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Submitted by Nadir Basilio (nadirsb@uninove.br) on 2018-07-20T19:48:50Z No. of bitstreams: 1 André Gustavo Moura Guimarães.pdf: 1691381 bytes, checksum: b4f575802538a0af96f868e24171236c (MD5) / Made available in DSpace on 2018-07-20T19:48:50Z (GMT). No. of bitstreams: 1 André Gustavo Moura Guimarães.pdf: 1691381 bytes, checksum: b4f575802538a0af96f868e24171236c (MD5) Previous issue date: 2018-03-06 / Introduction: neonatal pain results in neurobiological effects, and changes in behavioral reactions of children who were born prematurely. There is no clear description about the pain caused by chest physiotherapy technique, nor about the possible non-pharmacological interventions to prevent it. Objective: to evaluate neonatal pain and physiological parameters during the chest physiotherapy in premature neonates (PTNB) in neonatal intensive care. Method: a randomized controlled trial, not blinded, in which 120 PTNB in mechanical ventilation were studied. They were randomized into four groups: control group (CG), diaphragmatic stimulation group (EDG), manual hyperinflation group (MHG), thoracic vibration group (VTG), containing 30 individuals in each one. The protocol consisted of 3 phases, the first phase being considered the control, and the other associated with non-pharmacological techniques to reduce pain: application of the technique (phase 1), application of technique + facilitated tucking (phase 2), application of technique + glucose (phase 3). Heart rate (HR), respiratory rate (RR), SpO2, Behavioral pain scale Indicators of Infant Pain (BIIP, ranges from 0 to 10) and Neonatal Infant Pain Scale (NIPS, ranges from 0 -7) were recorded at pre, during and after (15 minutes) the procedures described. Results: 62 (51.66%) RNPT were female, and most considered small for gestational age (83, 69%). Physiological variables (HR, FR, and SpO2) behaved in a similar manner in all groups (CG, MHG, EDG, VTG), being greater in phase 1, however these variables were reduced at phase 2 and 3 (p < 0.05). This means that during the application of non-pharmacological intervention (facilitated tucking or glucose) there was reduction of those variables. BIIP and NIPS scales showed increased in all of the groups in the phase 1 during the application of the techniques, however, similar to the physiological variables, these scales had reduced scores when applied to facilitated tucking (phase 2) or glucose (phase 3), p < 0.05. The number of individuals who have had pain assessed by BIIP (> 3 points) at the moment after in the phase 1 was 83 (69%), in phase 2 was 22 (18%), and in phase 3 of 34 (28%), p < 0.001. Conclusions: The chest physiotherapy techniques can increase the pain in PTNB, however, the non-pharmacological techniques, such as facilitated tucking and glucose, were able to reduce it. / Introdução: A dor neonatal desencadeia efeitos neurobiológicos agudamente, e alterações nas reações comportamentais da criança nascida prematuramente. Não há descrição clara sobre a dor ocasionada por técnicas manuais de fisioterapia respiratória, tampouco sobre as possíveis intervenções não farmacológicas na prevenção da mesma. Objetivo: Avaliar a dor neonatal e parâmetros fisiológicos durante a fisioterapia respiratória em neonatos prematuros na UTI neonatal. Metodologia: ensaio clínico randomizado controlado, não cego, no qual foram estudados 120 recém-nascidos prematuros (RNPT), de ambos os sexos, em ventilação mecânica. Foram randomizados em quatro grupos: grupo controle (GC), grupo estimulação diafragmática (GED), grupo hiperinsuflação manual (GHM), grupo vibração torácica (GVT), contendo 30 indivíduos em cada. O protocolo constou de 3 fases, sendo a primeira fase considerada a controle, e as demais associadas a técnicas não farmacológicas de redução da dor: aplicação da técnica (fase 1), aplicação da técnica e contenção (fase 2), aplicação da técnica e glicose (fase 3). A frequência cardíaca (FC), respiratória (FR), SpO2, escala de dor Behavioral Indicators of Infant Pain (BIIP, varia de 0 a 10) e Neonatal Infant Pain Scale (NIPS, varia de 0 -7) foram registradas pré, durante e após (15 minutos) dos procedimentos em cada fase descrita. Resultados: 62 (51,66%) dos RNPT do sexo feminino, e a maioria considerados pequenos para idade gestacional (83 69%). As variáveis fisiológicas (FC, FR, e SpO2) se comportaram de maneira semelhante, em todos os grupos, sendo maior na fase 1, reduzindo nas fases 2 e 3 (p<0,05). Durante a aplicação de intervenção não farmacológica (contenção ou glicose) houve redução daquelas variáveis. As escalas BIIP e NIPS mostraram aumento em todos dos grupos na fase 1 durante a aplicação das técnicas, sendo reduzida a dor quando aplicado a contenção (fase 2) ou a glicose (fase 3), p< 0,05. O número de indivíduos que tiveram dor avaliado pela BIIP (> 3 pontos) no momento após na fase 1 foi 83 (69%), na fase 2 foi 22 (18%), e na fase 3 de 34 (28%) p< 0,001. Conclusões: As técnicas de manuais de fisioterapia respiratória demonstraram gerar dor nos RNPT, entretanto, técnicas não farmacológicas como contenção e glicose foram capazes de reduzi-la.

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: Årligen behöver cirka 11 500 barn vård på en neonatalavdelning, här vårdas för tidigt födda och vid födseln sjuka barn. Inläggningen är ofta en stressande upplevelse för föräldrarna till barnet. Sjuksköterskan har ett ansvar att vara lyhörd, respektfull och kommunicera väl med föräldrarna. Syfte: Syftet med studien var att belysa föräldrars upplevelse i samband med att barnet vårdas på en neonatalavdelning. Metod: Studien genomfördes som en litteraturstudie. Tre olika vetenskapliga databaser med omvårdnadsfokus användes och åtta resultatartiklar ingick i studien. Dessa artiklar analyserades med hjälp av innehållsanalys. Resultat: Framförallt framkom det att föräldrarna hade många emotionella upplevelser i samband med vistelsen på neonatalavdelningarna. Vidare lyftes betydelsen av kommunikation och information ifrån vårdpersonalen i samtliga artiklar. Delaktigheten i barnets vård och att få utföra föräldrauppgifter var av stor vikt. Konklusion: Behovet av stöd och kommunikation från sjuksköterskan till föräldrar var stort. Delaktigheten stärktes när föräldrarna involverades i vården, samt att deras anknytning till barnet förbättrades. / Background: Annually, about 11,500 children need care in a neonatal ward, cared for here are premature children and children who are ill from birth. The hospitalization is often a stressful experience for the parents of the child. The nurse has a responsibility to be sensitive, respectful and communicate well with the parents. Aim: The purpose of the study was to shed light on parents’ experience in connecting with their child while being cared for in the neonatal ward. Method: The study was conducted as a literature study. Eight results articles were collected through three different scientific databases with a focus on nursing. These articles were then analyzed using a content analysis. Results: Above all, it appears that the parents have many emotional experiences in connection with the neonatal stay. The meaning of communication and information from healthcare professionals is seen together in all articles. The participation in their child's care and being able to perform parental tasks was of great importance. Conclusion: The need for support and communication from the nurse to parents was great. Participation was strengthened when the parents were involved in the care and their connection to the child improved.

Introduction Neonatal abstinence syndrome (NAS) is a health condition in infants that results from the sudden discontinuation of substances that infants were exposed to in utero (Kocherlakota, 2014). Typical symptoms include: hyperirritability, sweating, hypertension, tremors, sleep deprivation, and seizures (Kocherlakota, 2014). The role of a SLP in treating infants with NAS in the NICU includes evaluation, assessment, and treatment of the feeding cycle. Our research is an early exploratory and descriptive study of the pre-natal, peri-natal, and post-natal characteristics of infants with NAS who required SLP assessment and intervention as opposed to those who did not. Our aim was to examine possible predictors of infants with feeding and swallowing difficulties. Methods Data was collected from a local hospital system that conducted a five-year retrospective chart review study. From charts of 140 infants in the NICU, infants were placed into two groups: infants who received SLP services (SLP group) and infants who did not receive SLP services (NSLP group). From those charts, 26 infants with NAS who received SLP services were placed in SLP group based on the availability of a match in NSLP group. Infants in both groups were matched based on gestational age, year of birth, and gender. Results/Conclusion There were no significant differences found between SLP group and NSLP groups in: number of prenatal visits, week/timing of initial prenatal visit, and dosage of buprenorphine taken by the mother. The two groups did not differ (all ps>.18) in their types of drug use, average dosage of buprenorphine taken, average number of prenatal visits, or average week of first visit. There was a statistically significant difference in maternal age in the SLP group (p<.05; M=29.7 years, SD=5.4) and in NSLP group (M=26.7 years, SD=4.3.). There was no statistically significant difference in initial measurements of weight, head circumference, length, Apgar scores at birth, and number of complications between groups. There were no significant differences found in NAS scores between groups regarding the highest NAS score or average NAS score, number of NAS scores and first day of collection or number of days collected. There was a statistically significant difference in the number of prescription drugs administered. Infants in SLP group had more prescription drugs on average (M=1.50, SD=.89) than NSLP group (M=1.04, SD=.20). There was a statistically significant difference in the amount of weight gained (SLP group gained 229 more grams) and in infant length of stay and overall cost (SLP group on average stayed in the NICU one week longer and cost $22,896 more). Little research has been conducted regarding NAS and the impact it has on feeding and swallowing. We found that there are statistically significant differences among infants who were in SLP and NSLP groups. It cannot be determined how many full-term infants have dysphagia; however, from a clinical opinion it is thought that most full-term babies with dysphagia also have a neurological impairment.

Background: Neonatal Abstinence Syndrome (NAS), a manifestation of the widespread opioid epidemic, has plagued our country, and particularly the region of Northeast Tennessee, for quite some time now. One question among many that seems to baffle almost everyone involved in research on the topic at hand is that why do only 35-40% of opioid exposed pregnancies result in NAS requiring medication while sparing the rest. Is there some discriminatory factor other than in utero opioid exposure involved? Thus, in light of this knowledge, we wanted to investigate whether birth weight at the time of delivery can influence the development of NAS; that is, are neonates of a low birth weight or high birth weight (with respect to gestational age thresholds) more likely to develop NAS. Methods: Therefore, we conducted a retrospective chart analysis of all deliveries within the Mountain States Health Alliance System over a 5 years period between July 1, 2011- June 30, 2016 at all 5 delivery sites in Northeast Tennessee and Southwest Virginia (N=18,728). Out of this sample size, we identified 2,392 at-term newborns as positive for prenatal opioid exposure, and then we stratified them into 2 categories: birth weight ≤3.5kg (proxy for low or average birth weight with respect to gestational age thresholds) and birth weight ≥3.5kg (proxy for high birth weight with respect to gestational age thresholds). Thereafter, we ran SPSS statistical analyses involving chi square, t tests, and logistic regression to assess whether one birth weight group was more likely to have a higher incidence rate of NAS compared to the other birth weight group. Results: We found that even after controlling for significant confounders such as marital status, race, and pregnancy smoking, benzodiazepine, and marijuana use, infants who were in the low to average birth weight group (≤3.5kg in this study) were almost twice as likely (statistically significant adjusted odds ratio of 1.95) to develop NAS compared to infants who were in the high birth weight group (≥3.5kg in this study). Our study helps shed some important light on the discriminatory factors for NAS development, with birth weight being a significantly associated clinical factor as we now know. Discussion & Implications: Unfortunately, the mechanism for the transport of opioids across the placenta is complicated, and poorly understood. There may be more ‘unbound or free opioids’ available in infants of low to average birth weight (with respect to gestational age thresholds) compared to infants of high birth weight (with respect to gestational age thresholds) resulting in a higher incidence of NAS in the former population. It is more of a speculation rather than a conclusion to explain the results of our study. However, being equipped with this knowledge that opioid exposed neonates of low to average birth weight (with respect to gestational age thresholds) have a higher risk of developing NAS will allow physicians to identify infants with a higher risk for NAS early, and this will subsequently lead to better outcomes and reduced severity in cases of NAS.

Background: The incidence of neonatal opioid withdrawal syndrome (NOWS), a drug withdrawal syndrome mainly associated with opioid exposure in-utero has significantly increased in the United States over the last decade with infants with NOWS staying longer in the hospital than those without NOWS. Objectives: To determine if feeding tube use while on admission is associated with length of hospital stay among infants diagnosed with NOWS. We also compared the differences between infants with NOWS who required the use of feeding tubes while on admission, and those that did not, based on infant and maternal characteristics. Methods: This was a retrospective cohort study of infants delivered between July 1, 2011 and June 30, 2016 at Ballad Health System. Our inclusion criteria were infants who were exposed to opioids in-utero and received a diagnosis of NOWS based on 2 consecutive Finnegan scores of 10, or 3 consecutive scores of 8, or treatment with morphine. Medical chart record of 294 infants who met these criteria were reviewed for infant and maternal characteristics. Our outcome variable was infant length of hospital stay and our predictor variable was feeding tube use an indicator for feeding difficulties. Chi-square test and t-test were used to compare infant and maternal characteristics by feeding tube use. Simple linear regression models were used to assess the effect of feeding tube use and infant and maternal characteristics on infant length of hospital stay. Multiple linear regression was used to model infant length of hospital stay predicted by feeding tube use, while adjusting for neonatal intensive care unit (NICU) admission, treatment with morphine, and maternal benzodiazepine use during pregnancy. All analyses were done using SAS 9.4. Results: Of the 294 infants diagnosed with NOWS, 22.11% had feeding difficulties that necessitated use of feeding tubes. Infants who used feeding tubes were significantly more likely to be born preterm (20.31% vs 8.73%, p=0.0096) to be admitted into the NICU (98.46% vs 51.09%, p=

ABSTRACT Background: Kangaroo-mother care (KMC) is a vital part of the neonatal care. The method is based on skin to skin contact, where the parent or another caregiver, holds the child on itsbare chest for an extensive period of time. This has been proven to have a positive effect on the childs physical and mental development. Less extensive research has been made on the methods effects on the parents.  Aim: The aim of this studie was to describe the parents experience of used KMC during their childs time on a NICU (neonatal intensive care unit).  Method: A literature study with descriptive design. Based off of 12 original qualitative studies from the databases PubMed, CINAHL and Web of Science.  Results: The parents experiences could be devided into four themes: Emotional- and physical experiences as a result of KMC, the unit’s effect on the experience of KMC and bonding. The method was appreciated by the parents and the overall experience was positive. However, the method can be demanding for the parents and the staff and environment on the NICU have a big influence on the experience.  Conclusion: Time on a NICU can be stressful for both child and parents. KMC has been proven to be beneficial for the child, but also for the parents’ experience of their childs care. The method should be practiced as much as possible, with the influence of the health care staff and unit’s environment. Keywords: Kangaroo-mother care method. Intensive care. Neonatal. Infant. Parents. / SAMMANFATTNING Bakgrund: Kängurumetoden (KMC) utgör en vital del av omvårdnaden på neonatala vårdavdelningar. Metoden utgörs av hud mot hud kontakt, där föräldern eller en annan vårdgivare har barnet vilande på bröstkorgen under en längre tid. Detta har visats ha positiv effekt på barnets fysiska och psykiska utveckling. Det finns mindre forskning gällande metodens effekt på föräldrarna . Syfte: Syftet var att beskriva föräldrarnas upplevelse av genomförd kängurumetod under sitt barns vårdtid på neonatal intensivvårdsavdelning. Metod: Litteraturstudie med beskrivande design och som är av kvalitativ karaktär. Baserat på 12 kvalitativa originalartiklar från databaserna PubMed, CINAHL och Webof Science.  Resultat: Föräldrarnas upplevelser kunde delas in i fyra kategorier; känslomässiga upplevelser till följd av KMC, kroppslig upplevelse till följd av KMC, vårdavdelningens påverkan på upplevelsen och anknytning. Metoden var något som uppskattades och upplevelsen var övervägande positivt. Dock ställer den krav på föräldrarna, där också vårdpersonal och vårdmiljö har en viktig påverkan. Slutsats: Tiden på en neonatal intensivvårdsavdelning kan vara påfrestande för både barn och föräldrar. Kängurumetoden har visats vara gynnsam för både barnet men också föräldrarnas upplevelse. Metoden bör tillämpas i så stor utsträckning som möjligt, där vårdpersonal och avdelning har en viktig roll. Nyckelord: Kängurumetoden. Intensivvård. Neonatal. Spädbarn. Föräldrar.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Background: The role of the physiotherapist in the neonatal intensive care unit is unclear. How other neonatal healthcare professionals and physiotherapists themselves perceive their role in the management of neonates, their practice patterns and services, their role in the neonatal intensive care multidisciplinary team, their use of evidence-based practice and awareness of the profession in this setting has not been well explored. This information is lacking in the South African healthcare context as well. Therefore, the aim of the study was to explore and describe the perception of doctors, nurses and physiotherapists of the role of the physiotherapist in public and private sector neonatal intensive care units in South Africa. Methods: A qualitative exploratory research design was used. All medical practitioners (paediatricians and neonatologists), nurses and physiotherapists working in the neonatal intensive care units in two private sector and two public sector hospitals in the Cape Metropole region in the Western Cape South Africa who provided consent to participate were included. An inclusive (total population) sampling method was used where all healthcare professionals working in these units were invited to an individual face-to-face audiotaped interview using a semi-structured interview guide and conducted by the researcher at a time and place convenient to the participants following informed consent. Data was transcribed verbatim and analysed using both deductive and inductive thematic content analysis to develop codes, categories and themes. Trustworthiness was ensured by ensuring credibility, conformability, dependability and transferability of data. Ethics was obtained from the relevant Institutional Review Board. Results: Twenty-one healthcare professionals participated, including doctors (n=5), nurses (n=6) and physiotherapists (n=10). The mean age in years of the participants was 41+/–11 years with the physiotherapists having the lowest mean age. The participants had various years of general and neonatal intensive care experience and physiotherapists in specific only had basic undergraduate qualifications with minimal specialised training in neonatal intensive care. Five major themes emerged namely: i) the role of the physiotherapists in the management of the neonatal ICU patient, ii) practice patterns and services iii) teamwork iv) training and qualifications including evidence-based practice, v) awareness of and exposure to neonatal intensive care physiotherapy. Conclusion: Physiotherapists working in this neonatal intensive care setting need to promote their profession through education of other neonatal healthcare professionals in order to improve awareness, referral patterns and integration into the multidisciplinary team. Evidence-based practices and improving training and skills development in the area of neonatal physiotherapy can be further explored in this setting.

Syfte: Att kartlägga barnmorskors erfarenheter vid akut omhändertagande av barn i samband med förlossning. Metod: Kvantitativ tvärsnittsstudie. Datainsamling genom webbenkäter som analyserades med deskriptiv statistik. Resultat: Totalt besvarades 100 enkäter av barnmorskor verksamma på förlossningsavdelning. Av barnmorskorna uppgav 64 % att de med säkerhet kunde identifiera barn med asfyxi, 49 % kunde utföra neonatal HLR med säkerhet. Både barnmorskor med kortare och längre erfarenhet behövde mer teoretisk och praktisk kunskap i akut omhändertagande av barn vid födelsen, mest kunskap behövde de med kortast erfarenhet. Barnmorskor med kortare erfarenhet var även mindre säkra i att stödja och informera föräldrar när barnet behövde akut omhändertagande. Slutsats: Det är barnmorskors ansvar att handlägga barn som är i behov av akut omhändertagande vid förlossning. Det är möjligt att det behövs mer förberedelser och längre introduktion i ämnet för nyutexaminerade barnmorskor. / Aim: To examine midwives experiences in emergency care of children immediately after birth. Method: Quantitative cross-sectional study. Data were collected through a web based survey and analyzed with descriptive statistics. Result: A total of 100 questionnaires were answered by midwives working at maternity wards. Among the midwives 64 % could with certainty identify children with asphyxia, 49 % could perform neonatal CPR with certainty. Midwives experienced a need for more theoretical and practical knowledge in emergency care of children at birth, those with the least experience felt a higher need for additional knowledge. Midwives with the least experience were less certain in the support of parents when their newborn needed emergency care. Conclusion: It is the midwives’ responsibility to care for children who are in need of emergency care during childbirth. It is possible that more preparation and longer introduction to the subject for new graduate midwives is needed.