O Ferro (Fe) atua em vários processos metabólicos, principalmente do neurodesenvolvimento, cujo conteúdo corporal é ainda de difícil determinação, podendo sofrer influência de fatores como a prematuridade e o Crescimento Intrauterino Restrito (CIUR). Este estudo objetivou descrever a evolução hematológica e do conteúdo de Fe em Recém-Nascidos (RN) de Termo (T) e Pré-Termo Tardios (PT T), com e sem CIUR, em aleitamento materno exclusivo, durante os primeiros dois meses de vida, analisando a influência da prematuridade, presença de CIUR e evolução nutricional. Incluiu-se 95 RN: Grupo 1A, 25 RN PT T sem CIUR; Grupo 1B, 24 RN PT T com CIUR; Grupo 2A, 21 RN T sem CIUR e Grupo 2B, 25 RN T com CIUR. A presença de CIUR foi determinada pelo peso nascimento <P5 para a curva de Alexander. Determinou-se ao nascimento, com um e dois meses de idade: medidas antropométricas (peso, comprimento e perímetro cefálico) e Índice de Massa Corporal (IMC), Hemoglobina (Hb), Hematócrito (Ht), Reticulócitos (Ret), Volume Corpuscular Médio (VCM), Hemoglobina Corpuscular Média (HCM), Variação da Distribuição das Células Vermelhas (RDW), Capacidade de Ligação do Fe (CLFe), Saturação de Transferrina (SatTf), Fe sérico e Ferritina. As análises estatísticas basearam-se: Teste não paramétrico de Kolmogorov-Smirnov para testar normalidade. ANOVA One-Way ou Kruskall-Wallis para a análise das variáveis contínuas; Teste Exato de Fischer ou Qui-quadrado para comparação de proporções; Coeficiente de Pearson para análise de correlações. Odds Ratio e respectivos 95% Intervalos de Confiança para avaliação do risco de anemia. Significância de 5%. As medidas antropométricas e IMC evoluíram com aumento ao longo do tempo (p<0,001). Os valores hematológicos reduziramse ao longo do tempo (p<0,001). A Hb foi maior nos grupos com CIUR ao nascimento e no T sem CIUR com dois meses (p<0,001). A variação relativa da Hb entre dois meses e nascimento foi maior no PT T com CIUR e menor no T sem CIUR (p<0,001). As reservas de Fe modificaram-se em todos os grupos. A CLFe foi maior no T sem CIUR ao nascimento (p<0,001) e com um mês vida (p=0,008). O Fe foi maior no T sem CIUR ao nascimento (p<0,001) e menor no PT T com CIUR que os grupos RN T com um mês de vida (p=0,007). A ferritina não apresentou diferenças entre os grupos. A Resumo _____________________________________________________________________________________________ xxxii SatTf foi maior no T sem CIUR ao nascimento (p<0,001) e a variação relativa da SatTf superior no PT T com CIUR (p=0,001). A Hb correlacionouse com o peso em todos os grupos (p<0,001) e a Ferritina nos PT T sem CIUR (r=-0,3250; p=0,0068) e com CIUR (r=-0,3280; p=0,0063). A anemia foi mais frequente nos grupos com CIUR (90,5% PT T com CIUR e 90% T com CIUR), sendo maior entre os RN de T com CIUR em relação aos sem CIUR (OR=16,500; p=0,0013) e nos PT T com CIUR em relação aos T sem CIUR (OR=17,417; p=0,0005). Provavelmente, as diferentes evoluções das reservas de Fe e a maior redução da hemoglobina no PT T com CIUR deveram-se à influência da prematuridade e do CIUR sobre seu crescimento. O CIUR parece ser o fator mais importante no desenvolvimento de anemia em RN em aleitamento materno exclusivo, pois somente os grupos com CIUR apresentaram risco de anemia aos dois meses de idade / Iron (Fe) acts in several metabolic processes, especially neurodevelopmental ones, which body content is still the difficult access and could be influenced by factors, such as, prematurity and Intrauterine Growth Restriction (IUGR). This study aimed at describing the hematological evolution and iron body content in Term (T) and Late Pre-Term (LPT) Newborns (NB), with and without IUGR, exclusive breastfeeding, during the first two months of life, and analyzing the prematurity influence, UGR presence and nutritional evolution. 95 NB were included: Group 1A, 25 LPTNB without IUGR, Group 1B, 24 LPTNB with IUGR, Group 2A, 21 TNB without IUGR and Group 2B, 25 TNB with IUGR. The presence of IUGR was determined by birth weight <P5 of Alexander Curve. At birth, one and two months of age were determined: anthropometric measures (weight, length, cephalic circumference) and Body Mass Index (BMI), Hemoglobin (Hb), Hematocrit (Ht), Reticulocytes, mean corpuscular volume, mean corpuscular hemoglobin, red blood cells distribution width, serum Fe, ferritin, Iron Binding Capacity (IBC) and Transferrin Saturation (TfSat). Statistical analysis was based on: Kolmogorov-Smirnov Test was used to verify normality. ANOVA One-Way or Kruskal-Wallis Test for continuous variables analysis, Fisher\'s Exact Test or Chi-Square Test for Comparison of proportions, Pearson Coefficient for correlations analysis, Odds Ratio and 95% Confidence Intervals for evaluation of anemia risk, Multiple Regression Stepwise Backward and Binary Logistic Regression for risk factors of Hb and anemia analysis at two months. Significance was set at 5%. The anthropometric measures and BMI increased along the time (p<0.001) and the hematological values decreased (p<0.001). The Hb was higher in groups with IUGR at birth and in T without IUGR at 2 months (p<0.001). The relative variation between 2 months and birth was higher in LPT with IUGR and lower in T without IUGR (p<0.001). The iron stores were modified in all the groups along the time. The IBC was higher in T without IUGR at birth (p<0,001) and 1 month of life (p=0.008). The serum iron was higher in T without IUGR at birth (p<0.001) and lower in LPT with IUGR than in the T NB groups at 1 month at life (p=0.007). Ferritin levels did not differ among the groups. The TfSat levels were higher in T without IUGR at birth (p<0.001) and the relative variation of TfSat was higher in LPT with IUGR (p=0.001). The Hb correlated with weight in all the groups (p<0.001) and the Ferritin in LPT without IUGR (r=-0.3250; p=0.0068) and with IUGR (r=-0.3280; p=0.0063). The anemia was more frequent in IUGR groups (90.5% in LPT with IUGR and 90% in T with IUGR). The anemia risk was hugher in T with IUGR than in without IUGR (OR=12.37, p=0.0022) and in LPT with IUGR in relation to T without IUGR (OR=13.06, p=0.0019). The different evolutions of the iron stores and the higher reduction of Hb in LPT with IUGR could be an effect of prematurity and IUGR influence on their growth. The IUGR must be the most important anemia development factor in exclusive breastfeeding NB, because only groups with IUGR showed risk for anemia at two months of age

A história relacionada à educação de ensino superior no que tange ao parto e nascimento, especialmente na enfermagem, ainda é pouco investigada, o que deixa uma lacuna sobre esta temática. Sendo assim, esta pesquisa teve como objetivo conhecer o ensino de graduação para alunos de enfermagem de escola pública, durante os anos de 1970 e 1980, relativo ao atendimento de mulheres no parto e nascimento de seu filho. Trata-se de pesquisa qualitativa que utilizou o referencial da Nova História, tendo como fonte de dados a história oral e documental. Para coleta dos dados utilizou-se a entrevista semiestruturada e foram entrevistados 12 colaboradores que são egressos da Escola de Enfermagem da UFRGS das décadas de 70 e 80. Os mesmos responderam aos critérios de inclusão e concordaram em participar da pesquisa, sendo realizada a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE). A análise dos dados foi do tipo temática. Os temas oriundos da análise foram: O ensino no cuidado ao recém-nascido: da transição do enfoque fisiológico para o intensivismo e O ensino do parto nas décadas de 70 e 80: o afastamento do fisiológico. Quanto ao cuidado ao recém-nascido houve um afastamento do ensino no que tange aos processos fisiológicos do bebê. Especialmente da década de 80, com a implantação das unidades de neonatologia, o cuidado passou a ser centrado no intensivismo e nas técnicas de atendimento ao recém-nascido grave. Para o ensino do parto observou-se um afastamento do aluno e dos docentes do atendimento à mulher durante o trabalho de parto, especialmente no período expulsivo do parto. Este afastamento foi progressivo e levou o ensino na área obstétrica a ter maior autonomia no puerpério, principalmente em alojamento conjunto. Neste contexto houve também a inserção do Processo de Enfermagem no contexto do ensino, com exigência dos professores para as questões de evolução, anamnese e registros de enfermagem. Portanto, nas décadas de estudo e neste contexto de ensino, nas áreas do parto e nascimento observou-se um afastamento das questões fisiológicas para ênfase no patológico, além do destaque para os registros e Processo de Enfermagem no ensino de graduação. / The story related to graduation teaching within the labor and birth, especially in nursing, is still very little investigated, which leaves a gap about this thematic. Therefore, this research aimed to understand the teaching to nursing students in public colleges, during the years of 1970 and 1980, related to women's care in labor and birth of their children. It is a qualitative research that used the reference of the New History, having as the datasource the oral and documentary history.For data collection was used the semi-structured interview and were interviewed 12 collaborators who are egresses of the UFRGS School of Nursing of the 70s and 80s. They answered the inclusion criteria and agreed to participate in the research, being realized the signature of the Informed consent form. The data analysis was of thematic type. The themes resulting from the analysis were: The teaching in the care of the newborn: from the transition of a physiological approach to the intensivism and the delivery of the teaching of the labor in the decades of 70 and 80: the departure of the physiological. As to the care for the newborn there was a seclusion in the teaching in relation to the physiological processes of the baby. Especially in the decade of 80, with the implementation of neonatal units, the care became centered in the intensivism and in the care techniques to severe newborn. For the teaching of childbirth it was observed a departure from the students and teachers of women's care during labor, especially in the expulsive period of the delivery. This estrangement was progressive and took the teaching in obstetrics fields to have a greater autonomy in the postpartum period, especially in rooming. In this context there was also the insertion of the Nursing Process in the context of the teaching, with demand from the teachers to the questions of evolution, anamnesis and nursing records. Therefore, in the decades of study and teaching in this context, in the areas of labor and birth there was a departure from the physiological issues to focus on the pathological, in addition to highlighting the records and nursing process in the undergraduate teaching.

Το γονίδιο του ανθρώπινου μετατρεπτικού ενζύμου της αγγειοτενσίνης ACE περιέχει έναν πολυμορφισμό δύο αλληλομόρφων που αποτελείται είτε από την παρουσία (I) είτε από την απουσία (D) ενός τμήματος 287 ζευγών βάσεων (bp). Πρόσφατες μελέτες έχουν προτείνει ότι το αλληλόμορφο Ι, μπορεί να σχετίζεται με απόδοση σχετιζόμενη με τη μυϊκή αντοχή. Αντιθέτως, το αλληλόμορφο D γονίδιο έχει συσχετισθεί με απόδοση σχετιζόμενη με τη μυϊκή ισχύ. Επιπλέον, έχει καταδειχθεί ότι η δραστικότητα του κυκλοφορούντος ACE (cACE) συσχετίζεται ευθέως με τη μυική ισχύ σε υγιείς ενήλικες. Η φυσιολογία και η βιοχημεία των αναπνευστικών μυών είναι παρόμοια με αυτή των σκελετικών μυών. Επομένως, η λειτουργικότητα των αναπνευστικών μυών και ιδίως του διαφράγματος, του πλέον σημαντικού αναπνευστικού μυ, μπορεί να επηρεάζεται αναλόγως. Η κόπωση των αναπνευστικών μυών μπορεί να οδηγεί σε αδυναμία διατήρησης του απαραίτητου κυψελιδικού αερισμού. Διάφορες μέθοδοι έχουν χρησιμοποιηθεί για να αξιολογηθούν οι ιδιότητες αντοχής των αναπνευστικών μυών. Ο διαφραγματικός δείκτης πίεσης-χρόνου (PTIdi) και ο μη επεμβατικός δείκτης πίεσης-χρόνου των αναπνευστικών μυών (PTImus), είναι δύο μέθοδοι εκτίμησης της αντοχής του διαφράγματος και των αναπνευστικών μυών, αντίστοιχα. Έχουν χρησιμοποιηθεί σε ενήλικες και παιδιά και έχουν τεκμηριωθεί σε νεογνά. Η διαφραγματική ισχύς και η ισχύς των αναπνευστικών μυών στα νεογνά μπορεί να αξιολογηθούν ειδικά με τη μέτρηση της μέγιστης δια-διαφραγματικής πίεσης (Pdimax) και της μεγίστης εισπνευστικής πίεσης αεραγωγών (Pimax), αντίστοιχα. Σκοπός. Να εξετασθεί η πιθανή συσχέτιση του πολυμορφισμού I/D του ACE και του κυκλοφορούντος ACE με την λειτουργικότητα του διαφράγματος και των αναπνευστικών μυών σε νεογνά. Δευτερεύων σκοπός ήταν ο προσδιορισμός της κατανομής του πολυμορφισμού I/D του ACE στον συγκεκριμένο πληθυσμό και η συσχέτισή του με την δραστικότητα του cACE. Υλικό και Μέθοδοι. Μελετήθηκαν νεογνά που είχαν εισαχθεί στην Μονάδα Εντατικής Νοσηλείας Νεογνών- Παιδιατρική κλινική του Πανεπιστημίου Πατρών. Τα Ι και D αλληλόμορφα του γονιδίου του ACE προσδιορίστηκαν με αλυσιδωτή αντίδραση πολυμεράσης (PCR amplification) σε DNA το οποίο εξήχθη από 0,5 mL ολικού αίματος. Η δραστηριότητα του ACE ορού αξιολογήθηκε με τη χρησιμοποίηση μιας UV κινητικής μεθόδου. Η αντοχή του διαφράγματος και των αναπνευστικών μυών εκτιμήθηκαν με μέτρηση του διαφραγματικού δείκτη πίεση-χρόνου (PTIdi) και του δείκτη πίεσης-χρόνου των αναπνευστικών μυών (PTImus), αντίστοιχα. Η διαφραγματική ισχύς και η ισχύς των αναπνευστικών μυών στα νεογνά αξιολογήθηκαν με μέτρηση της μέγιστης δια-διαφραγματικής πίεσης (Pdimax) και της μεγίστης εισπνευστικής πίεσης αεραγωγών (Pimax), αντίστοιχα. Αποτελέσματα. Συνολικά εξετάστηκαν 171 νεογνά. Στην πρώτη μελέτη της διατριβής μελετήθηκαν 148 νεογνά, στην δεύτερη μελέτη 132 και στην τρίτη μελέτη 110 νεογνά. Η κατανομή του πολυμορφισμού του ACE στο συγκεκριμένο πληθυσμό βρέθηκε κοντά σε προηγούμενα αναφερόμενα στοιχεία. Τα νεογνά με Ι/Ι γονότυπο είχαν χαμηλότερο PTIdi και PTImus από τα νεογνά με γονοτύπους είτε D/D ή I/D. Η ανάλυση των επιμέρους στοιχείων των PTIdi και PTImus έδειξε ότι μόνο οι λόγοι Pdimean (μέση διαδιαφραγματική πίεση) προς Pdimax και Pimean (μέση πίεση αεραγωγών) προς Pimax, αντίστοιχα, ήταν χαμηλότεροι σε νεογνά με γονότυπο I/I έναντι των νεογνών με γονοτύπους είτε D/D είτε I/D. Οι Pdimax και Pimax δεν ήταν στατιστικά διαφορετικές ανάμεσα στις τρείς ομάδες. Ανάλυση βηματικής παλινδρόμησης κατέδειξε σημαντική συσχέτιση των γονότυπων του ACE με τις τιμές του PTIdi και του PTImus, ανεξαρτήτως παραγόντων που θα μπορούσαν να επηρεάσουν την λειτουργικότητα του διαφράγματος και των αναπνευστικών μυών. Νεογνά με το D/D γονότυπο είχαν αυξημένη δραστικότητα ACE ορού σε σχέση με νεογνά με I/I ή I/D γονοτύπους. Η δραστικότητα του cACE σχετιζόταν σημαντικά ευθέως με τη Pimax και αντιστρόφως με το PTImus. Συμπεράσματα. Στις μελέτες αυτής της διατριβής ανεδείχθη συσχέτιση ανάμεσα στους γονοτύπους του ACE και την αντοχή του διαφράγματος και γενικότερα των αναπνευστικών μυών όπως αξιολογείται με τη μέτρηση των PTIdi και PTImus, αντίστοιχα, σε νεογνά. Δεν ανεδείχθη συσχέτιση ανάμεσα στους γονοτύπους του ACE και την ισχύ του διαφράγματος και γενικότερα των αναπνευστικών μυών όπως αξιολογείται με τη μέτρηση των Pdimax και Pimax, αντίστοιχα, σε αυτό τον πληθυσμό. Εντούτοις, κατεδείχθη μια θετική συσχέτιση μεταξύ της δραστικότητας του ACE ορού και της ισχύος των αναπνευστικών μυών, όπως αυτή αξιολογείται από μετρήσεις της Pimax , και μια αρνητική συσχέτιση ανάμεσα στη δραστικότητα του ACE ορού και του PTImus. Επιπλέον, δείχθηκε μια συσχέτιση του αλληλόμορφου D γονιδίου του γονοτύπου ACE με την αυξημένη δραστικότητα του cACE στα νεογνά. / The human ACE (angiotensin converting enzyme) gene contains a polymorphism consisting of either the presence (insertion, I) or absence (deletion, D) of a 287 base pair (bp) fragment. Recent studies have suggested that the I-allele may be associated with endurance performance. Conversely, D-allele has been associated with power-oriented performance. Moreover, it has been suggested that circulating ACE (cACE) activity is correlated with muscle strength in healthy adults. The physiological and biochemical properties of the respiratory and skeletal muscles are quite similar. Therefore, respiratory muscle and specific diaphragmatic function, may be similarly influenced. Fatigue of respiratory muscles may result in inability to maintain adequate alveolar ventilation. Several methods have been used to assess the endurance properties of respiratory muscles. Diaphragmatic pressure-time index (PTIdi) and the non-invasive pressure-time index of respiratory muscles (PTImus), are two methods of assessment of diaphragmatic and respiratory muscle endurance, respectively. They have been validated in both adults and infants. Diaphragmatic and respiratory muscle strength in infants can be assessed specifically, by measurement of maximum transdiaphragmatic pressure (Pdimax) and maximum inspiratory pressure (Pimax), respectively. Aims. To examine the possible association of the I/D genotypes of ACE and cACE, with diaphragmatic and respiratory muscle performance, in infants. Secondary aims were to identify the distribution of the I/D genotypes of ACE in the specific population and its association with cACE activity. Material and methods. Infants cared for at the Neonatal Intensive Care Unit- Paediatric Department of the University General Hospital of Patras, Greece, were eligible for the study. ACE genotyping was performed by polymerase chain reaction amplification on DNA, extracted from 0,5 ml of whole blood. Serum ACE activity was assayed by using a UV-kinetic method. The endurance of the diaphragm and the respiratory muscles was assessed by measurement of diaphragmatic pressure-time index (PTIdi) and pressure-time index of the respiratory muscles (PTImus), respectively. Diaphragmatic and respiratory muscle strength was assessed by measurement of maximum transdiaphragmatic (Pdimax) and maximum inspiratory (Pimax) pressures, respectively. Results. One hundred seventy one infants were recruited. One hundred fourty eight infants were included in the first study, one hundred thirty two in the second study and one hundred ten in the third study of this thesis. The distribution of the I/D genotypes of ACE in the specific population was close to previous reported data. Infants with I/I ACE genotype had lower PTIdi and PTImus than infants with either D/D or I/D genotypes. Analysis of the components of the PTIdi and PTImus has shown that the ratios of Pdimean to Pdimax and Pimean to Pimax , only, were lower in infants with the I/I genotype, compared to infants with either the D/D or I/D genotypes. Neither Pdimax, nor Pimax were statistically different between the three groups. A stepwise regression analysis revealed that ACE genotypes were significantly related to the PTIdi and PTImus measurements, independent of other factors that may affect diaphragmatic and respiratory muscle function. Infants with D/D genotype had significantly higher serum ACE activity than infants with I/I or I/D genotypes. Circulating ACE activity was significantly related to Pimax and inversely related to PTImus. Conclusions. In the studies of this thesis, an association between ACE genotypes and the endurance of the diaphragm and the respiratory muscles, assessed by measurement of PTIdi and PTImus, respectively, was demonstrated, in infants. No such association was demonstrated between ACE genotypes and strength of the diaphragm and the respiratory muscles, assessed by measurement of Pdimax and Pimax, respectively, in the specific population. However, a positive correlation between serum ACE activity and respiratory muscle strength, assessed by measurement of Pimax and and a negative correlation between serum ACE activity and PTImus, was shown. Moreover, an association of D-allele of ACE genotype with increased circulating ACE activity in infants, was demonstrated.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of the study was to determine the prevalence of certain known risk factors for intra-uterine growth restriction (IUGR) in women who gave premature birth to growth-restricted infants at a large regional hospital (Kalafong) in the Gauteng province of South Africa and to investigate the possible associations between the presence of various risk factors and the severity of growth restriction found in these infants. METHOD: The study was designed as cross-sectional, descriptive and observational. The subjects included singleton growth-restricted premature infants (n=80), without congenital abnormalities and their mothers (n=80). Anthropometric data [weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSF)] were collected from these mothers three to four days post-partum. Infant birth weights were recorded at birth, while the lengths and head circumferences were recorded within 2 days post-partum. Additional information, such as birth spacing, maternal age, smoking habits and alcohol use, was collected by personal interview and blood pressure data and HIV status was obtained from medical records. Data capturing and descriptive statistics were done using Microsoft Excel and comparative analytical statistics were performed with the Statistical Package for the Social Sciences (SPSS), version 12.0. RESULTS: The study demonstrated a high prevalence (69%) of infants born with a birth weight <3rd percentile. In the sample, 81% of the mothers were aged 17-34 years and most (93%) had their children 18 months or longer apart. Malnutrition prevalence was moderate. In 58% of the mothers the BMI was normal (18.5-24.9 kg/m2) and in 47% the upper arm muscle area (UAMA) was between the 10th-85th percentile. Grade III overweight occurred in 3% and TSF ≤5th percentile occurred in 35% of the mothers. About half (51%) of the mothers in the sample population had hypertension during the second trimester of pregnancy. Smoking and alcohol use during pregnancy was rare (1% and 6% respectively) and the prevalence of HIV infection in the mothers was 26%. The prevalence (16%) of Grade II overweight among the mothers of symmetric growth-restricted (SGR) infants was higher than among the mothers of asymmetric growth-restricted (AGR) infants (7%). Of the hypertensive mothers, 55% had infants with SGR compared to 45% with AGR (p=0.47). Although rare, smoking occurred only in mothers with AGR infants (3%). No significant differences were found between the smoking and non-smoking group (p=0.21). Although the use of alcohol was more prevalent at 6% in mothers with SGA infants and 7% in mothers with AGR infants, no significant associations were found (p=0.95). Although not significant (p=0.76), there was a higher prevalence of HIV infection in mothers with SGR infants at 29%, compared to 23% of mothers of AGR infants. CONCLUSION: Although further studies are needed before intervention strategies can be planned and implemented, the findings of this study suggest that apart from the usual factors (maternal age and nutritional status, smoking and alcohol use during pregnancy and birth spacing) that may influence intra-uterine growth, hypertension may contribute greatly to IUGR in this study population.

Introdução: O período neonatal é uma época de adaptação em que as reações patológicas e fisiológicas às vezes se confundem, sendo as alterações cutâneas comuns neste período. A frequência dessas manifestações tem sido estudada por diversos autores e difere entre os distintos grupos raciais. Na literatura médica, dados recentes mostram que 57 a 99% dos recém-nascidos (RN) apresentam algum achado dermatológico. Métodos: Foram selecionados de forma aleatória aproximadamente 25% dos nascidos vivos nas três maiores maternidades de Porto Alegre, de junho de 2011 a julho de 2012, para serem submetidos ao exame dermatológico realizado por dermatologistas. Resultados: Um total de 2878 neonatos foram examinados em datas mensalmente sorteadas através de um programa estatístico. A maioria dos neonatos eram da raça branca, 95,4% tinham até 48 horas de vida no momento do exame, 50,9% eram do sexo masculino, 54,9% nasceram por parto vaginal e 92,5% das mães realizaram o pré-natal. Dos RN examinados, 96% apresentavam algum achado dermatológico (IC 95%: 95,3-96,6); destes, 89,6% tinham lesões cutâneas transitórias neonatal (IC: 88% a 91%), 40% marca congênita (IC: 38% a 42%), 24,5% tinham alguma pustulose benigna neonatal (IC: 23% a 27%), 1,4% malformação cutânea (IC: 1% a 2%), 3% lesões secundárias ao trauma - incluindo arranhadura (IC: 2 a 4%) e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 40,9% dos RN (IC: 39% a 43%), seguido pela hiperplasia de glândulas sebáceas (35,3% - IC: 34% a 37%), melanocitose dérmica (23,1% - IC: 22% a 25%), eritema tóxico neonatal (21% - IC: 19% a 22%), eritema da pele (19,7% - IC: 18 a 21%), hiperpigmentação da genitália (18,9% - IC: 17% a 20%), mancha salmão (18,8% - IC: 17% a 20%), edema palpebral (17,2% - IC: 16% a 19%), cistos de mília (16,4% - IC 15% a 18%), descamação da pele (12,5% - IC: 11% a 14%), hipertrofia da genitália (11,4% - IC: 10% a 13%), xerose cutânea (10,7% - IC: 10% a 12%). Foi encontrada ainda uma prevalência de 3,4% de melanose pustulosa transitória neonatal (IC: 3% a 4%), 2,2% de mancha mongólica aberrante, 1,2% de nevo congênito, 0,7% de hemangioma ou precursor de hemangioma, 0,5% de pólipo anexial, 0,3% nevo sebáceo e 0,3% de bolhas de sucção. A presença ou não de afecções cutâneas neonatais foi semelhante nas diferentes estações do ano, porém alguns achados foram mais prevalentes em determinada época do ano. Conclusões: Os achados dermatológicos são frequentes em RN e alguns foram mais comuns do que o esperado. Evidenciando a importância do conhecimento das características da pele do bebê durante o período neonatal. A etnia do neonato e os fatores de risco gestacional influenciam na presença de achados dermatológicos neonatais. Enquanto outras características do neonato, como a idade gestacional e o gênero; bem como e as estações do ano podem influenciar na presença de determinadas lesões cutâneas no RN. / Introduction: Skin changes are common during the neonatal period due to physiological and environmental adjustments and to some pathological reactions. The frequency of these events differs among different regions and ethnicities. Recent data show that 57-99% of newborns (NB) have skin alterations. Methods: This study aims to evaluate skin changes in children born in the 3 three major maternities in Porto Alegre, Brazil, from June 2011 to July 2012. Results: A total of 2878 of the neonates were examined in monthly-randomized dates. The majory were Caucasian, 95,4% during the first 48h of life, 50,9% male, 54,9% born by vaginal delivery and 92.5% of the mothers received prenatal care. From the examined NB, 96% had some dermatologic finding (IC 95%: 95,3-96,6): 89.6% transient neonatal skin conditions (IC: 88% a 91%), 40% congenital birthmarks (IC: 38% a 42%), 24.5% had some benign neonatal pustulosis (IC: 23% a 27%), 1.4% had cutaneous malformations (IC: 1% a 2%), 3% of secondary trauma injuries – including scratch and 0.1% any infection. The most prevalent dermatologic findings were: lanugo (40.9% of the NB - IC: 39% a 43%), sebaceous hyperplasia (35,3% - IC: 34% a 37%), dermal melanocytosis (23,1% - IC: 22% a 25%), neonatal toxic erythema (21% - IC: 19% a 22%), erythema (19,7% - IC: 18 a 21%), genital hyperpigmentation (18,9% - IC: 17% a 20%), salmon patch (18,8% - IC: 17% a 20%), eyelid edema (17,2% - IC: 16% a 19%), milia (16,4% - IC 15% a 18%), desquamation (12,5% - IC: 11% a 14%), hypertrophy of the genitalia (11,4% - IC: 10% a 13%), skin xerosis (10,7% - IC: 10% a 12%). Other findings were transient neonatal pustular melanosis (3.4% - IC: 3% a 4%), aberrant Mongolian spot (2.2%), congenital nevi (1.2%), hemangioma or its precursors (0.7%), adnexal polyps (0.5%), naevus sebaceous (0.3%) and suction blisters (0.3%). Neonatal skin lesions occur with similar frequency in the different seasons (p=0.092), but some findings are more prevalent in certain time of the year. Conclusions: This study showed that skin changes are very frequent in neonates and some disorders are more common than expected. Prove the importance of a good knowledge of the NB skin. The ethnicity of the NB and the gestational risk factors influenced the presence of neonatal dermatological findings. While others neonatal characteristics, such as gestational age and NB gender, as well as the seasons can influence the presence of specific neonatal lesions skin.

Orientador: Maria Lucia Gomes Lourenço / Resumo: Atualmente, observamos uma maior necessidade de uma assistência adequada tanto pré-natal, quanto neonatal com o intuito de se reduzir a mortalidade de recém-nascidos, principalmente de animais com elevado valor genético e zootécnico. O exame eletrocardiográfico pode se revelar como ferramenta importante em neonatologia equina, visto que permite a determinação da frequência cardíaca, do ritmo cardíaco, distúrbios de condução e obtenção de índices de variabilidade da frequência cardíaca. Este trabalho visou retratar o comportamento dos parâmetros eletrocardiográficos em éguas prenhes, fetos e potros neonatos, com o intuito de determinar se a frequência cardíaca (FC) e os índices de variabilidade da frequência cardíaca (VFC) materna e fetal são indicativos da proximidade do parto; determinar viabilidade fetal e neonatal, e descrever a evolução do desenvolvimento do sistema nervoso autônomo durante este período, bem como detectar as particularidades na dinâmica eletrocardiográfica durante o período neonatal nos equinos da raça Paint Horse. Foram avaliados 20 éguas, 20 fetos e 20 potros cujos exames eletrocardiográficos maternos e fetais foram realizados entre 15 e sete dias pré-parto. Quanto ao eletrocardiograma neonatal, os momentos a serem avaliados foram: ao nascimento, quatro, oito, 12, 16, 20, 24, 36 e 48 horas pós parto e posteriormente uma vez por semana até os 35 dias de idade. Os resultados obtidos da VFC fetal e neonatal do presente estudo, quando comparados aos materno... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Currently, we observe an increased need for adequate assistance both prenatal, neonatal as aiming to reduce mortality of newborns, mainly animals with high genetic and livestock value. The electrocardiogram can represent an important tool in equine neonatology, since this test allows the determination of heart rate, cardiac rhythm, disturbances of conduction and obtaining indexes of heart rate variability. This study aimed to represent the behavior of electrocardiographic parameters in mares, fetuses and newborn foals, in order to determine whether the heart rate (HR) and indexes of heart rate variability (HRV) of the mare and the fetuses are indicative of birth proximity; to determine the fetal and neonatal viability, to describe the evolution of the development of the autonomic nervous system during this period, and to detect the particulars in the electrocardiographic dynamic during the neonatal period in foals of Paint Horse breed. There were 20 mares, 20 fetuses and 20 newborn foals, whose maternal and fetal electrocardiographic examinations were performed at, approximately, 15 and 07 days prepartum. The neonatal electrocardiogram occurred: at birth, four, eight, 12, 16, 20, 24, 36 and 48 hours after delivery and thereafter once per week until 35 days of age. The results of fetal and neonatal HRV of the present study, when compared to maternal indicated the parasympathetic dominance during fetal and neonatal sympathetic dominance during to the third and / or fourth weeks... (Complete abstract click electronic access below) / Mestre

Introdução: O período neonatal é uma época de adaptação em que as reações patológicas e fisiológicas às vezes se confundem, sendo as alterações cutâneas comuns neste período. A frequência dessas manifestações tem sido estudada por diversos autores e difere entre os distintos grupos raciais. Na literatura médica, dados recentes mostram que 57 a 99% dos recém-nascidos (RN) apresentam algum achado dermatológico. Métodos: Foram selecionados de forma aleatória aproximadamente 25% dos nascidos vivos nas três maiores maternidades de Porto Alegre, de junho de 2011 a julho de 2012, para serem submetidos ao exame dermatológico realizado por dermatologistas. Resultados: Um total de 2878 neonatos foram examinados em datas mensalmente sorteadas através de um programa estatístico. A maioria dos neonatos eram da raça branca, 95,4% tinham até 48 horas de vida no momento do exame, 50,9% eram do sexo masculino, 54,9% nasceram por parto vaginal e 92,5% das mães realizaram o pré-natal. Dos RN examinados, 96% apresentavam algum achado dermatológico (IC 95%: 95,3-96,6); destes, 89,6% tinham lesões cutâneas transitórias neonatal (IC: 88% a 91%), 40% marca congênita (IC: 38% a 42%), 24,5% tinham alguma pustulose benigna neonatal (IC: 23% a 27%), 1,4% malformação cutânea (IC: 1% a 2%), 3% lesões secundárias ao trauma - incluindo arranhadura (IC: 2 a 4%) e 0,1% doença infecciosa. O achado dermatológico mais frequente foi o lanugo, observado em 40,9% dos RN (IC: 39% a 43%), seguido pela hiperplasia de glândulas sebáceas (35,3% - IC: 34% a 37%), melanocitose dérmica (23,1% - IC: 22% a 25%), eritema tóxico neonatal (21% - IC: 19% a 22%), eritema da pele (19,7% - IC: 18 a 21%), hiperpigmentação da genitália (18,9% - IC: 17% a 20%), mancha salmão (18,8% - IC: 17% a 20%), edema palpebral (17,2% - IC: 16% a 19%), cistos de mília (16,4% - IC 15% a 18%), descamação da pele (12,5% - IC: 11% a 14%), hipertrofia da genitália (11,4% - IC: 10% a 13%), xerose cutânea (10,7% - IC: 10% a 12%). Foi encontrada ainda uma prevalência de 3,4% de melanose pustulosa transitória neonatal (IC: 3% a 4%), 2,2% de mancha mongólica aberrante, 1,2% de nevo congênito, 0,7% de hemangioma ou precursor de hemangioma, 0,5% de pólipo anexial, 0,3% nevo sebáceo e 0,3% de bolhas de sucção. A presença ou não de afecções cutâneas neonatais foi semelhante nas diferentes estações do ano, porém alguns achados foram mais prevalentes em determinada época do ano. Conclusões: Os achados dermatológicos são frequentes em RN e alguns foram mais comuns do que o esperado. Evidenciando a importância do conhecimento das características da pele do bebê durante o período neonatal. A etnia do neonato e os fatores de risco gestacional influenciam na presença de achados dermatológicos neonatais. Enquanto outras características do neonato, como a idade gestacional e o gênero; bem como e as estações do ano podem influenciar na presença de determinadas lesões cutâneas no RN. / Introduction: Skin changes are common during the neonatal period due to physiological and environmental adjustments and to some pathological reactions. The frequency of these events differs among different regions and ethnicities. Recent data show that 57-99% of newborns (NB) have skin alterations. Methods: This study aims to evaluate skin changes in children born in the 3 three major maternities in Porto Alegre, Brazil, from June 2011 to July 2012. Results: A total of 2878 of the neonates were examined in monthly-randomized dates. The majory were Caucasian, 95,4% during the first 48h of life, 50,9% male, 54,9% born by vaginal delivery and 92.5% of the mothers received prenatal care. From the examined NB, 96% had some dermatologic finding (IC 95%: 95,3-96,6): 89.6% transient neonatal skin conditions (IC: 88% a 91%), 40% congenital birthmarks (IC: 38% a 42%), 24.5% had some benign neonatal pustulosis (IC: 23% a 27%), 1.4% had cutaneous malformations (IC: 1% a 2%), 3% of secondary trauma injuries – including scratch and 0.1% any infection. The most prevalent dermatologic findings were: lanugo (40.9% of the NB - IC: 39% a 43%), sebaceous hyperplasia (35,3% - IC: 34% a 37%), dermal melanocytosis (23,1% - IC: 22% a 25%), neonatal toxic erythema (21% - IC: 19% a 22%), erythema (19,7% - IC: 18 a 21%), genital hyperpigmentation (18,9% - IC: 17% a 20%), salmon patch (18,8% - IC: 17% a 20%), eyelid edema (17,2% - IC: 16% a 19%), milia (16,4% - IC 15% a 18%), desquamation (12,5% - IC: 11% a 14%), hypertrophy of the genitalia (11,4% - IC: 10% a 13%), skin xerosis (10,7% - IC: 10% a 12%). Other findings were transient neonatal pustular melanosis (3.4% - IC: 3% a 4%), aberrant Mongolian spot (2.2%), congenital nevi (1.2%), hemangioma or its precursors (0.7%), adnexal polyps (0.5%), naevus sebaceous (0.3%) and suction blisters (0.3%). Neonatal skin lesions occur with similar frequency in the different seasons (p=0.092), but some findings are more prevalent in certain time of the year. Conclusions: This study showed that skin changes are very frequent in neonates and some disorders are more common than expected. Prove the importance of a good knowledge of the NB skin. The ethnicity of the NB and the gestational risk factors influenced the presence of neonatal dermatological findings. While others neonatal characteristics, such as gestational age and NB gender, as well as the seasons can influence the presence of specific neonatal lesions skin.

Made available in DSpace on 2014-08-06T17:29:44Z (GMT). No. of bitstreams: 2 Ana Paula Albuquerque.pdf: 545006 bytes, checksum: 13e9e703c0e1c3cca5435d26360ba9de (MD5) license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) Previous issue date: 2010 / Fundação Oswaldo Cruz. Instituto Fernandes Figueira. Departamento de Ensino. Programa de Pós-Graduação em Saúde da Criança e da Mulher. Rio de Janeiro, RJ, Brasil. / Estudo transversal, de abordagem quantitativa, para aplicação de um instrumento de medida de carga de trabalho. Foi realizado na Unidade Neonatal Cirúrgica do Instituto Fernandes Figueira, no período de 03 de julho de 2009 a 31 de agosto de 2009. Teve como objetivo avaliar a carga de trabalho da unidade neo cirúrgica através do instrumento NAS (Nursing Activities Score). Reviu-se a literatura sobre carga de trabalho, relacionando com dimensionamento de pessoal de enfermagem. A amostra foi composta por 23 RN que sofreram intervenção cirúrgica e que permaneceram internados por um período mínimo de 24h. O NAS foi aplicado 904 vezes na unidade estudada. Foi utilizado um tutorial para a melhor interpretação das atividades do NAS que facilitou a compreensão do instrumento. A pontuação média do NAS foi 77,2. Em média, 77% do tempo de um profissional de enfermagem é dedicado aos cuidados dos RN na unidade. Considerando que cada ponto NAS equivale a 14.4min, foi identificada na pesquisa, uma média de 18,5h de assistência por RN/24h. O valor médio para a equipe de enfermagem calculada pela pontuação NAS através da fórmula utilizada por Fugulin foi 36,9 profissionais. Em média, a equipe disponível no serviço foi de 24 profissionais. O número médio de profissionais projetado pelo instrumento NAS foi 54% mais elevado do que no quadro de profissionais de enfermagem disponível na unidade estudada. Isso indica que nessa unidade deve haver sobrecarga de trabalho. / Cross-sectional study of quantitative approach to implementation of an instrument for measuring workload. Was conducted at the Neonatal Surgical Fernandes Figueira Institute, the period of 03 July 2009 to August 31, 2009. Was to evaluate the workload of the unit neo surgical instrument through the NAS (Nursing Activities Score). We review the literature on workload in relation to dimensioning of nursing staff. The sample consisted of 23 infants who underwent surgery and remained hospitalized for a minimum of 24 hours. NAS was applied 904 times in the unit studied. We used a tutorial for the best interpretation of the activities of the NAS that facilitated the understanding of the instrument. The average score of NAS was 77,2. On average, 77% of the time of a nursing professional is dedicated to the care of newborns in the unit. Since each point equals NAS 14.4min, was identified in the survey, an average of 18,5 hours of assistance RN / 24h.The average value for the nursing staff NAS score calculated by the formula used by professionals Fugulin was 36.9. On average, the team was available in the service of 24 professionals. The average number of professional instrument designed by the NAS was 54% higher than in the context of nurses available in the unit studied. This indicates that this unit should be no work overload.

A história relacionada à educação de ensino superior no que tange ao parto e nascimento, especialmente na enfermagem, ainda é pouco investigada, o que deixa uma lacuna sobre esta temática. Sendo assim, esta pesquisa teve como objetivo conhecer o ensino de graduação para alunos de enfermagem de escola pública, durante os anos de 1970 e 1980, relativo ao atendimento de mulheres no parto e nascimento de seu filho. Trata-se de pesquisa qualitativa que utilizou o referencial da Nova História, tendo como fonte de dados a história oral e documental. Para coleta dos dados utilizou-se a entrevista semiestruturada e foram entrevistados 12 colaboradores que são egressos da Escola de Enfermagem da UFRGS das décadas de 70 e 80. Os mesmos responderam aos critérios de inclusão e concordaram em participar da pesquisa, sendo realizada a assinatura do Termo de Consentimento Livre e Esclarecido (TCLE). A análise dos dados foi do tipo temática. Os temas oriundos da análise foram: O ensino no cuidado ao recém-nascido: da transição do enfoque fisiológico para o intensivismo e O ensino do parto nas décadas de 70 e 80: o afastamento do fisiológico. Quanto ao cuidado ao recém-nascido houve um afastamento do ensino no que tange aos processos fisiológicos do bebê. Especialmente da década de 80, com a implantação das unidades de neonatologia, o cuidado passou a ser centrado no intensivismo e nas técnicas de atendimento ao recém-nascido grave. Para o ensino do parto observou-se um afastamento do aluno e dos docentes do atendimento à mulher durante o trabalho de parto, especialmente no período expulsivo do parto. Este afastamento foi progressivo e levou o ensino na área obstétrica a ter maior autonomia no puerpério, principalmente em alojamento conjunto. Neste contexto houve também a inserção do Processo de Enfermagem no contexto do ensino, com exigência dos professores para as questões de evolução, anamnese e registros de enfermagem. Portanto, nas décadas de estudo e neste contexto de ensino, nas áreas do parto e nascimento observou-se um afastamento das questões fisiológicas para ênfase no patológico, além do destaque para os registros e Processo de Enfermagem no ensino de graduação. / The story related to graduation teaching within the labor and birth, especially in nursing, is still very little investigated, which leaves a gap about this thematic. Therefore, this research aimed to understand the teaching to nursing students in public colleges, during the years of 1970 and 1980, related to women's care in labor and birth of their children. It is a qualitative research that used the reference of the New History, having as the datasource the oral and documentary history.For data collection was used the semi-structured interview and were interviewed 12 collaborators who are egresses of the UFRGS School of Nursing of the 70s and 80s. They answered the inclusion criteria and agreed to participate in the research, being realized the signature of the Informed consent form. The data analysis was of thematic type. The themes resulting from the analysis were: The teaching in the care of the newborn: from the transition of a physiological approach to the intensivism and the delivery of the teaching of the labor in the decades of 70 and 80: the departure of the physiological. As to the care for the newborn there was a seclusion in the teaching in relation to the physiological processes of the baby. Especially in the decade of 80, with the implementation of neonatal units, the care became centered in the intensivism and in the care techniques to severe newborn. For the teaching of childbirth it was observed a departure from the students and teachers of women's care during labor, especially in the expulsive period of the delivery. This estrangement was progressive and took the teaching in obstetrics fields to have a greater autonomy in the postpartum period, especially in rooming. In this context there was also the insertion of the Nursing Process in the context of the teaching, with demand from the teachers to the questions of evolution, anamnesis and nursing records. Therefore, in the decades of study and teaching in this context, in the areas of labor and birth there was a departure from the physiological issues to focus on the pathological, in addition to highlighting the records and nursing process in the undergraduate teaching.

O cuidado no fim de vida em neonatologia é um assunto que desperta diversos conflitos éticos entre os profissionais, principalmente pela possibilidade de adiamento da morte devido aos novos aparatos vindos do desenvolvimento da ciência, mesmo quando a cura não é mais possível. Este estudo analisou de maneira qualitativa a percepção dos profissionais de saúde de uma unidade de terapia intensiva neonatal da rede federal do Rio de Janeiro. Nesta pesquisa foram realizadas vinte entrevistas com fisioterapeutas, médicos, enfermeiros, técnicos de enfermagem, psicólogo e nutricionistas, todas do sexo feminino. Elementos como a percepção em relação a: qual conduta é realizada em pacientes em fim de vida, quais elas acreditam serem as mais adequadas, quais os sentimentos frente a um recémnascido terminal, quem elas percebem que decide nessas situações e quem elas creem que deveria participar do processo de decisão, assim como se elas gostariam de participar caso fossem mães de um bebê terminal, foram colhidos e divididos em categorias para serem discutidos. Como conclusão, nota-se que as profissionais relataram que condutas que levam a distanásia são frequentes no setor, apesar de muitas acreditarem que a melhor terapia seja a de cuidados paliativos. Sentimentos de tristeza, impotência e angústia são comuns entre elas ao lidar com a terminalidade e obstinação terapêutica. A falta de comunicação destaca-se como fator importante na visão das entrevistadas para a pequena contribuição de toda a equipe multidisciplinar e dos pais no processo decisório em situações de fim de vida. / The end of life care in neonatology is a subject that arouses many ethical conflicts between professionals, mainly by the possibility of death due to postponement of new devices coming from the development of science, even when cure is no longer possible. This qualitative study examined how the perception of health professionals in a neonatal intensive care unit of the federal network of Rio de Janeiro. This research was conducted twenty interviews with therapists, doctors, nurses, nursing technicians, psychologists and nutritionists, all female. Elements such as the perception in relation to: conduct which is performed in patients at end of life, which they believe to be the most appropriate, what feelings before a newborn terminal, whom they perceive that these situations and decide who they believe they should participate in the decision process, as well as whether they would like to participate if they were mothers of a baby terminal were collected and divided into categories for discussion. In conclusion, we note that the professionals reported that behaviors that lead dysthanasia are common in the industry, although many believe that the best therapy is palliative care. Feelings of sadness, helplessness and anxiety are common among them to cope with terminal and therapeutic obstinacy. The lack of communication is highlighted as an important factor in view of the interviewed for the small contribution of the entire multidisciplinary team and parents in decision-making in end of life situations.