This diploma thesis addresses the issue of prematurely born children. It focuses on the cooperation between neonatologic nurses in perinatal centers and the parents of the newborns. There are 3 goals of this thesis: 1. To explore and describe the level of cooperation and support of the parents and their involvement in the care of the premature newborns in perinatal centers in the Czech Republic. 2. To find out which priorities and expectations of the parents of the premature newborns are. 3. To contribute with these results to the improvement of mutual relationship between a medic and a parent. To achieve the goals described above the methods of quialitative and quiantitative research were used in the empirical part of the thesis. The quantitative research was carried out in perinatal centers in the Czech Republic using questionnaires filled by the nurses who work there. The qualitative research was carried out by questioning the mothers of the premature newborns using individual thematic semi-standardized interview. The results of the research will be provided to all perinatal centers in the Czech Republic that cooperated and can be used to improve the quality of cooperation between neonatologic nurses and parents of premature newborns.

As alterações respiratórias durante o aumento do volume gástrico, como na dieta por gavagem, acarretam algumas conseqüências ao recém-nascido pré-termo, alterando indicadores da função respiratória, como: aumento da freqüên cia respiratória e cardíaca, fadiga muscu lar, apnéias, cianose, hipoxemia e hiper capnia. Um posicionamento corporal adequado apresenta grande influência sobre a biomecânica da caixa torácica, pois serve como ponto de apoio à mus culatura respiratória, ocasiona maior contratibilidade do músculo, altera a pressão pleural, aumenta o volume de ar pulmonar gerando menor esforço respi ratório e menor desvantagem mecânica ao sistema respiratório. O posicionamen to direcionado aos recém-nascidos pre maturos promove uma reorganização sensorial, sono tranqüilo, menor gasto energético e menor desordem no equilíbrio muscular postural, promovendo menor índice de complicações futuras no desenvolvimento. O presente estudo propôs analisar através dos indicadores da função respiratória a resposta aos posicionamentos em recém-nascidos pré-termo submetidos ao aumento do volume gástrico durante a gavagem. Foi realizado um estudo com delineamento prospectivo, randomizado e tipo cross over. Foram estudados 16 recém-nasci dos prematuros de 31 a 34 semanas de idade gestacional, com peso de nasci mento até 2.500 g. Foram selecionados os recém-nascidos que recebiam a dieta via sonda oro-gástrica com volume total de 150 ml/kg/dia, que se encontravam do sétimo ao décimo dias de vida, sem oxigenoterapia suplementar. Foi utilizado a cada administração da dieta um posicionamento de decúbito diferente, sendo todos com 30° de elevação. Cada recém-nascido recebeu quatro gava gens com intervalo entre elas de 3 ho ras. Os decúbitos foram: lateral direito, lateral esquerdo, pronação e supinação. Os indicadores da função respiratória analisados foram: freqüência respirató ria e cardíaca, saturação de oxigênio, tiragem intercostal, batimento de asa nasal e gemência. Os parâmetros foram coletados de dois em dois minutos a partir de cinco minutos antecedendo a gavagem até o quinto minuto após o término da administração da dieta. Os recém-nascidos acompanhados apre sentaram média de 32 semanas de idade gestacional (desvio padrão, DP, 1,31), peso médio ao nascimento de 1.722 g (DP 276,33). Na comparação entre os decúbitos, a freqüência respiratória média apresentou-se com valores mais altos durante toda a coleta em supina ção e lateral esquerdo (média = 69 e 68, incursões por minuto, ipm) e os valores mais baixos foram encontrados em lateral direito e pronação (61 e 59 ipm). Nos posicionamentos em lateral direito e pronação a freqüência cardíaca média obteve os níveis mais estáveis e mais baixos durante toda a coleta, porém, a supinação apresentou os valores mais altos (média = 142,4, batimentos por minuto, bpm). No decúbito lateral esquerdo e supinação a saturação de oxigênio médio apresentou os menores valores (média geral = 94%) principal mente após a gavagem. Na tiragem intercostal, no batimento de asa nasal e na gemência o lateral direito e pronação apresentaram maior ausência destes sinais, e o lateral esquerdo e supinação apresentaram maior freqüência a eles. Assim, conclui-se que os decúbitos lateral direito e pronação demonstraram maior repercussão positiva nos indica dores da função respiratória, sendo a supinação e lateral esquerdo as posi ções de maiores efeitos negativos nos recém-nascidos submetidos ao aumento do volume gástrico. / The respiratory alterations during the gastric volume\'s increasing, as the gavages, cause some consequences to the premature newborn, modifying the respiratory function indication as: increase of the respiratory and cardiac frequency, muscular fatigue, apneas, cyanosis, hypoxemia and hypercapnia. An appropriate corporal positioning presents great influence on the biomechanics of the rib cage, abutment to the respiratory musculature; it causes greater muscle contraction, modifies the pleural pressure, it increases the pulmonary air volume, causing less respiratory effort and less mechanics\' disadvantages to the respiratory system. The positioning directed to the premature newborns promote a sensorial reorganization, calm sleep, less energy expenses and less clutter in the postural muscular balance, promoting less possibility of future complications in the baby\'s development. The purpose of this study is to analyze through the pointers of the respiratory function the reply of the positioning of in newborn premature submitted to the increase of the gastric volume during the gavages feeding. It was made a study with prospective delineation, randomized and crossover type. It was studied 16 preterm infants of 31 - 34 weeks of gestational age, weighting about 2.500 g. It had been selected newborn that received the diet through the oral-gastric sounding with the volume of 150 ml/kg/day, which was found in the seventh to the tenth days of life, without supplemental oxygen-therapy. It was used different positions to each act of receiving the diet, with 30 degrees elevation. Each newborn used four gavages with spaces of time between them of 3 hours. The positions were: right lateral, left lateral, prone and supine. The analyzed indicators of the respiratory function were: respiratory and cardiac frequency, oxygen saturation, drawing of intercostals, beating of nasal wing and grunting. The parameters were collected from two to two minutes from five minutes preceding the gavage until the fifth minute after the administration diet ending. The newborns studied presented about 32 weeks of gestational age (shunting line standard, DP, 1.31), average weight to the birth of 1.722 g (DP 276,33). Comparing the positions, the average respiratory frequency presented higher values during all the collection in supine and left lateral (average = 69 and 68, breaths per minute, rpm) and the lowest values were found in right lateral and prone (61 and 59 rpm). In the average cardiac frequency, the positions in the right lateral and prone were the ones that had kept the lower levels steadiest during all the collection. However, the supine presented the highest values (average = 142,4, beatings per minute, bpm). In the saturation of medium oxygen, the left lateral and supine presented less values mainly after (average generality = 94%) the gavages. In the drawing of intercostals, in the beating of nasal wing and the grunting, the right lateral and prone presented a greater absence of these signals, and the left lateral and supine presented greater frequency of them. Thus, it is concluded that the right lateral and prone positions showed a greater positive repercussion in the pointers of the respiratory function, being the lateral left and supine the positions of bigger negative effects in the submitted newborn to the increase of the gastric volume.

As alterações respiratórias durante o aumento do volume gástrico, como na dieta por gavagem, acarretam algumas conseqüências ao recém-nascido pré-termo, alterando indicadores da função respiratória, como: aumento da freqüên cia respiratória e cardíaca, fadiga muscu lar, apnéias, cianose, hipoxemia e hiper capnia. Um posicionamento corporal adequado apresenta grande influência sobre a biomecânica da caixa torácica, pois serve como ponto de apoio à mus culatura respiratória, ocasiona maior contratibilidade do músculo, altera a pressão pleural, aumenta o volume de ar pulmonar gerando menor esforço respi ratório e menor desvantagem mecânica ao sistema respiratório. O posicionamen to direcionado aos recém-nascidos pre maturos promove uma reorganização sensorial, sono tranqüilo, menor gasto energético e menor desordem no equilíbrio muscular postural, promovendo menor índice de complicações futuras no desenvolvimento. O presente estudo propôs analisar através dos indicadores da função respiratória a resposta aos posicionamentos em recém-nascidos pré-termo submetidos ao aumento do volume gástrico durante a gavagem. Foi realizado um estudo com delineamento prospectivo, randomizado e tipo cross over. Foram estudados 16 recém-nasci dos prematuros de 31 a 34 semanas de idade gestacional, com peso de nasci mento até 2.500 g. Foram selecionados os recém-nascidos que recebiam a dieta via sonda oro-gástrica com volume total de 150 ml/kg/dia, que se encontravam do sétimo ao décimo dias de vida, sem oxigenoterapia suplementar. Foi utilizado a cada administração da dieta um posicionamento de decúbito diferente, sendo todos com 30° de elevação. Cada recém-nascido recebeu quatro gava gens com intervalo entre elas de 3 ho ras. Os decúbitos foram: lateral direito, lateral esquerdo, pronação e supinação. Os indicadores da função respiratória analisados foram: freqüência respirató ria e cardíaca, saturação de oxigênio, tiragem intercostal, batimento de asa nasal e gemência. Os parâmetros foram coletados de dois em dois minutos a partir de cinco minutos antecedendo a gavagem até o quinto minuto após o término da administração da dieta. Os recém-nascidos acompanhados apre sentaram média de 32 semanas de idade gestacional (desvio padrão, DP, 1,31), peso médio ao nascimento de 1.722 g (DP 276,33). Na comparação entre os decúbitos, a freqüência respiratória média apresentou-se com valores mais altos durante toda a coleta em supina ção e lateral esquerdo (média = 69 e 68, incursões por minuto, ipm) e os valores mais baixos foram encontrados em lateral direito e pronação (61 e 59 ipm). Nos posicionamentos em lateral direito e pronação a freqüência cardíaca média obteve os níveis mais estáveis e mais baixos durante toda a coleta, porém, a supinação apresentou os valores mais altos (média = 142,4, batimentos por minuto, bpm). No decúbito lateral esquerdo e supinação a saturação de oxigênio médio apresentou os menores valores (média geral = 94%) principal mente após a gavagem. Na tiragem intercostal, no batimento de asa nasal e na gemência o lateral direito e pronação apresentaram maior ausência destes sinais, e o lateral esquerdo e supinação apresentaram maior freqüência a eles. Assim, conclui-se que os decúbitos lateral direito e pronação demonstraram maior repercussão positiva nos indica dores da função respiratória, sendo a supinação e lateral esquerdo as posi ções de maiores efeitos negativos nos recém-nascidos submetidos ao aumento do volume gástrico. / The respiratory alterations during the gastric volume\'s increasing, as the gavages, cause some consequences to the premature newborn, modifying the respiratory function indication as: increase of the respiratory and cardiac frequency, muscular fatigue, apneas, cyanosis, hypoxemia and hypercapnia. An appropriate corporal positioning presents great influence on the biomechanics of the rib cage, abutment to the respiratory musculature; it causes greater muscle contraction, modifies the pleural pressure, it increases the pulmonary air volume, causing less respiratory effort and less mechanics\' disadvantages to the respiratory system. The positioning directed to the premature newborns promote a sensorial reorganization, calm sleep, less energy expenses and less clutter in the postural muscular balance, promoting less possibility of future complications in the baby\'s development. The purpose of this study is to analyze through the pointers of the respiratory function the reply of the positioning of in newborn premature submitted to the increase of the gastric volume during the gavages feeding. It was made a study with prospective delineation, randomized and crossover type. It was studied 16 preterm infants of 31 - 34 weeks of gestational age, weighting about 2.500 g. It had been selected newborn that received the diet through the oral-gastric sounding with the volume of 150 ml/kg/day, which was found in the seventh to the tenth days of life, without supplemental oxygen-therapy. It was used different positions to each act of receiving the diet, with 30 degrees elevation. Each newborn used four gavages with spaces of time between them of 3 hours. The positions were: right lateral, left lateral, prone and supine. The analyzed indicators of the respiratory function were: respiratory and cardiac frequency, oxygen saturation, drawing of intercostals, beating of nasal wing and grunting. The parameters were collected from two to two minutes from five minutes preceding the gavage until the fifth minute after the administration diet ending. The newborns studied presented about 32 weeks of gestational age (shunting line standard, DP, 1.31), average weight to the birth of 1.722 g (DP 276,33). Comparing the positions, the average respiratory frequency presented higher values during all the collection in supine and left lateral (average = 69 and 68, breaths per minute, rpm) and the lowest values were found in right lateral and prone (61 and 59 rpm). In the average cardiac frequency, the positions in the right lateral and prone were the ones that had kept the lower levels steadiest during all the collection. However, the supine presented the highest values (average = 142,4, beatings per minute, bpm). In the saturation of medium oxygen, the left lateral and supine presented less values mainly after (average generality = 94%) the gavages. In the drawing of intercostals, in the beating of nasal wing and the grunting, the right lateral and prone presented a greater absence of these signals, and the left lateral and supine presented greater frequency of them. Thus, it is concluded that the right lateral and prone positions showed a greater positive repercussion in the pointers of the respiratory function, being the lateral left and supine the positions of bigger negative effects in the submitted newborn to the increase of the gastric volume.

Darbo tikslas - atskleisti slaugytojų patirtis, dirbant Naujagimių reanimacijos ir intensyviosios terapijos skyriuje. Kokybinio tyrimo klausimas. Kokios yra slaugytojų patirtys, dirbant Naujagimių reanimacijos ir intensyviosios terapijos skyriuje? Tyrimo metodika. Tyrimas atliektas taikant kokybinį fenomenologinį tyrimo metodą. Tyrimo duomenys buvo renkami nuo 2012 metų birželio iki 2012 metų gruodžio mėnesio, Kauno perinatologijos centro Naujagimių reanimacijos ir intensyviosios terapijos skyriuje (NRITS). Tyrime dalyvavo dešimt informantų – slaugytojų, dirbančių NRITS. Informantai buvo pasirinkti tikslinės atrankos būdu. Tyrimo duomenys rinkti individualaus atviro interviu metodu. Kiekvieno interviu trukmė buvo nuo 40 iki 90 min. Visi interviu, tyrimo dalyvėms sutikus, buvo įrašomi į diktofoną. Visi į diktofoną įrašyti interviu buvo iššifruoti t.y. paversti tekstu. Toliau tekste išskirti reikšminiai kodai - kurie buvo sujungti į potemes ir potemės sujungtos į temas. Duomenų analizė buvo atliekama taikant tyrimo duomenų tranguliaciją ir tyrėjų tranguliaciją. Tai leido užtikrinti duomenų patikimumą ir validumą. Įžvalgos. Slaugytojos savo profesiniame darbe NRITS susiduria su stipriais emociniais, vidiniais išgyvenimais ir keliamais klausimais, į kuriuos neturi atsakymų nei tėvams, nei pačios sau. Vienas iš sunkiausių emocinių išgyvenimų yra slaugomo naujagimio mirtis. Slaugytojoms trūksta žinių apie tai, kaip reikia elgtis su mirštančio naujagimio tėvais, todėl nežinodami... [toliau žr. visą tekstą] / Aim of the research: To detect nurses experiences in Neonatal Intensive Care Unit. Qualitative research question. What are nurses’ experiences in Neonatal Intensive Care Unit? Methods of the research. The research was conducted using a qualitative phenomenological method. The data were collected from June 2012 to December 2012, in Kaunas Perinatal Center at Neonatal Intensive Care Unit (NICU). The research involved ten informants - nurses working at NICU. The informants were selected by purposive sampling. Individual open interview method was used for data collection. Each interview lasted from 40 to 90 minutes. All interviews were tipe recorded and transcribed verbatim. While analyzing interviews, researchers noted their interpretations and associations. The identified codes were merged into subthemes and general themes were identified. Data analysis was performed using the data trangulation and researchers‘trangulation. It ensured validity and credibility of this study. Insights. Nurses in their professional work at Neonental Intensive Care Unit face with strong emotional, internal feelings and questions to which they do not have answers. They have answers neither for parents nor for themselves. One of the most difficult emotional experiences is the death of the newborn. Nurses' lack of knowledge about how to deal with the parents at the moment of the death newborn and because of that they do not know what is right, the survey participants think of themselves how they would... [to full text]

This diploma thesis deals with the onset of full breastfeeding in preterm infants and with the possible influence of alternative feeding methods on breastfeeding in immature newborns. Based on the study of literature, research questions were identified to find out in which gestation week full breastfeeding is taking place in premature babies and to what extent alternative feeding methods affect the onset of full breastfeeding in premature babies. They also had to find out whether feeding the infant bottles actually leads to unsuccessful breastfeeding. Three objectives were set for the diploma thesis. The first was to find out in which gestational week full breastfeeding is taking place in premature babies, provided the mother has enough breast milk. The second goal investigated the extent to which alternative feeding methods affect early pregnancy, provided the mother has enough breast milk. The third objective was to find out whether feeding a baby bottle actually leads to unsuccessful breastfeeding. To achieve the objectives of my thesis, I chose qualitative research, which was done in two groups of respondents, namely preterm newborns and their mothers. For each group of respondents, I chose different research techniques. For research on premature newborns, I chose structured observation. In a research survey among mothers of preterm babies, I chose a semi-standardized interview.

Darbo tikslas – ištirti neišnešiotų naujagimių tėvų poreikius naujagimių intensyviosios terapijos skyriuje. Uždaviniai: 1.Nustatyti tėvų poreikius, remiantis tėvų ir slaugytojų požiūriu. 2.Palyginti tėvų poreikius atskirose poreikių grupėse, remiantis tėvų ir slaugytojų požiūriu. 3.Palyginti tėvų poreikius atskirose poreikių grupėse, remiantis mamų ir tėčių požiūriu. 4. Nustatyti ryšius tarp neišnešiotų naujagimių tėvų poreikių ir jų socialinių bei demografinių charakteristikų. 5.Atskleisti mamų, gulinčių ligoninėje kartu su savo neišnešiotais naujagimiais, poreikius ir lūkesčius. Hipotezės 1.Tėvų požiūriu, neišnešiotų naujagimių tėvams naujagimių intensyviosios terapijos skyriuje svarbiausi yra informacijos poreikiai. 2.Neišnešiotų naujagimių tėvai naujagimių intensyviosios terapijos skyriuje ir slaugytojai, dirbantys šiame skyriuje, skirtingai vertina visas penkias tėvų poreikių grupes. Kokybinio tyrimo klausimas - Kokie yra mamų, gulinčių ligoninėje kartu su savo neišnešiotais naujagimiais, poreikiai ir lūkesčiai? / The aim of the study was to analyze the needs of parents who have premature newborns in the Neonatal Intensive Care Unit. Objectives of the study: 1.To identify the needs of parents perceived by parents themselves and by nurses. 2.To compare the parents’ and nurses’ perceptions of parental needs in all needs subscales. 3.To compare the mothers’ and fathers’ perceptions of parental needs in all needs subscales. 4.To determine the relation between parental needs and their socio-demographic characteristics. 5.To reveal the needs and expectations of mothers while being hospitalized with their premature newborns. Hypotheses 1.Parents who have premature newborns in a Neonatal Intensive Care Unit identify informational needs as the most important subscale of needs. 2.The perceptions of parental needs by parents who have premature newborns in a Neonatal Intensive Care Unit and by nurses who work in this unit are different in all subscales of needs. Qualitative research question - What are the needs and expectations as expressed by mothers while being hospitalized with their premature newborns?

Currently, the care of premature newborn infants and their parents is mainly focused on the so-called Newborn Individualized Developmental Care and Assessment Program (NIDCAP) that is aimed at protection of the developing central nervous system of a premature child.The aim of nursing care is to help premature child to cope with the premature delivery. To adjust the environment and the way of care so it suits the individual needs of every child. The support of the parental role and the efforts to involve parents in the care of a newborn infant as early as possible are stressed. The following objectives were defined in the diploma thesis. To process experience with introducing new forms of the developmental care of excessively or extremely premature newborn infants from the point of view of nursing. To characterize current provision of individualized developmental care of newborn infants born before week 32 of gestation. To map the role of the nurse in delivering individualized developmental care and to find out how parents perceive the developmental care of excessively and extremely premature newborn infants. 4 research questions were raised on the basis of the objectives of the thesis. Which forms of the individualized developmental care are used in care of a newborn infant born before week 32 of gestation most? Which problems do nurses have to cope when employing individualized developmental care in the day-to-day care of newborn infants born before week 32 of gestation with and which roles of nurses are applied most when providing care? How do parents of newborn infants born before week 32 of gestation perceive the care of their child included in the individualized developmental care? The theoretical part of the thesis deals with the issue of excessively and extremely premature newborn babies, characteristics of the individualized developmental care and the nursing strategies, the role of a nurse and the role of parents. The practical part is focused on the qualitative research. The results of the research suggest the nurses have included the individualized developmental care into the nursing care of premature newborn infants at the Department of Neonatal Medicine in the Hospital in České Budějovice, however, not in its full extent. The parents perceive the included aspects of this care positively,the nursing staff is important. The research has identified problems nurses have to cope with when they implement this care and what the reserves in the implementation are. A map of the individualized developmental care that can be used by nurses in practice is the result of the research.

The thesis, or more precisely its theoretical part, introduces the field of Neonatology, namely the specification of premature newborns concerning supportive care for them. In the thesis, the basic concepts of Neonatology are presented as well as the system of neonatological care, including the needs of premature newborns, which are part of everyday nursing care. Following the above chapters, the thesis describes not only the nursing care as such but also the possibilities of psychosocial care in Neonatology. For a more comprehensive presentation of the issue of premature newborns, the thesis also includes findings concerning ethical issues in Neonatology and it introduces some organizations in the Czech Republic, which are an integral part of the supportive care. The character of the thesis should correspond with the program of nursing care, namely nursing in selected clinical disciplines - the module of paediatrics. In the empirical part of the thesis, qualitative research by interviewing has been used. Despite this scientific approach is more time-consuming, the author considered this method more meaningful and natural concerning the chosen topic because it concerns the support of the lives of these children and their families. Premature newborns are unique, affecting and enriching human being as such. The target of the thesis was firstly to find out how supportive care in premature newborns is perceived by its providers, secondly to disclose the considerations of the care providers regarding premature newborns in České Budějovice. The research was effectuated in connection with the above objectives, which have importance and a significant value for the author. Conclusions of the Thesis: The informants assumed that society didn't have enough information about the provided services. Almost all the informants collaborated on some research or project. As service providers, the respondents acknowledged the comments from the clients. The informants were interested in improving or enhancing the services. The addressed people have specified many factors and difficulties that make their work difficult. The informants concretized foreign experience. The respondents felt considerate enough. The informants expressed sincerely that there was a lot of space for improvement in their profession. The respondents mostly took a partner and gentle stand to the premature newborns and their families. The service providers gave due reasons for a specific approach in their statements. The informants expressed their respect for premature newborns and their families, giving a specific justification. They mostly expressed respect for the needs of the families, for the biorhythms of the baby, for the naturalness, the intuition and the personal pace of the baby. The thesis can be seen as a source of information for both the general and professional public, which could improve current practice. Based on the presentation of the issue through the thesis, the author has published a guide on premature newborns.

Introdução: a revisão de literatura aponta que os recém-nascidos submetidos ao banho de imersão produzem menor variação térmica pós-banho comparado aos submetidos ao banho com esponja. No Brasil, o Ministério da Saúde vem capacitando profissionais que atuam em unidades de internação neonatal para implementar o Método Mãe Canguru e, entre outras práticas, recomenda que o recém-nascido pré-termo (RNPT) e com baixo peso seja submetido ao banho de imersão envolto em cueiro ou lençol, sugerindo mudança da prática hegemônica do banho com esponja ou banho de imersão convencional. No entanto, a técnica de banho de imersão recomendada carece de evidências científicas quanto a sua segurança em relação às repercussões na estabilidade da temperatura corporal (T), frequência cardíaca (FC), cortisol salivar (CS) e comportamental em RNPT. Hipótese: os RNPT submetidos ao banho de imersão envoltos em lençol (BIE) apresentam respostas fisiológicas e comportamentais similares aos submetidos à técnica de banho de imersão convencional (BIC), nos primeiros 20 minutos pós-banho. Objetivo: avaliar os parâmetros fisiológicos e comportamentais de RNPT submetidos ao banho de imersão envolto em lençol (BIE) e banho de imersão convencional (BIC). Método: ensaio clínico randomizado cruzado com amostra composta por 43 RNPT, internados na Unidade Neonatal de um hospital escola da cidade de São Paulo. Os RNPT foram alocados no grupo A ou B, seguindo uma lista de randomização gerada pelo software R que foi envelopada e mantida com os auxiliares da pesquisa responsáveis pelos banhos dos RNPT. A randomização definiu a técnica do primeiro banho que o RN seria submetido. Somente após análise dos dados foi aberto o envelope da randomização sendo identificado que no grupo A, o primeiro banho foi o BIC (intervenção controle) e no grupo B, o BIE (intervenção experimental). A técnica do BIE seguiu a técnica recomendada no Manual Atenção Humanizada ao Recém-Nascido de Baixo Peso: Método Mãe-Canguru, publicada pelo Ministério da Saúde. Foram utilizadas filmadoras para obter os valores da FC e da SatO2 registradas pelo monitor cardíaco instalado nos RNPT e para captar imagens das reações comportamentais antes e após os banhos. As temperaturas axilares foram aferidas com termômetro digital e amostras de saliva foram coletadas com esponja oftálmica (Merocel)®, refrigeradas e processada pelo teste Elisa. As filmagens do estado comportamental 10 minutos pré e 10 e 20 minutos pós-banho foram analisadas utilizando o instrumento de avaliação do sono-vigília validado por Brandon e Holditch-Davis. Os dados foram registrados em formulário próprio e armazenados em planilha Microsoft Excel. A análise estatística foi realizada com os programas Minitab, versão 16.1 e SPSS, versão 20. Além da análise descritiva das variáveis numéricas para obtenção de medidas de tendência central e dispersão e frequências absoluta e relativa, foram utilizados os testes Qui-quadrado e Exato de Fisher; o teste T pareado, ANOVA e Modelos Generalizados Lineares na análise dos dados. Resultados: As temperaturas axilares médias dos RNPT pré-BIC e pré-BIE foram, respectivamente, 36,695°C e 36,667°C, p = 0,329. No 10° minuto pós-BIC e BIE, as médias das temperaturas axilares foram, respectivamente, 36,533°C e 36,535°C, p = 0,944. No 20° minuto pós-BIC e BIE, as médias da temperatura axilar foram 36,626°C e 36,628°C, p = 0,663. Houve queda na temperatura axilar no 10° minuto pós-banho, independente do tipo de banho realizado (p <0,001). A hipótese de que o BIE é equivalente ao BIC em relação à variação da temperatura axilar foi confirmada. Houve redução significante nos valores das FC no 10° e 20° minutos pós-BIC e BIE comparados aos valores pré-banho, independente do tipo de banho (p<0,001). Ocorreu aumento gradativo dos valores médios de SatO2 no 10º e 20° minutos após os banhos sem diferenças significantes nos valores pré-banhos, p = 0,969. A concentração do cortisol salivar aumentou após o banho em ambos os grupos, p = 0,001, entretanto não ocorreram diferenças entre os grupos, ou seja, os níveis de cortisol salivar aumentaram após o banho, independente do tipo de banho, p = 0,797. O percentual de tempo em estado sono ativo aumentou após o banho, independente do tipo de banho, p<0,001, ou seja, houve mudança significativa no comportamento do recém-nascido, sem diferenças entre os banhos, p = 0,425. Conclusão: Tanto os RNPT que receberam BIC quanto os que receberam BIE apresentaram queda na temperatura corporal no 10° minuto pós-banho com aumento da temperatura corporal no 20° minuto pós-banho. Comparado aos achados da literatura, a redução da temperatura corporal foi menor que no banho com esponja. O BIE é equivalente ao BIC, portanto ambos são indicados aos RNPT. Convêm salientar o aumento dos custos do BIE em razão do consumo de lençol e da capacitação necessária da equipe de enfermagem nesta técnica de banho, sem prolongar o tempo médio dispendido no banho, visto que poderá reduzir a temperatura da água do banho e consequentemente causar queda na temperatura corporal do RN. / Introduction: the literature review shows that newborns underwent to immersion baths produce less post-bath thermal variation compared to those underwent to the sponge bath. In Brazil, the Ministry of Health has been qualifying working professionals in neonatal hospitalization units to implement the Kangaroo Mother Care and, among other practices, recommends that the preterm newborn infants (PNI) and underweight are underwent to the swaddle immersion bath wrapped in clothes or sheet, suggesting change of the hegemonic practice of sponge bath or conventional immersion bath. However, the immersion bath technique recommended requires more scientific evidence about its safety in relation to impact on the stability of body temperature (T), heart rate (HR), salivary cortisol (SC) and behavioral in PNI. Hypothesis: PNI underwent to swaddle immersion bath wrapped in sheet (SIB) have physiological and behavioral responses similar to those underwent to the conventional immersion bath technique (CIB), in the first 20 minutes post-bath. Objective: To evaluate the physiological and behavioral parameters of preterm newborn infants underwent to swaddle immersion bath in sheet (SIB) and conventional immersion bath (CIB). Method: Randomized crossover clinical trial with a sample of 43 preterm newborn infants in the neonatal unit of a university hospital in the city of Sao Paulo. PNI were allocated in the A or B groups, following a randomization list which was generated by the software R, which was enveloped and maintained with research assistants who were responsible for the baths of PNI. Randomization list defined the first bath technique that the newborn was underwent. The randomization envelope was only opened after data analysis being identified that in group A, the first bath was the CIB (control intervention) and group B, the SIB (experimental intervention). The SIB technique followed the technique recommended in the Humane Care Infant, Low Birth Weight: Kangaroo Mother Care Manual, published by the Ministry of Health of Brazil. Video cameras were used for the HR and SpO2 values recorded at heart monitor installed in the PNI and to capture images of behavioral responses before and after baths. Axillary temperatures were measured with a digital thermometer and saliva samples were collected with ophthalmic sponge (Merocel) ®, refrigerated and processed by the Elisa test. The video recorded of behavioral states of 10 minutes pre-baths and 10 and 20 minutes post-baths were analyzed using the sleep-wake assessment tool validated by Brandon and Holditch-Davis. Data were recorded and stored in the proper form in Microsoft Excel spreadsheet. Statistical analysis was performed using Minitab software, version 16.1 and SPSS, version 20. In addition to the descriptive analysis of numerical variables to obtain measures of central tendency, dispersion, absolute and relative frequencies, Chi-square tests were used and Fisher Exact, the paired T-test, ANOVA and Generalized Linear Models in the data analysis. Results: The mean axillary temperatures of PNI pre-CIB and SIB were respectively 36.695 °C and 36.667 °C, p = 0.329. At 10 minutes post-CIB and SIB, the mean axillary temperatures were, respectively, 36.533 ° C to 36.535 ° C, p = 0.944. At 20 minutes post- CIB and SIB, the average of axillary temperature were 36.626°C and 36.628 ° C, p = 0.663. There was a decrease in the axillary temperature at 10 minutes post-bath, regardless of the type performed bath (p < 0.001). The hypothesis that the SIB is equivalent to the CIB related to the variation in the axillary temperature was confirmed. There was a significant reduction in the HR values at the 10th and 20 th minutes after CIB and SIB compared to pre-bath values, regardless type of the bath (p< 0.001). There was a progressive rise on SpO2 mean values on the 10th and 20 th minutes after baths with no significant differences in pre-baths values, p = 0.969. The salivary cortisol concentrations increased after bathing in both groups, p = 0.001, however there were no differences between the groups, in other words, salivary cortisol levels increased after bathing, regardless of the type of bath, p = 0.797. The percentage of time in active sleep state increased after bathing, regardless of bath type, p <0.001, that is meaning there was significant change in newborn behavior, without differences between baths, p = 0.425. Conclusion: Both the PNI who received CIB, as those receiving SIB, had a decrease in body temperature in the 10th minute post bath followed by an increased body temperature at 20 minutes post-bath. Compared to previous studies, reduction of body temperature was lower than in the sponge bath. The SIB is equivalent to the CIB therefore both are recommended for preterm infants. It should be emphasized the increased in the SIB costs due to the bed sheet consumption and the required nursing staff training in this bath technique, without extending the average time spent in the bath, as it may reduce the temperature of the bath water, consequently causing body temperature drop on the newborn

Introdução: a revisão de literatura aponta que os recém-nascidos submetidos ao banho de imersão produzem menor variação térmica pós-banho comparado aos submetidos ao banho com esponja. No Brasil, o Ministério da Saúde vem capacitando profissionais que atuam em unidades de internação neonatal para implementar o Método Mãe Canguru e, entre outras práticas, recomenda que o recém-nascido pré-termo (RNPT) e com baixo peso seja submetido ao banho de imersão envolto em cueiro ou lençol, sugerindo mudança da prática hegemônica do banho com esponja ou banho de imersão convencional. No entanto, a técnica de banho de imersão recomendada carece de evidências científicas quanto a sua segurança em relação às repercussões na estabilidade da temperatura corporal (T), frequência cardíaca (FC), cortisol salivar (CS) e comportamental em RNPT. Hipótese: os RNPT submetidos ao banho de imersão envoltos em lençol (BIE) apresentam respostas fisiológicas e comportamentais similares aos submetidos à técnica de banho de imersão convencional (BIC), nos primeiros 20 minutos pós-banho. Objetivo: avaliar os parâmetros fisiológicos e comportamentais de RNPT submetidos ao banho de imersão envolto em lençol (BIE) e banho de imersão convencional (BIC). Método: ensaio clínico randomizado cruzado com amostra composta por 43 RNPT, internados na Unidade Neonatal de um hospital escola da cidade de São Paulo. Os RNPT foram alocados no grupo A ou B, seguindo uma lista de randomização gerada pelo software R que foi envelopada e mantida com os auxiliares da pesquisa responsáveis pelos banhos dos RNPT. A randomização definiu a técnica do primeiro banho que o RN seria submetido. Somente após análise dos dados foi aberto o envelope da randomização sendo identificado que no grupo A, o primeiro banho foi o BIC (intervenção controle) e no grupo B, o BIE (intervenção experimental). A técnica do BIE seguiu a técnica recomendada no Manual Atenção Humanizada ao Recém-Nascido de Baixo Peso: Método Mãe-Canguru, publicada pelo Ministério da Saúde. Foram utilizadas filmadoras para obter os valores da FC e da SatO2 registradas pelo monitor cardíaco instalado nos RNPT e para captar imagens das reações comportamentais antes e após os banhos. As temperaturas axilares foram aferidas com termômetro digital e amostras de saliva foram coletadas com esponja oftálmica (Merocel)®, refrigeradas e processada pelo teste Elisa. As filmagens do estado comportamental 10 minutos pré e 10 e 20 minutos pós-banho foram analisadas utilizando o instrumento de avaliação do sono-vigília validado por Brandon e Holditch-Davis. Os dados foram registrados em formulário próprio e armazenados em planilha Microsoft Excel. A análise estatística foi realizada com os programas Minitab, versão 16.1 e SPSS, versão 20. Além da análise descritiva das variáveis numéricas para obtenção de medidas de tendência central e dispersão e frequências absoluta e relativa, foram utilizados os testes Qui-quadrado e Exato de Fisher; o teste T pareado, ANOVA e Modelos Generalizados Lineares na análise dos dados. Resultados: As temperaturas axilares médias dos RNPT pré-BIC e pré-BIE foram, respectivamente, 36,695°C e 36,667°C, p = 0,329. No 10° minuto pós-BIC e BIE, as médias das temperaturas axilares foram, respectivamente, 36,533°C e 36,535°C, p = 0,944. No 20° minuto pós-BIC e BIE, as médias da temperatura axilar foram 36,626°C e 36,628°C, p = 0,663. Houve queda na temperatura axilar no 10° minuto pós-banho, independente do tipo de banho realizado (p <0,001). A hipótese de que o BIE é equivalente ao BIC em relação à variação da temperatura axilar foi confirmada. Houve redução significante nos valores das FC no 10° e 20° minutos pós-BIC e BIE comparados aos valores pré-banho, independente do tipo de banho (p<0,001). Ocorreu aumento gradativo dos valores médios de SatO2 no 10º e 20° minutos após os banhos sem diferenças significantes nos valores pré-banhos, p = 0,969. A concentração do cortisol salivar aumentou após o banho em ambos os grupos, p = 0,001, entretanto não ocorreram diferenças entre os grupos, ou seja, os níveis de cortisol salivar aumentaram após o banho, independente do tipo de banho, p = 0,797. O percentual de tempo em estado sono ativo aumentou após o banho, independente do tipo de banho, p<0,001, ou seja, houve mudança significativa no comportamento do recém-nascido, sem diferenças entre os banhos, p = 0,425. Conclusão: Tanto os RNPT que receberam BIC quanto os que receberam BIE apresentaram queda na temperatura corporal no 10° minuto pós-banho com aumento da temperatura corporal no 20° minuto pós-banho. Comparado aos achados da literatura, a redução da temperatura corporal foi menor que no banho com esponja. O BIE é equivalente ao BIC, portanto ambos são indicados aos RNPT. Convêm salientar o aumento dos custos do BIE em razão do consumo de lençol e da capacitação necessária da equipe de enfermagem nesta técnica de banho, sem prolongar o tempo médio dispendido no banho, visto que poderá reduzir a temperatura da água do banho e consequentemente causar queda na temperatura corporal do RN. / Introduction: the literature review shows that newborns underwent to immersion baths produce less post-bath thermal variation compared to those underwent to the sponge bath. In Brazil, the Ministry of Health has been qualifying working professionals in neonatal hospitalization units to implement the Kangaroo Mother Care and, among other practices, recommends that the preterm newborn infants (PNI) and underweight are underwent to the swaddle immersion bath wrapped in clothes or sheet, suggesting change of the hegemonic practice of sponge bath or conventional immersion bath. However, the immersion bath technique recommended requires more scientific evidence about its safety in relation to impact on the stability of body temperature (T), heart rate (HR), salivary cortisol (SC) and behavioral in PNI. Hypothesis: PNI underwent to swaddle immersion bath wrapped in sheet (SIB) have physiological and behavioral responses similar to those underwent to the conventional immersion bath technique (CIB), in the first 20 minutes post-bath. Objective: To evaluate the physiological and behavioral parameters of preterm newborn infants underwent to swaddle immersion bath in sheet (SIB) and conventional immersion bath (CIB). Method: Randomized crossover clinical trial with a sample of 43 preterm newborn infants in the neonatal unit of a university hospital in the city of Sao Paulo. PNI were allocated in the A or B groups, following a randomization list which was generated by the software R, which was enveloped and maintained with research assistants who were responsible for the baths of PNI. Randomization list defined the first bath technique that the newborn was underwent. The randomization envelope was only opened after data analysis being identified that in group A, the first bath was the CIB (control intervention) and group B, the SIB (experimental intervention). The SIB technique followed the technique recommended in the Humane Care Infant, Low Birth Weight: Kangaroo Mother Care Manual, published by the Ministry of Health of Brazil. Video cameras were used for the HR and SpO2 values recorded at heart monitor installed in the PNI and to capture images of behavioral responses before and after baths. Axillary temperatures were measured with a digital thermometer and saliva samples were collected with ophthalmic sponge (Merocel) ®, refrigerated and processed by the Elisa test. The video recorded of behavioral states of 10 minutes pre-baths and 10 and 20 minutes post-baths were analyzed using the sleep-wake assessment tool validated by Brandon and Holditch-Davis. Data were recorded and stored in the proper form in Microsoft Excel spreadsheet. Statistical analysis was performed using Minitab software, version 16.1 and SPSS, version 20. In addition to the descriptive analysis of numerical variables to obtain measures of central tendency, dispersion, absolute and relative frequencies, Chi-square tests were used and Fisher Exact, the paired T-test, ANOVA and Generalized Linear Models in the data analysis. Results: The mean axillary temperatures of PNI pre-CIB and SIB were respectively 36.695 °C and 36.667 °C, p = 0.329. At 10 minutes post-CIB and SIB, the mean axillary temperatures were, respectively, 36.533 ° C to 36.535 ° C, p = 0.944. At 20 minutes post- CIB and SIB, the average of axillary temperature were 36.626°C and 36.628 ° C, p = 0.663. There was a decrease in the axillary temperature at 10 minutes post-bath, regardless of the type performed bath (p < 0.001). The hypothesis that the SIB is equivalent to the CIB related to the variation in the axillary temperature was confirmed. There was a significant reduction in the HR values at the 10th and 20 th minutes after CIB and SIB compared to pre-bath values, regardless type of the bath (p< 0.001). There was a progressive rise on SpO2 mean values on the 10th and 20 th minutes after baths with no significant differences in pre-baths values, p = 0.969. The salivary cortisol concentrations increased after bathing in both groups, p = 0.001, however there were no differences between the groups, in other words, salivary cortisol levels increased after bathing, regardless of the type of bath, p = 0.797. The percentage of time in active sleep state increased after bathing, regardless of bath type, p <0.001, that is meaning there was significant change in newborn behavior, without differences between baths, p = 0.425. Conclusion: Both the PNI who received CIB, as those receiving SIB, had a decrease in body temperature in the 10th minute post bath followed by an increased body temperature at 20 minutes post-bath. Compared to previous studies, reduction of body temperature was lower than in the sponge bath. The SIB is equivalent to the CIB therefore both are recommended for preterm infants. It should be emphasized the increased in the SIB costs due to the bed sheet consumption and the required nursing staff training in this bath technique, without extending the average time spent in the bath, as it may reduce the temperature of the bath water, consequently causing body temperature drop on the newborn