterizando a amostra como muito prematuros e de muito baixo peso. Em relação às variáveis fisiológicas observou-se durante todo o procedimento que a frequência cardíaca no DRU manteve-se menor em relação aos valores apresentados pelo GI; a Frequência Respiratória (FR) no DRU apresentou-se maior quando comparada ao GI e os valores de saturação periférica de oxigênio mantiveram-se estáveis nos dois grupos. O comportamento do RNPT, pela EBM e a dor pela NIPS, apresentaram escores semelhantes em ambos os grupos antes do inicio do procedimento, porém, significativamente menor no GI durante a intervenção. Aponta-se então, que o POP de posicionamento proporcionou redução da FR, nos escores das escalas de dor e comportamento, quando comparadas ao DRU. Acredita-se que um posicionamento padronizado na hospitalização contribuirá em longo prazo para o DNPM adequado

Class of 2012 Abstract / Specific Aims: The purpose of this study is to evaluate and compare clinical outcomes and cost involved with use of poractant versus beractant for the treatment of respiratory distress syndrome (RDS) in a level III, neonatal intensive care unit (NICU) within an academic medical center. Methods: This retrospective cohort study included patients if they were admitted to the NICU for RDS between April 1, 2010 to November 30, 2010 and December 1, 2010 to June 30, 2011 treated with beractant and poractant respectively. Patients were excluded from the study if they were greater than 35 weeks gestational age and survived less than 48 hours. This is a review and the information needed from the patients was submitted in a data extraction form. Data collected included demographic variables (age, birthweight, birth length, gender, and race/ ethnicity), FiO2 measurement, mechanical ventilation time, length of hospitalization in the NICU, the incidence complications in the first 28 days, number of doses given, use of the nasal CPAP, concurrent complications or comorbidites such as pulmonary hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosis, intraventricular hemorrhage, and retinopathy of maturity. Main Results: Data from 27 neonates in beractant and 13 in poractant groups were collected. The FiO2 measurements in both groups were generally similar. However, FiO2 was consistently lower in the poractant group. (p = 0.044 from a runs statistical test) Conclusions: The FiO2 measurement is poractant group was lower compared with beractant group, however the difference was noted to be not statistically significant.

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.

The purpose of this research was to offer a description of the complexity of nurses’ medication administration practices in relationships with technology. The clinical situations and circumstances in which nurses administer medications today are comprised of rapidly changing technological initiatives that are intended to support safe, efficient care. Nurses’ medication administration practices are not immune to a rapidly changing technological health care environment. Research and literature has documented medication administration occurs in complex situations and nurses apply particular knowledge that supports decision-making and clinical practices for patient safety. Praxiographic methodology was used to describe deeply embedded knowledge and values that shape and guide contemporary nursing practice. Lack of attention to knowledge and values that shape and guide nursing practice and care, may contribute to the risk that those practices may be lost as nurses retire amongst a rapidly changing healthcare environment. A highly technical Neonatal Intensive Care Unit (NICU) was the location for the study. Participants included twelve NICU nurses and a pharmacist. The research findings included the significance of understanding NICU nurses’ use of local and universal maps to navigate the complexity of medication administration. Furthermore, the research documented NICU nurses’ medication administration practices as inseparable from technology. Further practice-based research is recommended to support the development of technologies that incorporate nurses’ medication administration practices. / Graduate

Bakgrund: Av de ca 110 000 – 120 000 barn som föds årligen i Sverige, behöver drygt tio procent vård på neonatalavdelning. Att amma sitt barn har väldokumenterade fördelar och är särskilt anpassat för det individuella barnets behov vilket ger fördelar både på fullgångna och prematurfödda barn. Syfte: Syftet med studien är att belysa faktorer vilka påverkar det amningsfrämjande arbetet på neonatalavdelningar. Metod: Allmän litteraturöversikt som innefattar totalt 16 vetenskapliga artiklar. Samtliga artiklar vilka inkluderats i resultatet har granskats enligt kvalitetsmall. Resultat: Amning och bröstmjölk väcker starka och blandade känslor hos vårdpersonalen. Vårdpersonal som genomgått någon form av utbildning inom området amning var generellt mer positivt inställda till att ge amningsstöd trots påverkan på arbetsbördan. Flaskmatning sågs som ett bekvämt alternativ även om bröstmjölkens fördelar var väl kända. Slutsats: I vilken utsträckning amningsstöd utförs och vilken kvalitet det har beror på stor del på vårdpersonalens egna upplevelser och känslor gällande amning. Då få studier fanns att tillgå är det en indikation på att vidare forskning inom området behövs. / Background: In Sweden, approximately 110,000 – 120,000 babies are born every year. More than ten percent of all newborn babies born in Sweden are in need of care in neonatal care units. Breastfeeding has well-documented benefits and is specifically tailored to the needs of the individual child, providing benefits for both full-term and premature born babies. Aim: The purpose of the study is to shed light on factors that affect breastfeeding work in neonatal wards. Method: General literature review. Including a total of 16 scientific articles. All articles included in the results have been reviewed according to the quality template.  Results: Breastfeeding and breast milk triggered strong and mixed feelings in the health care workers. Healthcare professionals who had undergone some form of training in the field of breastfeeding were generally more positive towards providing breastfeeding support despite the impact on the workload. Bottle feeding was seen as a convenient option although the benefits of breast milk were well known. Conclusion: The extent to which breastfeeding support is performed and the quality of it depends largely on the healthcare staff's own experiences and feelings regarding breastfeeding. Since few studies were available, it is an indication that further research in the field is needed.

Family-centered care (FCC) is considered the gold standard for care delivery in the Neonatal Intensive Care Unit (NICU). However, there are challenges with the implementation of FCC in practice and there is limited literature about how to tailor this approach for specialized NICU populations. To explore FCC for surgical neonates in the NICU, the concept was explored using Roger’s evolutionary concept analysis. Results illustrate that FCC in the NICU is a philosophy or care, rather than a set of interventions. The subsequent cross-sectional descriptive exploratory study showed that the surgical infants in our sample (n=11) received a limited amount of skin-to-skin care (median 0 mins/day) and parents reported challenges to being involved in their infant’s care. This thesis supports the challenges with the implementation of FCC in practice and both the need to consider multiple perspectives and the need for broader systemic change in order to support a FCC philosophy.

No description available.