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Use of self-inflating bags for neonatal resuscitationOddie, S.J., Wylie, J., Scally, Andy J. January 2005 (has links)
No / Lung inflation is the most important, and most difficult step in newborn resuscitation. A wide variety of devices are used to achieve lung inflation, but there are relatively few data to guide clinicians in their choice of device.
We tested the ability of instructors and trained candidates on a newborn life support course to deliver initial inflation breaths to a test lung, using a pressure limited blow-off valve, a 240-ml self-inflating bag and a 500-ml self-inflating bag in sequence.
Use of a 240-ml self-inflating bag was associated with shorter initial inflations of 1.8 s mean (95% CI 1.60-1.99 s), compared with 2.42 s (2.24-2.61 s), 2.40 s (2.08-2.71 s) for 500-ml self-inflating bags and 'Tom Thumb' T piece, respectively. Delivery of breaths within a target pressure range of 30 � 5 cm H2O was significantly better using a T piece than either self-inflating bag (proportion within target range 0.05 (95% CI 0-0.11), 0.17 (95% CI 0.12-0.23), 0.89 (95% CI 0.83-0.94) for 240-ml and 500-ml self-inflating bags and 'Tom Thumb' T piece, respectively. Excessive pressure delivery with both sizes of self-inflating bag was frequent.
These data do not support use of 240-ml or 500-ml self-inflating bags for resuscitation of newborn term infants. A variable pressure T piece blow-off system may be the easiest device to use for newborn resuscitation and the most reliable at delivering desired pressures for set times.
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A study to determine the policies and practices of local public health nurses in regard to follow-up of premature infantsLemay, Muriel J. January 1965 (has links)
Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2999-01-01
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An analysis of the values influencing neonatal nurses' perceptions and behaviors in selected ethical dilemmasRaines, Deborah A. 01 January 1992 (has links)
The purpose of this research was to identify the values influencing the nurse's perception and choice of behavior in a hypothetical clinical situation. The theoretical framework was Rokeach's (1973) Theory on the Nature of Human Values and Value Systems. A descriptive study using a mailed survey was conducted on a random sample of 331 members of the National Association of Neonatal Nurses. Data on individual nurses' values, perception of information and behavioral choices were collected with an investigator developed questionnaire, consisting of a values scale (alpha =.82) and an information scale and choice alternatives related to three hypothetical vignettes: a low birthweight infant (alpha =.75), an infant with trisomy-13 (alpha =.70) and a chronically ill infant (alpha =.68).
Results of this study indicate that (1) nurses identified a hierarchy of values related to their practice; "doing right" (x = 6.1), beneficence (x = 5.4), and justice (x = 4.8), (2) information related to the infant was consistently most important; however, in uncertain situations, rules or external protocols had an increased influence on the behavioral choice process, (3) the behavioral choice option with the greatest agreement was different for each situation, and a consistently negative association between the options within each vignette indicates that nurses have clearly defined choice preferences, (4) model testing revealed a consistent relationship among the variable of justice and protocol, doing right and infant characteristics, and infant characteristics and the choice options across the three vignettes (p <.05).
The major findings include the identification of the value dimension, "doing right" and a lack of congruence between the values the nurse identifies as important and the actions the individual implements in practice. The phenomenon of "doing right" is a combination of items originally hypothesized to measure nurse autonomy, family autonomy and beneficence. The convergence of these items results in an unique dimension that represents the nurse's internally directed motivation or sense of duty to the infant/family unit. The lack of congruence between the identified values and the behaviors implemented in practice represents the sense of frustration and feeling of powerlessness experienced by nurses (n = 97) as they balance the role of professional and the role of employee.
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Parents’ perception of nursing support in neonatal intensive care units in private hospitals in the Western CapeNdango, Immaculate Nyonka January 2018 (has links)
Magister Curationis - MCur / Parents undergo negative experiences that include parental anxiety, depression, and posttraumatic stress when their new-born babies are hospitalised in neonatal intensive care unit. During this stressful period, parents need assistance from staff in order to cope.
A quantitative, descriptive survey design was used to describe parents’ perception of nursing support during their baby’s admission in neonatal intensive care units (NICU) at three selected private hospitals in the city of Cape Town in the Western Cape Province. A structured existing 21- item Likert type questionnaire, the Nurse-Parent Support Tool (NPST) was used to collect data from an all-inclusive sample of 85 parents with a response rate of 78.8% (n=67). The purpose of the questionnaire was to determine their perception of information giving and communication by nurses; emotionally supportive behaviours by nurses; care given support or instrumental support and to identify parents’ perception of esteem or appraisal support while in the NICU environment. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24.
The findings of this study suggested that the overall mean score for parents’ perception of nursing support was high 4.6 (±0.5) out of a possible of 5. There was no significant difference in the overall mean perceived support score between the different facilities. No significant differences were found in terms of all the demographics characteristics with regard to perceptions of the support that was received, thus indicating that there was no relationship between the demographic variables and perception of support. The findings suggested that though high parental support was reported, the area of involving parents in the care of their babies i.e. letting them decide whether to stay or leave during procedures need improvement.
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Avaliação neurológica de recém-nascidos com microcefalia secundária à infecção congênita pelo vírus Zika / Neurological assessment of neonates with microcephaly due to congenital Zika vírus infectionCoelho, Marili André 22 March 2019 (has links)
INTRODUÇÃO: Houve uma epidemia de infecção pelo vírus Zika (ZIKV) no Brasil, entre 2015 e 2016, que refletiu no aumento de casos de microcefalia neonatal secundária à infecção congênita pelo ZIKV. Para compreensão do padrão de acometimento neurológico dessas crianças foi realizado um projeto de pesquisa pelo Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (HCFMRP-USP), conhecido como ZIG, e realizado seguimento neurológico desses pacientes por meio do Exame Neurológico de Hammersmith Neonatal (HINE-N). OBJETIVOS: Avaliar pacientes com microcefalia secundária à infecção congênita pelo ZIKV por meio do HINE- N, descrever as características clínicas e de neuroimagem dos pacientes estudados e identificar fatores pré-natais, perinatais e demográficos potencialmente relacionados ao grau de comprometimento do exame neurológico. METODOLOGIA: O presente estudo faz parte do Núcleo de Estudos sobre Infecção Materna, Perinatal e Infantil (NEIMPI) do HCFMRP-USP e trata-se de um estudo não experimental, transversal, com intuito de correlacionar variáveis qualitativas e quantitativas. Participaram do estudo crianças com microcefalia secundária à infecção congênita pelo ZKV nascidas no município de Ribeirão Preto e seu Departamento Regional de Saúde (DRS XIII), no período de outubro de 2015 a dezembro de 2016. Os dados foram coletados no período de outubro de 2015 a janeiro de 2017. Realizou-se avaliação do perímetro craniano (PC), aplicação do HINE e coleta de dados em prontuário. Os dados foram processados e analisados com a utilização do Pacote Estatístico Statistical Package for the Social Sciences (SPSS), versão 22.0. RESULTADOS: Foram avaliadas 18 crianças, sendo predomínio do sexo feminino (55,6%), nascidas a termo, com exceção de uma que nasceu com 32 semanas, maioria originária de Ribeirão Preto (66,7%), via de parto normal (72,2%), ocorrido no Centro Obstétrico do HCFMRP - USP (83,3%), todas as crianças tiveram APGAR maior que 7. O peso de nascimento foi entre 1228 e 3200 gramas, com PC entre 26 e 31,5 cm. 72,2% das crianças fizeram ultrassom transfontanela e 100% fizeram ressonância magnética de encéfalo, com associação entre os resultados encontrados neles (ambos com p<ou=0,001). O score HINE-N foi baixo, porém não foram encontradas associações entre o score e as variáveis clínicas (ambos com p>0,05). Evidenciou-se associação entre a realização de pré-natal e a cidade de residência, local de nascimento, diagnóstico de microcefalia e de infecção pelo ZIKV no pré-natal, tipo de parto (p< ou = 0,001). A medida do PC apresentou associação direta com a presença de crise convulsiva (p<0,05) e houve associação entre crise convulsiva, ventriculomegalia e calcificação (p< ou= 0,001). CONCLUSÃO: O padrão de acometimento neurológico das crianças com microcefalia secundária à infecção congênita pelo ZIKV é muito severo, com presença de sinais precoces de paralisia cerebral desde o exame neonatal. Este estudo sugere seguimento prospectivo desses pacientes para melhor avaliação prognóstica e associação do score HINE com condições clínicas pré e perinatais / INTRODUCTION: There was an epidemic of Zika virus infection (ZIKV) in Brazil between 2015 and 2016, which reflected the increase in cases of neonatal microcephaly secondary to congenital ZIKV infection. A study was carried out for the Hospital das Clínicas of the University of São Paulo at Ribeirão Preto Medical School (HCFMRP-USP), and the followup of these patients was performed using the Neonatal Hammersmith Neurological Exam (HINE-N) aiming to understand the neurological involvement pattern of these children. OBJECTIVES: To evaluate patients with microcephaly secondary to ZIKV congenital infection using HINE-N, to describe the clinical and neuroimaging characteristics of the patients studied, and to identify prenatal, perinatal and demographic factors potentially related to the degree of impairment of neurological examination. METHODOLOGY: This study is part of the Center for Studies on Maternal, Perinatal and Child Infection (NEIMPI) of the HCFMRP-USP. It is a non-experimental, cross-sectional study aimed at correlating qualitative and quantitative variables. Children with microcephaly secondary to congenital ZKV infection born in the city of Ribeirão Preto and its Regional Health Department (DRS XIII), from October 2015 to December 2016, participated in the study. Data were collected in the period of October 2015 to January 2017. An evaluation of the cranial perimeter (PC), the application of HINE and data collection in medical records were performed. Data were processed and analyzed using the Statistical Package for Social Statistical Package (SPSS), version 22.0. RESULTS: A total of 18 children were evaluated, being 55,6% female, all to term with the exception of one who was born at 32 weeks, most of them from Ribeirão Preto (66.7%), normal delivery (72.2%), occurred in the Obstetric Center of the HCFMRP - USP (83.3%), all children had APGAR greater than 7. The birth weight was between 1228 and 3200 grams, with PC between 26 and 31.5 cm. 72.2% of the children had transfontanel ultrasonography and 100% had brain magnetic resonance imaging, with an association between the results found in them (both with p <or = 0.001). The HINE-N score was low, but no associations were found between the score and the clinical variables (both with p> 0.05). It was evidenced an association between prenatal and city of residence, place of birth, diagnosis of microcephaly and ZIKV infection in the prenatal period, type of delivery (p <or = 0.001). The PC measurement presented a direct association with the presence of seizures (p <0.05) and there was an association between seizure, ventriculomegaly and calcification (p <or = 0.001). CONCLUSION: The pattern of neurological involvement of children with microcephaly secondary to congenital ZIKV infection is very severe, with early signs of cerebral palsy since the neonatal examination. This study suggests a prospective follow-up of these patients for better prognostic evaluation and association of the HINE score with pre and perinatal clinical conditions
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Neonatal Intensive Care Unit Speech-Language Pathologists’ Perceptions of Infants with Neonatal Abstinence SyndromeFabrize, Lauren 01 August 2019 (has links)
Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations.
Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics.
Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state.
Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.
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Hipotermia previne alterações comportamentais decorrentes da anóxia neonatal, em ratos / Hypothermia prevents neonatal anoxia-induced behavioral changes, in ratsMatsuda, Victor Daniel Vasquez 27 April 2017 (has links)
Uma das causas mais importantes de lesão encefálica em neonatos na atualidade é a anóxia neonatal. Este é um dos problemas mais graves e comuns nos serviços de perinatologia dos hospitais no mundo, sendo ainda pior em países subdesenvolvidos, devido à carência de precauções e cuidados requeridos. Há relativamente pouco tempo estudos têm indicado que a hipotermia promove um importante efeito neuroprotetor, podendo ser usada como tratamento alternativo promissor para danos causados pela anóxia neonatal. Porém, embora diversas pesquisas mostrem a ação neuroprotetora da hipotermia, não existem evidencias consistentes do seu papel preventivo em relação as alterações comportamentais decorrentes da anóxia neonatal. O objetivo deste trabalho foi avaliar se a hipotermia previne alterações comportamentais decorrentes da anóxia neonatal, incluindo funções de memória espacial, condicionamento aversivo e ansiedade. Foram incluídos no estudo 91 ratos Wistar machos organizados em 4 grupos: anóxia com hipotermia (AH), anóxia sem hipotermia (AC), controle (para anóxia) com hipotermia (CH) e controle sem hipotermia (CC). O protocolo de anóxia neonatal foi iniciado 24 horas após o nascimento dos ratos, usando uma câmara semi-hermética saturada com nitrogênio gasoso. A temperatura da câmera foi mantida a 37°C e o tempo de exposição à anóxia foi de 25 minutos. Animais controle para anóxia foram expostos à mesma câmera, exceto pelo nitrogênio que foi substituído por ar. O tratamento com hipotermia foi iniciado imediatamente após da anóxia em uma câmara a 30°C, onde os animais permaneceram durante 5 horas. O tratamento controle para hipotermia envolveu o mesmo protocolo, exceto pela temperatura da câmera que foi mantida a 37°C. No final do período, os neonatos foram colocados em uma câmara aquecida a 37°C por 40 minutos até se recuperarem. Quando os animais atingiram 70 dias de idade foram submetidos ao paradigma teste-reteste no labirinto em cruz elevado, para avaliar níveis de ansiedade, atividade locomotora e memória aversiva. Subsequentemente, quando os animais fizeram 75 dias, iniciou-se o teste de memória espacial no Labirinto Aquático de Morris. Finalmente, quando os animais atingiram 115 dias de idade, realizou-se o teste de condicionamento de medo ao som e ao contexto. A anóxia neonatal e a hipotermia não interferiram nos níveis de ansiedade no Labirinto em cruz elevado. Porém, a hipotermia aumentou a atividade locomotora e comportamentos de avaliação de risco. Os resultados obtidos no Labirinto Aquático de Morris indicam que a hipotermia previne prejuízos na memória espacial induzidos pela anóxia neonatal. Finalmente, a anóxia neonatal reduziu a taxa de extinção de memória aversivas, efeito que foi prevenido pela hipotermia. No conjunto, esses resultados mostram, por um lado, que a hipotermia previne alterações da memória espacial e de medo condicionado. Por outro lado, eles mostram que a hipotermia induz aumento da atividade locomotora e de comportamentos de avaliação de risco em ratos / Neonatal anoxia is one of the main causes of brain injury in newborns. This is among the most serious problems in many hospitals around the world and is even worse in developing countries due to the lack of required precautions and care. Recent studies have indicated that hypothermia promotes important neuroprotective effects. Thus, it could constitute a promising alternative treatment to dysfunctions caused by neonatal anoxia. Although there have been studies demonstrating that hypothermia promotes neuroprotection following neonatal anoxia, there is no solid evidence showing to which extent this neuroprotection prevents behavioral changes. This study aimed at evaluating to which extent behavioral changes induced by neonatal anoxia are prevented by hypothermia, focusing on anxiety, spatial memory and fear conditioning, in rats. The study included 91 male Wistar rats organized in 4 groups: anoxia with hypothermia (AH), anoxia without hypothermia (AC), control (for anoxia) with hypothermia (CH) and control without hypothermia (CC). Neonatal anoxia protocol started 24 hours after birth, using a semi-hermetic chamber saturated with nitrogen gas. The chamber temperature was maintained at 37°C and the time of exposure to anoxic conditions was 25 minutes. Hypothermia treatment started immediately after the anoxia protocol, within a chamber at 30°C, where the newborns remained for 5 hours. At the end of this period, newborns were transferred to a chamber at 37°C for 40 minutes until its recovery. Control treatment for anoxia involved the same protocol except for the nitrogen that was substituted for air. Control treatment for hypothermia involved to maintain the subjects in the same chamber at 37°C for 5 hours. When the animals were 70 days old, they were subjected to the elevated plus maze, in order to evaluate their anxiety, locomotor activity and aversive memory. Subsequently, when the animals were 75 days old, their spatial memory was evaluated in the Morris Water Maze. Finally, when the animals were 115 days old, they were subjected to an auditory and contextual fear conditioning task. Neonatal anoxia did not interfere with anxiety as evaluated in the elevated plus maze. In contrast, hypothermia by itself increased risk assessment behavior in the elevated plus maze. Performance in the Morris water maze task indicated that hypothermia prevents anoxia-induced disruption of spatial memory. Extinction of both auditory and contextual fear conditioning were slowed by anoxia, and this effect was prevented by hypothermia treatment. Therefore, the present experiments show that hypothermia prevents anoxia-induced (1) disruption of spatial memory and (2) slowing of extinction of fear conditioning; however, by itself, hypothermia increases risk assessment, in rats
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Assistir o nascimento de recém-nascidos com malformação desfigurante: a vivência do enfermeiro / The nurse`s experience for attending babies with visible congenital disfigurement in the delivery roomAlmeida, Marcia Maria Giglio de 02 August 2005 (has links)
O nascimento de um bebê malformado, especialmente, quando a aparência é defigurada, provoca um impacto nos profissionais que prestam atendimento ao recémnascido, imediatamente, após o nascimento, repercutindo na qualidade da assistência prestada. Este estudo foi motivado pela inquietação da pesquisadora procurar compreender as ações e reações dos enfermeiros quando assistem o nascimento de recém-nascidos com malformação desfigurante no contexto da sala de parto. O estudo teve como objetivo: compreender a experiência dos enfermeiros que assistem o nascimento de um recém-nascido com malformação desfigurante. Optou-se por realizar uma pesquisa com abordagem qualitativa, estudo de caso coletivo, e os dados foram analisados à luz do referencial teórico do Interacionismo Simbólico. A coleta de dados ocorreu por meio de entrevista semi-estruturada com enfermeiros que atuam no centro obstétrico de um Hospital Municipal, situado na zona sul da cidade de São Paulo. As entrevistas foram gravadas em fita cassete, posteriormente, transcritas em sua íntegra e analisadas. A análise dos dados permitiu identificar categorias conceituais que compuseram os dois temas: Compartilhando com a equipe médica a assistência ao recém-nascido e Assumindo a responsabilidade da assistência ao binômio mãe-recém-nascido. Os resultados do estudo salientaram a dificuldade enfrentada pelo enfermeiro na assistência do nascimento de um bebê malformado em decorrência do despreparo na formação profissional, relacionada ao processo de comunicação enfermeiro-paciente e dificuldade de lidar com as próprias emoções / The birth of a malformed child, specially when the malformation affects the baby appearance, provokes impact on caregivers who attend the baby immediately after childbirth and on quality of attendance. This study was motivated by the necessity of understanding the performance of nurses when they attend babies with visible congenital malformation. The aim of this study was to understand the nurse`s experience for attending babies with visible congenital disfigurement in the context of delivery room. The qualitative methodological approach used in this study was the Collective Case Study and to analyse data it was used the Symbolic Interactionism theoretical framework. The sample was composed by ten nurses that work at the birth center of a public hospital located in the south district of São Paulo city. Data was obtained by interview that was recorded, transcripted and analysed. From data analysis categories emerged that composed two themes: Sharing the newborn care with medical staff and Assuming the responsibility of the mother-infant care. The results point out the difficulties faced by the nurses when they need to take care of the babies who have visible congenital disfigurement due to their unprepared formation related to the nurse-patient relationship and the difficulties to deal with their emotions
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Serious game E-baby- Família: avaliação de interface de tecnologia educacional digital junto aos pais de bebês pré-termo com foco no quadro respiratório / \"E-Baby-Família\" serious game: assessment of a digital educational technology interface together with parents of preterm babies with a focus on the respiratory conditionFreire, Mayra Jardim Medeiros 22 May 2017 (has links)
Mundialmente, estima-se que nasçam, por ano, 15 milhões de bebês pré-termo com alto risco de morbi-mortalidade neonatal, pós-neonatal e durante a infância, devido à imaturidade dos órgãos/sistemas, principalmente respiratório. A prematuridade é a principal causa de morte em recém-nascidos (especialmente nas primeiras 4 semanas de vida) e agora a segunda causa de morte após pneumonia em crianças com idade inferior a 5 anos. A re-hospitalizações, por afecções respiratórias, são comuns nesta população. No Brasil, 72,9% das pessoas no Brasil têm acesso à internet, seja por computador, celular ou tablet, esse dado reforça a relevância de introduzir novas tecnologias no campo da pesquisa e do processo de ensino- aprendizagem, em computadores (e-learning) e em dispositivos móveis (m-learning). Acreditando na importância da tecnologia adequada ao uso e em especial, respondendo de forma adequada à clientela, público alvo desta, elegeu-se, para este estudo como objetivo avaliar a interface de uma tecnologia educacional digital - jogo de computador, sobre a identificação e cuidado acerca do quadro respiratório do bebê pré-termo, junto à família, com base em critérios ergonômicos. Trata-se de um estudo metodológico, com avaliação embasada nos critérios ergonômicos estabelecidos pelo Ergolist (2008) junto aos pais de bebês pré-termo. A coleta de dados foi executada por meio da caracterização dos sujeitos, e avaliação objetiva sobre o game. Com base nos dados coletados através do questionário de avaliação ergonômica de interface do serious game E-Baby-Família, todos os itens do formulário de receberam mais de 70% de concordância com as afirmações realizadas quanto ao game. Com isso, podemos concluir que o serious game \"E- Baby-Família \" foi avaliado positivamente quanto à ergononomia de sua interface, demonstrando sua viabilidade para uso com os pais de bebês nascidos prematuros. Os pais, cada vez mais participativos no cuidado aos filhos pré-termo em unidades neonatais necessitam aprender sobre seus filhos e podem ser beneficiados pela tecnologia realística. Com esse estudo, reforçamos a ideia sobre a importância em incluir a família no suporte ao bebê pré-termo, preparando-os para os cuidados que deverão ser prestados no domicílio, amenizando suas inseguranças e prevenindo o bebê prematuro de possíveis complicações que possam acontecer após a alta hospitalar. Atrelado a isso, podemos ressaltar sobre a importância do uso de ferramentas tecnológicas em uma era onde os avanços na área da tecnologia só agregam valores às práticas do processo de ensino-aprendizagem / Globally, it is estimated that, every year, 15 million preterm babies are born with a high risk of neonatal and post-neonatal morbimortality, or even during childhood, because of the immaturity of the organs/systems, mainly the respiratory ones. Prematurity is the major cause of death in newborns (especially in the first 4 weeks of life), and now the second greatest cause of death after pneumonia in children under the age of 5. Re-hospitalizations because of respiratory disorders are common in this population. In Brazil, 72.9% of people in Brazil have access to the internet, whether by means of a computer, cell phone or tablet, and this data emphasizes the relevance of introducing new technologies in the field of research and of the teaching-learning process, on computers (e-learning) and on mobile devices (m- learning). By believing in the importance of the technology suited to the use and, in particular, responding in an appropriate way to the clientele, i.e., the target audience of this technology, the objective chosen for this study focused on the assessment of the interface of a digital educational technology - computer game, with respect to the identification and care of the respiratory condition of the preterm baby, together with the family, based on ergonomic criteria. This is a methodological study, with an assessment underpinned by the ergonomic criteria established by the Ergolist (2008), involving parents of preterm babies. Data collection was performed by means of the characterization of the subjects, in addition to an objective assessment of the game. Based on the data collected through the questionnaire for assessing the ergonomic interface of the \"E-Baby-Família\" serious game, all items of the form received over 70% agreement with the statements made with respect to the game. Accordingly, we can conclude that the \"E-Baby-Família\" serious game was positively assessed with regard to the ergonomics of its interface, which proves its feasibility to use with the parents of prematurely born babies. Parents, who are increasingly involved in the care of preterm children in neonatal units, should learn about their children, and therefore may be benefited from the realistic technology. With this study, we highlight the idea about the importance of including the family members in the support towards the preterm baby, thereby preparing them for the care that should be provided at home, mitigating their insecurities and preventing the premature baby from possible complications that may take place after hospital discharge. Coupled with this, we can point out the importance of the use of technological tools in an era in which the advances in the field of technology only add value to the practices of the teaching-learning process
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Morbidade e mortalidade de recém-nascido pré-termo de mães portadoreas de corioamnionite histológica / Morbidity and Mortality of Preterm Newborns of mothers with histological ChorioamnionitisKandler, Ingrid 18 August 2017 (has links)
Introdução: A infecção amniótica e a corioamnionite (CAM) são determinantes de infecções materna e do recém-nascido, parturição e nascimento prematuro, morbidade e mortalidade pós-natal. Embora métodos clínicos, histopatológicos, microbiológicos, bioquímicos e moleculares possam diagnosticar CAM, muitos serviços hospitalares não examinam as placentas das parturientes, permanecendo muitos casos sem diagnóstico. O presente estudo utiliza o exame extemporâneo do cório placentário (EECP) proposto por Blanc em 1959 para o diagnóstico de CAM em mães que tiveram Recém-Nascido Pré- Termo (RNPT) e avaliou a morbidade e mortalidade nesse grupo de pacientes. Objetivo: Verificar a relação entre a CAM histológica e o prognóstico do RNPT nascidos no ano de 2012 no Hospital Universitário Cassiano Antônio de Moraes (HUCAM) em Vitória - ES. Justificativa: A maioria dos óbitos do período neonatal continua sendo por sepse, e esta também leva muitas sequelas no RNPT, assim exames que possam auxiliar no diagnóstico precoce da sepse neonatal ajudarão na instituição rápida do tratamento e consequentemente redução das sequelas, da mortalidade neonatal e redução dos índices de mortalidade neonatal e mortalidade infantil. Hipótese: RNPT filhos de mães com CAM terão mais complicações pós-parto, tais como: sepse neonatal, insuficiência respiratória, asfixia perinatal e óbito do que aqueles cujas mães não tiveram CAM. Metodologia: Estudo transversal, onde todas as placentas examinadas e laudadas no ano de 2012, no laboratório de Patologia do HUCAM em Vitória, ES, foram analisadas em conjunto com a evolução dos RNPT. Os casos foram categorizados por idade gestacional, desfecho perinatal e presença ou ausência de CAM. Resultados: No presente estudo foram selecionados 274 RNPT, desses 61 (22,2%) as placentas foram positivas para CAM e 213 (77,8%) as placentas foram negativas CAM. Quanto ao sexo (51,5%) eram masculinos (48,5%) eram femininos e não houve diferença estatiscamente significante.Quanto ao Apgar 5\', 14 (5,1%) tiveram Apgar menor ou igual a 5 e 260 (94,9%) tiveram Apgar maior do que 5.Quanto ao peso, nos RNPT selecionados 82 (29,9%) foram classificados como PIG, 184 (67,2%) foram classificados como AIG e 8 (2,9%) foram classificados como GIG.Quanto a necessidade de oxigenioterapia 154 (56,2%) necessitaram de suporte ventilatório e oxigênio nas primeiras 72 horas de vida e 116 (42,4%) ficaram em ar ambiente, sem necessidade de oxigênio nas primeiras 72 hs de vida. Quanto a sepse neonatal 140 (51%) tiveram hemograma classificado pelo Escore de Rodwell menor ou igual a 3, ou seja, sem risco para sepse neonatal precoce e 16 (5,9%) tiveram Escore Rodwell maior ou igual a 3, com risco para sepse neonatal precoce. Quanto o desfecho do RNPT, 169 (61,7%) dos casos receberam alta, 78 (28,5%) foram transferidos para outras Unidade de Terapia intensiva Neonatal (UTIN) devido superlotação do HUCAM e 27 (9,9%) dos casos foram a óbito.Teste t para médias e Teste de Mann-Whitney, foi encontrada diferença estatisticamente significante nas variáveis: Idade gestacional, Peso ao nascer, Estatura ao nascimento (EM), Pressão Arterial Média (PAM), número total de leucócitos (LEUCO) e proteína C reativa (PCR), já as variáveis frequência cardíaca (FC), temperatura axilar (TAX), leucócitos imaturos (IMAT), leucócitos segmentados (SEG) e plaquetas (PLAQ) não houve diferença estatística significante entre os grupos com CAM e sem CAM. Discussão: O estudo demonstrou que os RNPT nascidos de mães com CAM são mais graves, pois tem mais chances de nascerem asfixiados, ter insuficiência respiratória grave com necessidade de VPM, sepse neonatal precoce e vão mais a óbito do que os RNPT de mães sem CAM. Conclusão: Se a gestante apresentar sinais clínicos de infecção no trabalho de parto, deve-se ficar atento ao suporte que será dado ao RNPT, pois ele tem mais chances de apresentar complicações ao nascimento tais como, asfixia e insuficiência respiratória. Assim o EECP deve ser feito o mais rápido possível e o resultado entregue a equipe de Neonatologia do serviço para que a terapêutica antimicrobiana seja instituída precocemente e não precise aguardar alterações no hemograma e PCR e/ou na clínica do paciente para ter o início do tratamento da infecção / Introduction: Amniotic infection and chorioamnionitis (CAM) are determinants of maternal and newborn infections, parturition and preterm birth, postnatal morbidity and mortality. Although clinical, histopathological, microbiological, biochemical and molecular methods can diagnose CAM, many hospital services do not examine the placenta of the parturients, many cases remain undiagnosed. The present study utilizes extemporaneous placental laryngoscopy (ECC) proposed by Blanc in 1959 for the diagnosis of CAM in mothers who had Preterm Newborn (PTNB) and evaluated morbidity and mortality in this group of patients. Objective: To verify the relationship between the histological CAM and the prognosis of the PTNB born in 2012 at the Cassiano Antônio de Moraes University Hospital (HUCAM) in Vitória - ES. Rationale: Most neonatal deaths continue to be sepsis, and this also leads to many sequels in PTNB, so tests that may help in the early diagnosis of neonatal sepsis will aid in the rapid institution of treatment and consequently reduction of sequelae, neonatal mortality, and Reduction of neonatal mortality rates and infant mortality. Hypothesis: Children born to mothers with CAM will have more postpartum complications such as: neonatal sepsis, respiratory failure, perinatal asphyxia and death than those whose mothers did not have CAM. Methodology: Cross-sectional study, in which all the placentas examined and lauded in 2012, in the HUCAM pathology laboratory in Vitória, ES, were analyzed together with the evolution of the PTNBs. The cases were categorized by gestational age, perinatal outcome and presence or absence of CAM. Results: In the present study, 274 PTNBs were selected, of which 61 (22.2%) placentas were positive for CAM and 213 (77.8%) placentas were CAM negative. As for the gender (51.5%) were male (48.5%) were female and there was no statistically significant difference. As for Apgar 5 \', 14 (5.1%) had Apgar less than or equal to 5 and 260 9%) had Apgar greater than 5. Regarding weight, 82 (29.9%) were classified as PIG, 184 (67.2%) were classified as AIG, and 8 (2.9%) were (56.2%) required ventilatory support and oxygen in the first 72 hours of life, and 116 (42.4%) remained in ambient air, with no need for oxygen in the first 72 hours of life. life. As for neonatal sepsis, 140 (51%) had a hemogram classified by Rodwell score less than or equal to 3, that is, without risk for early neonatal sepsis, and 16 (5.9%) had Rodwell score greater than or equal to 3, with risk For early neonatal sepsis. Regarding the outcome of the PTNB, 169 (61.7%) of the cases were discharged, 78 (28.5%) were transferred to other NICUs due to overcrowding of HUCAM and 27 (9.9%) of the cases died. For mean and Mann-Whitney tests, a statistically significant difference was found in the following variables: gestational age, birth weight, height at birth, mean arterial pressure (MAP), total leukocyte count (LEUCO) and C-reactive protein PCR), the variables heart rate (HR), axillary temperature (TAX), immature leukocytes (IMAT), segmented leukocytes (SEG) and platelets (PLAQ) were not statistically significant between CAM and CAM groups. Discussion: The study showed that the infants born to mothers with CAM are more severe, as they are more likely to be asphyxiated, have severe respiratory insufficiency with need for MVP, early neonatal sepsis and more than death of the infants of mothers without CAM. Conclusion: If the pregnant woman presents clinical signs of infection in labor, one should be aware of the support that will be given to the PTNB, since it is more likely to present complications at birth, such as asphyxia and respiratory failure. Thus the EECP must be done as soon as possible and the result delivered to the Neonatology team of the service so that the antimicrobial therapy is instituted early and does not have to wait for changes in the blood count and PCR and / or in the patient\'s clinic to have the beginning of the treatment Infection
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