Introdução: A prematuridade é atualmente o principal problema clínico associado à mortalidade e morbidade neonatal e tem consequências adversas para a saúde e desenvolvimento infantil. Uma parte significativa desta população é classificada como pequenos para a idade gestacional e apresentam baixo peso ao nascimento. Em decorrência do parto prematuro, os recém-nascidos apresentam frequentemente, complicações clínicas ao nascimento aumentando risco de internação em Unidade de Terapia Intensiva Neonatal. No momento da admissão, pontuações neonatais de gravidade da doença são usadas para ajustar os resultados entre os recém-nascidos internados, dentre eles o SNAPPE-II. Devido à instabilidade clínica, os prematuros utilizam em sua maioria, sondas para a alimentação devido a incapacidade de alimentação por via oral. É considerável a falta de critérios para tomadas de decisões clínicas quanto ao momento da introdução e progressão da alimentação oral. Atualmente exite uma escassez de testes de confiabilidade na literatura sobre o uso dessas intervenções. Objetivo: Verificar a correlação entre a gravidade do recém-nascido prematuro no momento da admissão na UTIN aos preditores clínicos para introdução da alimentação por via oral nesta população. Método: Participaram deste estudo 62 recém-nascidos prematuros submetidos à avaliação fonoaudiológica durante internação na Unidade de Terapia Intensiva Neonatal em um hospital terciário. Foram coletados dados de variáveis demográficas, dados clínicos em prontuário médico, indicadores fonoaudiológicos, dados da avaliação fonoaudiológica da sucção nutritiva e não nutritiva e preditores de gravidade neonatal utilizando o Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE-II). A análise estatistica foi realizada utilizando duas formas distintas: tamanho para a idade gestacional e peso ao nascimento. Resultados: O desfecho da avaliação fonoaudiológica não apresenta estatisticamente associação significativa com a pontuação do SNAPPE-II quando os recém-nascidos pré-termo são comparados de acordo com o tamanho para idade gestacional. O tempo de introdução para via oral e transição para via oral completa, além da pontuação do SNAPPE II mostram melhores resultados em recém-nascidos de baixo peso quando comparados com recém-nascidos de extremo baixo peso e muito baixo peso Conclusão: Para as variáveis estudadas nota-se comportamentos parecidos para recém-nascidos de extremo baixo peso e muito baixo peso, com exceção do SNAPPE II. São necessários estudos voltados para a identificação do momento da prontidão para introdução da via oral, principalmente em recém-nascidos prematuros com peso inferior a 1500g / Introduction: Prematurity in actually the main clinical problem linked to mortality and morbidity in newborns and has adverse consequences for health and childhood development. Significant part of this population is classified as small for gestational age and birth low wight. As a consequence of premature delivery, newborns often present clinical complications at birth, increaning rates of hospitalization in Neonatal Intensive Care Unit (NICU). The time of admission, gravity newbon score is used to adjust the outcomes of hospitalized newborns, such as SNAPPE-II. Became of clinical instability, newborns use, most of them, tube for feeding, became of inability of oral feeding. It is considerable the lack of criteria for clinical decision choices for the proper moment of introducting and developing oral feeding. Nowadays, there are few reliability test in literature, over there interventions. Objective: Verify correlation between gravity of premature newborn at admission time in NICU to clinical predicton for introduction oral feeding for this population. Methods: Sixty two premature newborn have participated of this study, subject to speech therapy during hospitalization in NICU in a tertiary hospital. Demographic variable data has been collected, clinical data from medical records, speech therapist indicators, speech evaluation data from suck-swallow and predictors of newborn gravity, using Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE II). Statistic analyze was fulfilled by two distinct ways: size for gestational age. Introducing time for oral feeding and transition for complete oral feeding, besides punctuation of SNAPPE II, show better outcomes in low weight newborn, compared to extreme low weight and very low weight newborn. Conclusion: For studied variables, similar behaviors are noted for extreme low weight newborns, with exception of SNAPPE II. It is necessary futher studies turned to identification at the moment of readiness of introduction of oral feeding, mainly in premature newborns with inferior weight than 1.500 grames

Submitted by Ubirajara Cruz (ubirajara.cruz@gmail.com) on 2017-07-03T16:29:01Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Luciana_Araujo.pdf: 888386 bytes, checksum: c72bfaa15763320c2a04fb09a09bfaf2 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2017-07-03T17:53:51Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Luciana_Araujo.pdf: 888386 bytes, checksum: c72bfaa15763320c2a04fb09a09bfaf2 (MD5) / Made available in DSpace on 2017-07-03T17:53:51Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Luciana_Araujo.pdf: 888386 bytes, checksum: c72bfaa15763320c2a04fb09a09bfaf2 (MD5) Previous issue date: 2016-02-17 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / O desenvolvimento de septicemia neonatal em potros é uma consequência comum da placentite ascendente. A presença de sepse tem sido associada com diversas desordens metabólicas, incluindo desregulação no metabolismo da glicose, do cálcio e do lactato. Entretanto as alterações bioquímicas demonstradas por estes potros logo após o nascimento e a sua relação com a sobrevivência não estão completamente esclarecidas. A utilização de parâmetros bioquímicos mais específicos durante as primeiras horas de vida pode ser útil para a realização de um diagnóstico precoce de sepse e pode auxiliar no estabelecimento de um prognóstico para estes potros. Este trabalho teve por objetivo avaliar os parâmetros bioquímicos de potros nascidos de éguas submetidas à indução experimental de placentite ascendente, durante as primeiras 48h de vida, relacionando estes parâmetros bioquímicos com a presença de sepse e com a sobrevivência destes animais. Foram utilizados 35 potros neste estudo. O grupo controle foi composto por sete potros saudáveis, nascidos de éguas sem alterações clínicas e gestacionais. Vinte e oito potros nascidos de éguas submetidas à indução experimental de placentite ascendente foram divididos em dois grupos de acordo com o escore de sepse em potros não sépticos (n=19) e potros sépticos (n=9). Os potros nascidos de éguas com placentite foram classificados ainda de acordo com a sobrevivência em sobreviventes e não sobreviventes. Foram coletadas amostras de sangue venoso no momento do nascimento (até 10 minutos após o parto), com 12, 24 e 48h de vida. Os níveis séricos de glicose, lactato, triglicerídeos, colesterol, ureia, creatinina, bilirrubina total, bilirrubina direta, bilirrubina indireta, proteínas plasmáticas totais (PPT), fibrinogênio e gama glutamiltransferase (GGT) foram mensurados. Os dados obtidos foram expressos em mediana e intervalo interquartil. Foi realizada análise de variância e comparação entre as médias pelo teste LDS. A comparação entre o índice de sobrevivência foi realizada através do Teste Exato de Fisher. Ao nascimento os valores de glicose e GGT foram menores nos grupo séptico [37 mg/dL (16,5-47,5); 23 UI (17,5-26,5)] e no grupo não sobrevivente [41 mg/dL (24-66); 23 UI (17,5-24,5)]. As concentrações de lactato, ureia, creatinina, triglicerídeos e colesterol foram maiores nos potros sépticos durante as primeiras 48 horas. Potros não sobreviventes apresentaram maiores concentrações de lactato, triglicerídeos e colesterol em relação a potros sobreviventes nas 48h. Potros sépticos nascidos de éguas com placentite ascendente demonstraram alterações no metabolismo energético, caracterizado por elevações nos níveis de triglicerídeos e colesterol e hipoglicemia ao nascimento, e redução na atividade da enzima hepática GGT, com elevação dos valores de lactato e ureia durante as primeiras 48h de vida. Com relação à sobrevivência observamos que potros não sobreviventes apresentaram menores valores de glicose e GGT durante as 48h de vida e elevadas concentrações de lactato, triglicerídeos e colesterol. Marcadores bioquímicos como glicose, triglicerídeos, colesterol e GGT podem ser utilizados como indicadores de comprometimento já ao nascimento e da presença de sepse, e podem ser utilizados como fatores prognósticos em potros doentes. / The development of neonatal sepsis in foals is a common consequence of ascending placentitis. Sepsis has been associated with various metabolic disorders including dysregulation of glucose, calcium and lactate metabolism. However the biochemical changes showed by these foals after birth and their relationship to survival are not completely understood. The use of more specific biochemical parameters during the first hours of life can be useful to perform an early diagnosis of sepsis and can assist in establishing a prognosis for these foals. The aim of this study was to evaluate the biochemical profile of foals born from mares with experimentally induced ascending placentitis during the first 48h of life, relating these biochemical parameters with the presence of sepsis and the survival of these animals. A total of 35 foals were included in the present study. The control group it was comprised by seven healthy foals; born from mares without clinical or gestational changes and. Twenty eight foals born from mares with experimentally induced ascending placentitis were assigned into two groups according to the sepsis score in nonseptic foals (n=19) and septic foals (n=9), and according to outcome in survivors and nonsurvivors. Blood samples were obtained on birth (10 minutes after birth) and 12, 24 and 48h after the birth. Blood concentration of glucose, lactate, triglycerides, cholesterol, urea, creatinine, total bilirubin, direct bilirubin, indirect bilirubin, total plasmatic protein (PPT), fibrinogen and gamma glutamyltransferase (GGT) were measured. Data were described using median and interquartile range. It was performed One-Way ANOVA and post-hoc LSD test. The comparison between survival rates was made using Fisher's exact test. At birth, the glucose and GGT was lower in septic foals [37 mg/dL (16.5-47.5); 23 UI (17.5-26.5)] and nonsurvivors [41 mg/dL (24-66); 23 UI (17.5-24.5)]. Lactate, urea, creatinine, triglycerides and cholesterol concentration were higher in septic foals during the first 48h of life. Nonsurvivors foals showed higher lactate, triglycerides and cholesterol concentrations than survivors foals. Septic and nonsurvivors foals demonstrated changes in lipid metabolism characterized by hypertriglyceridemia, hypercholesterolemia and hypoglycemia at birth and reduction in the activity of GGT liver enzyme, with elevation in lactate and urea concentrations in nonsurvivors foals. Biochemical markers as glucose, triglycerides, cholesterol and GGT can be used as indicators of impairment at birth and the presence of sepsis, and can be used as prognostic factors in critically ill foals.

Introdução: A prematuridade é atualmente o principal problema clínico associado à mortalidade e morbidade neonatal e tem consequências adversas para a saúde e desenvolvimento infantil. Uma parte significativa desta população é classificada como pequenos para a idade gestacional e apresentam baixo peso ao nascimento. Em decorrência do parto prematuro, os recém-nascidos apresentam frequentemente, complicações clínicas ao nascimento aumentando risco de internação em Unidade de Terapia Intensiva Neonatal. No momento da admissão, pontuações neonatais de gravidade da doença são usadas para ajustar os resultados entre os recém-nascidos internados, dentre eles o SNAPPE-II. Devido à instabilidade clínica, os prematuros utilizam em sua maioria, sondas para a alimentação devido a incapacidade de alimentação por via oral. É considerável a falta de critérios para tomadas de decisões clínicas quanto ao momento da introdução e progressão da alimentação oral. Atualmente exite uma escassez de testes de confiabilidade na literatura sobre o uso dessas intervenções. Objetivo: Verificar a correlação entre a gravidade do recém-nascido prematuro no momento da admissão na UTIN aos preditores clínicos para introdução da alimentação por via oral nesta população. Método: Participaram deste estudo 62 recém-nascidos prematuros submetidos à avaliação fonoaudiológica durante internação na Unidade de Terapia Intensiva Neonatal em um hospital terciário. Foram coletados dados de variáveis demográficas, dados clínicos em prontuário médico, indicadores fonoaudiológicos, dados da avaliação fonoaudiológica da sucção nutritiva e não nutritiva e preditores de gravidade neonatal utilizando o Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE-II). A análise estatistica foi realizada utilizando duas formas distintas: tamanho para a idade gestacional e peso ao nascimento. Resultados: O desfecho da avaliação fonoaudiológica não apresenta estatisticamente associação significativa com a pontuação do SNAPPE-II quando os recém-nascidos pré-termo são comparados de acordo com o tamanho para idade gestacional. O tempo de introdução para via oral e transição para via oral completa, além da pontuação do SNAPPE II mostram melhores resultados em recém-nascidos de baixo peso quando comparados com recém-nascidos de extremo baixo peso e muito baixo peso Conclusão: Para as variáveis estudadas nota-se comportamentos parecidos para recém-nascidos de extremo baixo peso e muito baixo peso, com exceção do SNAPPE II. São necessários estudos voltados para a identificação do momento da prontidão para introdução da via oral, principalmente em recém-nascidos prematuros com peso inferior a 1500g / Introduction: Prematurity in actually the main clinical problem linked to mortality and morbidity in newborns and has adverse consequences for health and childhood development. Significant part of this population is classified as small for gestational age and birth low wight. As a consequence of premature delivery, newborns often present clinical complications at birth, increaning rates of hospitalization in Neonatal Intensive Care Unit (NICU). The time of admission, gravity newbon score is used to adjust the outcomes of hospitalized newborns, such as SNAPPE-II. Became of clinical instability, newborns use, most of them, tube for feeding, became of inability of oral feeding. It is considerable the lack of criteria for clinical decision choices for the proper moment of introducting and developing oral feeding. Nowadays, there are few reliability test in literature, over there interventions. Objective: Verify correlation between gravity of premature newborn at admission time in NICU to clinical predicton for introduction oral feeding for this population. Methods: Sixty two premature newborn have participated of this study, subject to speech therapy during hospitalization in NICU in a tertiary hospital. Demographic variable data has been collected, clinical data from medical records, speech therapist indicators, speech evaluation data from suck-swallow and predictors of newborn gravity, using Score for Neonatal Acute Physiology Perinatal Extension Version II (SNAPPE II). Statistic analyze was fulfilled by two distinct ways: size for gestational age. Introducing time for oral feeding and transition for complete oral feeding, besides punctuation of SNAPPE II, show better outcomes in low weight newborn, compared to extreme low weight and very low weight newborn. Conclusion: For studied variables, similar behaviors are noted for extreme low weight newborns, with exception of SNAPPE II. It is necessary futher studies turned to identification at the moment of readiness of introduction of oral feeding, mainly in premature newborns with inferior weight than 1.500 grames

Este trabalho discute as vicissitudes da constituição do sujeito do desejo na clínica do bebê pré-termo, constituição agenciada pela articulação das funções materna e paterna que atualizam para um sujeito a estrutura da linguagem, isto é, que articulam o desejo à dimensão da falta. Na clínica do bebê pré-termo o investimento desejante que sustenta a aposta simbólica que preside a inscrição do infans no dizer e no desejo do Outro é posto à prova, pois os pais, primeiros representantes do Outro (simbólico) para o recém-nascido, são confrontados de maneira intempestiva com a dualidade da vida e da morte. A escuta dos pais durante a hospitalização de seus bebês numa unidade de tratamento intensivo neonatal revela que a construção do laço primordial entre pais e filhos sofre o impacto do discurso técnico-científico, pois o lugar e o saber dos pais são inicialmente deslocados pelo saber médico e sancionados como insuficientes para cuidar da criança. Os fragmentos das falas dos pais apresentados neste trabalho são analisados à luz dos ensinamentos da psicanálise. Essa análise mostra que a escuta dos pais humaniza esse nascimento, pois implica-os numa elaboração psíquica que atenua a angústia e o sentimento de desamparo que acompanha esses nascimentos, visto que o bebê pré-termo produz uma inquietante estranheza em seus pais. O apoio psíquico fornecido a eles favorece a retificação do olhar fundador em relação ao bebê, minimizando o impacto das separações precoces que ameaçam a construção dos laços de amor e de desejo entre pais e filhos, a qual sabemos ser uma prerrogativa da saúde psíquica. / This work discusses the vicissitudes of the constitution of the subject of the desire in the clinic of preterm babies, a constitution that is promoted by the articulation of the motherly and fatherly functions that update to a subject the structure of language, that is, that articulates the desire with the dimension of lack. In the preterm baby clinic, the desiring investment that sustains the symbolic anticipation that presides the inscription of the infans in the discourse and in the desire of the Other is challenged, since parents, the first representatives of the (symbolic) Other for the newborn, are confronted in an untimely way with the duality of life and death. The hearing of the parents during the hospitalization of their babies in an neonatal intensive-care unit reveals that the construction of the primordial bond between parents and children suffers the impact of the techno-scientific discourse, since the place and the knowledge of parents are initially displaced by the medical knowledge and sanctioned as being insufficient to take care of the child. The fragments of the testimonials of the parents presented in this work are analyzed at the light of the teachings of psychoanalysis. This analysis shows that the hearing of the parents humanizes this birth, because it involves them in a psychical elaboration that attenuates the anguish and the feeling of helplessness that follows these births, considering that the premature baby produces a disturbing strangeness in its parents. The psychic support offered to them favors the rectification of the founding gaze in relation to the baby, thus minimizing the impact of the precocious separations that threaten the construction of the bonds of love and desire between parents and children that we know as being a prerogative of the psychic health.

Preterm birth (PTB) is defined as birth before 37 weeks gestational age. PTB is a common outcome and one that may be increasing in prevalence with serious individual and public health implications both immediately and long term. While PTB is a pregnancy specific outcome it is more appropriately viewed as the culmination of risk factors present both before pregnancy and possibly in past generations. This thesis attempts to review the implications, risk factors and current prevention strategies directed at PTB while placing it in an intergenerational and life cycle context. Three novel investigations are presented and their consequences are discussed. These investigations cover the lifespan and relate to identifying PTB and treating its immediate health outcomes. The first examines mitochondrial genetics and it's relation to PTB. There is a strong a priori hypothesis that mitochondrial genetics, being maternally inherited, may contribute to an individual's risk for PTB. However, in two genome wide association studies, no evidence is found for any mitochondrial polymorphisms being related to PTB. The second investigation reports an attempt to identify women at risk for PTB within a given pregnancy. Using routinely collected maternal information and serum screening data a potentially useful screening method is derived. While the algorithm does not have ideal performance characteristics it compares favorably to other population wide screening techniques and could be improved through future validation and data collection. The third and final investigation attempts to address quality of care for infants born preterm. In a network of neonatal intensive care units, wide variations in mortality outcomes are observed. Intensity of medical intervention appears to be an important predictor of mortality for the lowest gestational age infants. However, this intensity of intervention does not fully explain the observed differences in mortality outcomes. Finally, these study are discussed in context with one another and a new framework for considering PTB is presented that may help to guide future investigation into predicting, preventing and caring for those at risk for or experiencing a PTB.

En dépit du nombre croissant d’études cliniques sur le canal artériel (CA), des failles méthodologiques entretiennent plusieurs incertitudes concernant l’efficacité et la sécurité des traitements chez les bébés nés prématurés. L’objectif de cette recherche était de comparer les concentrations de prostaglandine E2 (PGE2) et les mesures du flux mésentérique par échographie Doppler chez les enfants nés prématurément et ayant un canal artériel traité à l’ibuprofène par voie intraveineuse ou entérale, en utilisant la méthodologie randomisée contrôlée et à double insu. Dans notre étude pilote, 20 nouveau-nés prématurés de moins de 34 semaines ayant un CA symptomatique confirmé par échocardiographie, furent randomisés au traitement à l’ibuprofène par voie intraveineuse ou entérale. La voie d’administration fut maintenue à l’insu de l’équipe traitante, des cardiologues et des investigateurs. Des dosages des prostaglandines plasmatiques ont été mesurés avant le début du traitement ainsi que 3, 24 et 48 h après le début du traitement. Les mesures du flux mésentérique ont été effectuées avant le traitement à l’ibuprofène ainsi que 1 h et 3 h après le traitement. Nous avons démontré à partir de nos observations que les niveaux plasmatiques de prostaglandines E2 diminuent chez les patients ayant répondu au traitement à l’ibuprofène, indépendamment de la voie d’administration. Nous n’avons pas observé de changement dans l’évolution des dosages de PGE2 chez les patients qui n’ont pas répondu au traitement. Les paramètres mesurés par échographie Doppler au niveau de l’artère mésentérique supérieure n’étaient pas affectés par la voie d’administration du traitement à l’ibuprofène, intraveineuse ou entérale. La présente étude suggère ainsi que le traitement du CA par ibuprofène intraveineux ou entéral n’influe pas sur le flux sanguin mesuré par échographie Doppler. La baisse de la prostaglandine E2 coïncide avec la fermeture du CA, et son dosage pourrait jouer un rôle dans la gestion du traitement. Nous avons démontré la faisabilité d’une étude clinique randomisée à double insu dans le traitement du canal artériel; une méthodologie qui devrait désormait être employé dans la recherche clinique sur les traitements de la persistance du CA. / Despite the growing body of research on the patent ductus arteriosus (PDA), issues with clinical research methodology impairs much of our understanding regarding treatment efficacy and safety in the preterm population. The purpose of this study was to determine plasma prostaglandin E2 (PGE2) concentrations in preterm infants with symptomatic persistence of the ductus arteriosus treated with IV and oral ibuprofen, and measure Doppler flow parameters in the superior mesenteric artery, utilizing randomized controlled and double-blind methodology. Twenty patients age < 34 wks with a symptomatic PDA confirmed by echocardiography randomized to oral vs intravenous ibuprofen regimen. Treating physician, cardiologists and study investigators were blinded to treatment allocation. Plasma PGE2 levels were measured prior to ibuprofen treatment and at 3, 24 and 48 h after treatment. Mesenteric Doppler measurements were taken prior to ibuprofen treatment, and 1 h and 3 h after treatment. Our results showed that plasma PGE2 levels decreased over time in patients that exhibited ductal closure after IV or oral ibuprofen treatment; no time-dependent changes in PGE2 were seen in subjects that failed to respond to ibuprofen. Superior mesenteric artery Doppler flow measurements were not affected by ibuprofen treatment (IV or oral), regardless of efficacy on ductal closure and of PGE2 changes. We conclude that treatment with oral or intravenous ibuprofen does not impact on superior mesenteric artery blood flow measured by Doppler ultrasound. Decreases in plasma PGE2 concentrations coincide with ibuprofen efficacy, and may be more cost-effective to monitor than ultrasound. This study also demonstrated the successful use of double blinded randomized controlled research methodology, which should be more strictly applied in future clinical research on PDA treatment.

This diploma thesis deals with the issues of a family of a newborn with a developmental risk. The theoretic part deals with the most common problems endangering the healthy development of a newborn, also with family and the process of coping with the crisis. Further on, it deals with possibilities of family support during their stay in hospital and also after the baby has been discharged into home care, using the support of non-health care groups. The objective of the diploma thesis was to detect possibilities of psycho-social support for the family of a newborn with a developmental risk. The thesis answers questions of, how parents feel in this situation after the birth of their child, during its stay in hospital and subsequently after the discharge into home care, what kind of support services they use to help them manage this period. Further on it deals with questions of whether the information of support options is sufficient and whether this support system works from the parent?s perspective.This diploma thesis was processed on a basis of qualitative survey results. The questioning method of half-format with parents was used and the method of document summary analysis. The investigated samples were parents of ten children treated in The Developmental Care Unit of Neonatology ward in the hospital of České Budějovice a.s. During the hospitalization of the child, it is important, that the medical team communicates openly, gives well timed and clear information and allows direct involvement in the child care. The outcome of this investigation points out the important role of the partner, family and friends as the main source of support. Also sharing feelings and needs with other parents is rand as a considerable source of support. However, the mothers especially, miss this sharing opportunity after their baby has been discharged into home care. Another interesting outcome is the absence of a psychologist, who specializes in newborn matters as an important source of support for parents. The survey shows, how important the psychosocial support is for parents, not just during hospitalization, but also after the discharge of their baby. Whereas they feel that the healthcare service is adequate, they especially miss the psychosocial support after the discharge from hospital. This is especially true of families of babies with developmental risk, without any serious health problem. Listed subjects could be used by professionals dealing with care of newborn with developmental risk, who provide complex care for families of the children with perinatal condition. Therefore, specialized psychological help should be an evident part of the care provided. The hypothesis were determined on the basis of qualitative survey results, which could be verified by further investigation:Hypothesis 1: For mothers of a newborn with developmental risk it is important to get help in the framework of supporting parental groups.Hypothesis 2: After the discharge of their child into home care, parents would appreciate psychosocial support in the framework of outpatient service.

The topic of the thesis Nursing Care of Newborns in the Process of Perioperative Care deals with specific and distinct features of such care from the viewpoint of nursing. The main objective was to specify all tasks of nurses in the process of perioperative care and the procedures they use. Last but not least, we focused on how the nursing care differs with regard to the age of newborns. The selected research method was qualitative research using semi-structured interviews with nurses from perinatology centers. The research covered 10 respondents with various levels of education and lengths of practical experience. Nurses most frequently understand the term of perioperative care as the care provided before, during and after a surgery. Most of them actually perform preparation of the child before the surgery and then they provide postoperative care. Only 2 out of the 10 respondents are directly involved in the surgery procedure and thus accompany the newborns throughout the entire process of perioperative care. The care provided before the surgery most often includes identification of the child, checking of its vital functions, involvement in blood collection, including intravenous cannulation, administration of prescribed medication, preparation of the surgical site and communication with the parents. Children are most frequently accompanied by their mothers and nurses need to communicate with them. Nurses transport the child to the operating room, hand the child over and subsequently take it back after the surgery. They also record all those activities in the medical files and in some cases they check signed informed consents. Intraoperative care consists mainly of monitoring of the newborn, assisting to the physician in airway management - intubation and during the entire surgery procedure. The most common surgical procedures performed in children are hernia, bowel and heart surgeries. The nurses also generally mentioned surgeries of developmental disorders. After the surgery nurses usually move the child to the neonatology intensive care unit which is equipped with a ventilator, incubator and all types of medication. They regularly check and record child´s vital functions, monitor the surgical wound and its proximity, intake and excretion, they provide nutrition etc. Nurses also assess the pain, most frequently using the NIPS scale, and they educate the parents. Post-surgery complications occur only sporadically and they include infections, bleeding or abstinence syndrome after administration of opiates. The collected data have shown only one difference relating to the age of newborns who underwent a surgery. Specifically, certain surgeries, e.g. of necrotic enterocolitis, are performed more frequently on less mature newborns. In general, most of the surgeries are performed on prematurely born neonates and extremely immature neonates. When asked what they would like to change or improve in the perioperative care from the nursing point of view the nurses primarily mentioned more contacts between the mother and child and consistent compliance with aseptic procedures. The responding nurses were mostly content, they praised the highly specialized care and the good cooperation between the nursing team and the medical team which consists of pediatricians and specialists. Results of those teams thus contribute to continually decreasing mortality rate of high-risk and pathological newborns and to better quality of life of those children after the surgery.

It is understood that the organization of perinatal care, according to the risk approach, implies that every pregnant and newborn are adequately cared for at the level of complexity they need. The purpose of the present study was to describe the structure and processes of care for pregnant women and newborns, including essential neonatal care, in maternity hospitals in the State of Sergipe. It is an integrated cross-sectional study to the research Born in Sergipe: survey about pre - natal, delivery and puerperium, conducted between June 2015 and April 2016 in public, mixed and private hospitals of Sergipe that had performed a minimum of 500 births in 2014, totaling 11 hospitals. Initially, a questionnaire was administered to managers of the eligible units on the existing structure and work processes. Subsequently, a representative number of postpartum women from these hospitals were interviewed and, after discharge, their medical records and those of their newborns were analyzed. The results showed that Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 Units of Intermediate Unit (UI) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for attending high-risk deliveries. Moreover, regarding components of the Essential Newborn Care corresponding strategies which aim to improve the health of the newborn at different stages, from conception to the postnatal period, only 18% of women had the presence of Companion always for delivery, 41% had skin-to-skin contact early with their child and 33.1% breastfed in the first hour of life. It was observed an adequate distribution of NICU beds between Capital and Interior considering the current legislation, low adherence to protocols of hypertensive and hemorrhagic emergencies; there was low coverage also for the humanization policies, risk rating for the pregnant woman and practices of Essential Newborn Care, especially the skin - to - skin contact and breastfeeding in the first hour of life. / A organização da assistência perinatal, segundo o enfoque de risco, implica que toda gestante e recém-nascido sejam atendidos adequadamente no nível de complexidade que necessitam. O presente estudo teve por objetivo descrever a estrutura e os processos de atendimento à gestante e ao recém-nascido, incluindo os cuidados neonatais essenciais, das maternidades do Estado de Sergipe. Trata-se de um estudo transversal integrado à pesquisa Nascer em Sergipe: inquérito sobre assistência pré-natal, parto e puerpério, realizado entre junho de 2015 e abril de 2016 nas maternidades públicas, mistas e privadas de Sergipe que tiveram pelo menos 500 partos em 2014, totalizando 11 maternidades. Inicialmente foi aplicado um questionário aos gestores das unidades elegíveis sobre a estrutura e os processos de trabalhos existentes. Posteriormente, um número representativo de puérperas desses hospitais foi entrevistado e, após a alta, seus prontuários e os de seus recém-nascidos foram analisados. Os resultados mostraram que Sergipe dispõe de 78 leitos de Unidade de Terapia Intensiva Neonatal (UTIN) e 90 de Unidade Intermediária (UI) para atendimento da demanda espontânea e programada. Somente seis maternidades (54,5%) realizam a classificação de risco e quatro (36,3%) possuem protocolos para atendimento das parturientes de alto risco. Além disso, os componentes do Essential Newborn Care que correspondem a estratégias que têm o objetivo melhorar a saúde do recém-nascido em diferentes estágios, desde a concepção até o período pós-natal, estavam presentes em apenas 18% das mulheres que tiveram a presença do acompanhante em todos os momentos do parto, 41% que tiveram contato pele a pele precoce com seu filho e 33,1% que amamentaram na primeira hora de vida. Observou-se uma distribuição adequada de leitos de UTIN entre Capital e Interior levando-se em consideração a legislação vigente, baixa adesão aos protocolos das emergências hipertensivas e hemorrágicas; houve baixa cobertura também em relação às políticas de humanização, classificação de risco para a gestante e às práticas do Essential Newborn Care, principalmente o contato pele a pele precoce e a amamentação na primeira hora de vida.

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No. of bitstreams: 2 Dissertação - Jaciane Soares de Sá - 2013.pdf: 2086467 bytes, checksum: 981c508d390d7ce0ea5a9d89c434b7c2 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2013-11-08 / The Catheter Peripherally Inserted Central is a device used in intravenous therapy in neonatal intensive care units and pediatric and in neonatal intermediate care units, which promotes venous access safe for a long time and with a low rate of infection, however, the use of this technology by being a complex process, may be subject to adverse events. The aim of the study was to analyze the use of central venous catheter peripherally inserted into a child public hospital from the perspective of nurses, identify and classify the events in the stages of the process of insertion, maintenance and removal of PICC and verify the procedures adopted in these events and the consequences for patients. Descriptive analysis was performed of the results, with minimum and maximum for continuous variables and absolute and relative frequencies for categorical variables. Qualitative data were grouped and categorized by approaching answers. Results The results showed a predominance of females with an average age between 24-58 years and 5 or more years of professional performance, function and institution. The working day was 30 hours per week and 53.8% were specialists with training course for handling PICC. 84.6% witnessed some kind of adverse event, 57.7% in the insertion, highlighting the difficulty of progression / closing valve / capillary fragility; 84.6% in keeping with an obstruction of the catheter 61.5% EA as mentioned, caused by the blood reflux, drug incompatibility, poor permeabilization and lack of washing (flushing) of the catheter; and 15.4% in recession, caused by rupture / breakage of the catheter. The adopted clinical management were the exchange of venous access, monitoring, traction of the catheter and pressure dressing in case of bleeding. The consequences for patients were prolonged length of stay in the service, need to complement therapy and new IV line installation. The results signaled the size of adverse event occurrences in the safe use of PICC, the safety measures and quality of patient care, requiring the training of nursing professionals, combined with a policy of promoting continuing education activities and formulation strategies to minimize flaws and building a professional and institutional culture of safety. / O Cateter Central de Inserção Periférica é um dispositivo utilizado em terapia intravenosa nas unidades de terapia intensiva neonatal e pediátrica e nas unidades de cuidados intermediários neonatais, que promove acesso venoso seguro por tempo prolongado e com baixo índice de infecção, todavia, a utilização dessa tecnologia, por ser um processo complexo, pode estar sujeito à ocorrência de eventos adversos. O objetivo do estudo foi analisar a utilização do cateter venoso central de inserção periférica em um hospital público infantil sob a ótica dos enfermeiros, identificar e classificar os eventos ocorridos nas fases do processo de inserção, manutenção e retirada do PICC e verificar as condutas adotadas na ocorrência desses eventos e as consequências para os pacientes. Foi realizada análise descritiva dos resultados, apresentando mínima e máxima para variáveis contínuas e frequência absoluta e relativa para as variáveis categóricas. Os dados qualitativos foram agrupados e categorizados por aproximação de respostas. Os resultados Os resultados evidenciaram a predominância do sexo feminino com idade média entre 24 a 58 anos e 5 ou mais anos de atuação profissional, na função e na instituição. A jornada de trabalho foi de 30 horas semanais e 53,8% eram especialistas com curso de capacitação para manuseio do PICC. 84,6% presenciaram algum tipo de evento adverso, 57,7% na inserção, destacando-se a dificuldade de progressão/fechamento da válvula/fragilidade capilar; 84,6% na manutenção sendo a obstrução do cateter com 61,5% o EA mais citado, ocasionado por refluxo sanguíneo, incompatibilidade de medicamentos, permeabilização inadequada e falta de lavagem (flushing) do cateter; e 15,4% na retirada, ocasionada por ruptura/quebra do cateter. As condutas clínicas adotadas foram a troca do acesso venoso, o monitoramento, o tracionamento do cateter e curativo compressivo em caso de sangramento. As consequências para os pacientes foram prolongamento do tempo de permanência no serviço, necessidade de terapêutica complementar e instalação de novo acesso venoso. Os resultados sinalizaram a dimensão de ocorrências de eventos adversos na utilização segura do PICC, nas medidas de segurança e na qualidade da assistência ao paciente, sendo necessária a capacitação dos profissionais de enfermagem, aliada a uma política de promoção de atividades de educação permanente e formulação de estratégias para minimizar as falhas existentes e a construção de uma cultura de segurança profissional e institucional.