The significant accuracy demonstrated by our predictive model shows that NICeSim might be used for hypothesis testing to minimize in vivo experiments. We observed that the model delivers predictions that are in very good agreement with the literature, demonstrating that NICeSim might be an important tool for supporting decision making in medical practice. Other very important characteristics of NICeSim are its flexibility and dynamism. NICeSim is flexible because it allows the inclusion and deletion of variables according to the requirements of a particular study. It is also dynamic because it trains a just-in-time model. Therefore, the system is improved as data from new patients become available. Finally, NICeSim can be extended in a cooperative manner because it is an open-source system.

Background Coronavirus disease (COVID‐19) is related to several extrapulmonary disorders; however, little is known about the clinical, laboratory, and histopathological characteristics of pernio‐like skin lesions associated with COVID‐19 infection. Objective To evaluate and summarize the clinical, laboratory, and histopathological characteristics of pernio‐like lesions reported in the literature. Methods We conducted a search of the PubMed, SciELO, and ScienceDirect databases for articles published between January 1, 2020 and November 30, 2020, following the PRISMA recommendations (PROSPERO registration ID: CRD42020225055). The target population was individuals with suspected or laboratory‐confirmed COVID‐19 with pernio‐like lesions. Observational studies, research letters, and case/series reports were all eligible for inclusion. Observational studies were evaluated using a random‐effects model to calculate the weighted mean prevalence, overall mean, and 95% confidence interval. We evaluated case studies using the chi‐square test for dichotomous variables and the Mann‐Whitney test for continuous variables. Results A total of 187 patients from case reports and 715 patients from 18 observational studies were included. The mean age of patients was 16.6 years (range 14.5‐18.8). Feet were affected in 91.4% (87.0‐94.4%) of patients in observational studies. The proportion of patients with a positive RT‐PCR test was less than 15%. Lesion topography and morphology were associated with age. Conclusion Lesions mostly occurred in pediatric patients, and the morphological characteristics tended to differ between pediatric and non‐pediatric populations. There is a possible multifactorial component in lesion pathophysiology. The non‐positivity of laboratory tests does not exclude an association with COVID‐19. Pernio‐like lesions may be a late manifestation of COVID‐19.

The median duration of breastfeeding in preterm infants was below the recommended one and discontinuation was associated with gestational <32 weeks and the fact that the infant was no longer receiving exclusive breastfeeding in the first outpatient visit. When these two variables were associated, their negative effect on the median duration of breastfeeding was potentiated.

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Objective:Identify and analyze variables associated with shorter duration of breastfeeding in preterm infants.Methods:Retrospective cohort of premature infants followed up at secondary referral service in the period of 2010-2015. Inclusion: first appointment in the first month of corrected age and have undergone three or more consultations. Exclusion: diseases that impaired oral feeding. Outcome: duration of breastfeeding. A total of 103 preterm infants were evaluated, accounting for 28.8% of the preterm infants born in the municipality in that period, with a power of study of 80%. Descriptive analysis, t-test, chi-square test, Kaplan-Meier curves and Cox regression were used. p-values <0.05 were considered significant.Results:The median duration of breastfeeding among preterm infants was 5.0 months. The risk of breastfeeding discontinuation among preterm infants with gestational age <32 weeks was 2.6-fold higher than for those born at 32 weeks or more and the risk of breastfeeding interruption in preterm infants who were receiving breastfeeding supplementation in the first outpatient visit was 3-fold higher when compared to those who were exclusively breastfed in the first consultation.Conclusions:The median duration of breastfeeding in preterm infants was below the recommended one and discontinuation was associated with gestational <32 weeks and the fact that the infant was no longer receiving exclusive breastfeeding in the first outpatient visit. When these two variables were associated, their negative effect on the median duration of breastfeeding was potentiated.

OBJECTIVE:To analyze adherence to the recommended iron, zinc and multivitamin supplementation guidelines for preemies, the factors associated with this adherence, and the influence of adherence on the occurrence of anemia and iron, zinc and vitamin A deficiencies.METHODS:This prospective cohort study followed 58 preemies born in 2014 until they reached six months corrected age. The preemies were followed at a referral secondary health service and represented 63.7% of the preterm infants born that year. Outcomes of interest included high or low adherence to iron, zinc and multivitamin supplementation guidelines; prevalence of anemia; and prevalences of iron, zinc, and vitamin A deficiencies. The prevalence ratios were calculated by Poisson regression.RESULTS:Thirty-eight (65.5%) preemies presented high adherence to micronutrient supplementation guidelines. At six months of corrected age, no preemie had vitamin A deficiency. The prevalences of anemia, iron deficiency and zinc deficiency were higher in the low-adherence group but also concerning in the high-adherence group. Preemies with low adherence to micronutrient supplementation guidelines were 2.5 times more likely to develop anemia and 3.1 times more likely to develop zinc deficiency. Low maternal education level increased the likelihood of nonadherence to all three supplements by 2.2 times.CONCLUSIONS:Low maternal education level was independently associated with low adherence to iron, zinc and vitamin A supplementation guidelines in preemies, which impacted the prevalences of anemia and iron and zinc deficiencies at six months of corrected age.

Factors associated with packed red blood cell transfusions in premature infants in an intensive care unit Fatores associados à transfusão de concentrado de hemácias em prematuros de uma unidade de terapia intensiva ORIGINAL ARTICLE INTRODUCTION Anemia occurs frequently in premature infants, which makes this population prone to transfusion treatments. (1) Packed red blood cells are the most frequently administered blood products to newborns, and these transfusions are generally necessary in two situations: 1) to guarantee adequate tissue oxygenation during intensive care treatment and 2) to treat significantly symptomatic anemia. (2) The repercussions of transfusions and the adoption of policies to reduce blood transfusions have become enormous challenges because more premature newborns survive anemia. (1) Preterm infants with gestational ages <30 weeks, birth weights <1,000 g, or severe infectious diseases are candidates for blood transfusions. (3) Several reasons may underlie the occurrence of anemia in premature infants. The time to cut the umbilical cord in the delivery room determines the newborn's hematocrit. Delays in the clamping of the umbilical cord increases the blood volume shortly after birth, which improves

ObjectiveTo analyze the process of care provided to premature infants in a neonatal intensive care unit and the factors associated with their mortality. MethodsCross-sectional retrospective study of premature infants in an intensive care unit between 2008 and 2010. The characteristics of the mothers and premature infants were described, and a bivariate analysis was performed on the following characteristics: the study period and the "death" outcome (hospital, neonatal and early) using Pearson's chi-square test, Fisher's exact test or a chi-square test for linear trends. Bivariate and multivariable logistic regression analyses were performed using a stepwise backward logistic regression method between the variables with p<0.20 and the "death" outcome. A p value <0.05 was considered to be significant. ResultsIn total, 293 preterm infants were studied. Increased access to complementary tests (transfontanellar ultrasound and Doppler echocardiogram) and breastfeeding rates were indicators of improving care. Mortality was concentrated in the neonatal period, especially in the early neonatal period, and was associated with extreme prematurity, small size for gestational age and an Apgar score <7 at 5 minutes after birth. The late-onset sepsis was also associated with a greater chance of neonatal death, and antenatal corticosteroids were protective against neonatal and early deaths. ConclusionsAlthough these results are comparable to previous findings regarding mortality among premature infants in Brazil, the study emphasizes the need to implement strategies that promote breastfeeding and reduce neonatal mortality and its early component.