OBJECTIVE:To evaluate clinical outcomes, growth and exclusive breastfeeding rates in premature infants assisted by Kangaroo Mother Care at birth, at discharge and at six months of life. METHODS: Prospective study of a premature infants cohort assisted by Kangaroo Mother Care in a tertiary public maternity in Northeast Brazil with birth weight ≤1750g and with clinical conditions for Kangaroo care. RESULTS: The sample was composed by 137 premature infants, being 62.8% female, with average birth weight of 1365±283g, average gestational age of 32±3 weeks and 26.2% were adequate for gestational age. They have been admitted in the Kangaroo Ward with a median of 13 days of life, weighing 1430±167g and, at this time, 57.7% were classified as small for corrected gestational age. They were discharged with 36.8±21.8 days of chronological age, weighing 1780±165g and 67.9% were small for corrected gestational age. At six months of life (n=76), they had an average weight of 5954±971g, and 68.4% presented corrected weight for gestational age between percentiles 15 and 85 of the World Health Organization (WHO) weight curve. Exclusive breastfeeding rate at discharge was 56.2% and, at six months of life, 14.4%. CONCLUSIONS: In the studied sample, almost two thirds of the children assisted by Kangaroo Mother Care were, at six months of life, between percentiles 15 and 85 of the WHO weight curves. The frequency of exclusive breastfeeding at six months was low.
Objective: To describe the structure and the processes of care for pregnant women/newborn infants, including the Essential Newborn Care (ENC), in maternity hospitals in Sergipe State, Brazil. Methods: A cross-sectional study carried out between June 2015 and April 2016 in all maternity hospitals of Sergipe with more than 500 deliveries/year (n=11). A questionnaire on the existing structure and work processes was administered to the managers. Subsequently, a representative number of postpartum women from these hospitals were interviewed (n=768). Their medical records, as well as newborn infants’ records, were also analyzed. Results: Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 beds of Intermediate Care Unit (IMCU) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for high-risk parturient care. Regarding the ENC components, only 41% (n=315) of the women had early skin-to-skin contact with their babies, 33.1% (n=254) breastfed in the first hour of life, and 18% (n=138) had a companion always during birth. Conclusions: The distribution of NICU beds between capital city and other cities of the State is adequate, considering Brazilian guidelines. However, there was a low adherence to the protocols for hypertensive and hemorrhagic emergencies, and a low coverage of humanization policies, pregnancy risk classification and ENC practices, especially breastfeeding in the first hour of life, and companion always during birth.
BackgroundThe inhibition of gastric acid secretion with ranitidine is frequently prescribed off-label to newborns admitted to neonatal intensive care units (NICU). Some studies show that the use of inhibitors of gastric acid secretion (IGAS) may predispose to infections and necrotising enterocolitis (NEC), but there are few data to confirm this association. This study aimed to compare the rates of neonatal infections and NEC among preterm infants (<37 weeks gestation) hospitalised in a NICU exposed or not to treatment with ranitidine.MethodsA retrospective cohort study was conducted with all consecutive preterm newborns admitted to a NICU between August-2014 and October-2015. The rates of infection, NEC, and death of newborns exposed or not to ranitidine were recorded.ResultsA total of 300 newborns were enrolled, of which 115 had received ranitidine and 185 had not. The two groups were similar with regard to the main demographic and clinical characteristics. Forty-eight (41.7%) of the 115 infants exposed to ranitidine and 49 (26.5%) of the 185 infants not exposed were infected (RR = 1.6, 95%CI 1.1–2.2, p = 0.006). The late onset (>48 h) blood culture positive infection rate was higher in the group exposed to ranitidine than in the untreated group (13.0% vs. 3.8%, p = 0.001). There was no significant association between the use of ranitidine and NEC (Bell stage >II) (p = 0.36). The mortality rate risk was 4-fold higher in infants receiving ranitidine (16.5% vs. 8.6%, p < 0.001).ConclusionRanitidine use in neonates was associated with an increased risk of infections and mortality, but not with NEC.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-017-2482-x) contains supplementary material, which is available to authorized users.
ObjectivesTo assess the use of the WHO’s Essential Newborn Care (ENC) programme items and to investigate how the non-use of such technologies associates with the mothers' characteristics and hospital structure.DesignA cross-sectional observational health facility assessment.SettingThis is a secondary analysis of the ‘Birth in Brazil’ study, a national population-based survey on postnatal women/newborn babies and of 266 publicly and privately funded health facilities (secondary and tertiary level of care).ParticipantsData on 23 894 postnatal women and their newborn babies were analysed.Main outcome measuresThe facility structure was assessed by evaluating the availability of medicines and equipment for perinatal care, a paediatrician on call 24/7, a neonatal intensive care unit (NICU) and kangaroo mother care. The use of each ENC item was assessed according to the health facility structure and the mothers’ sociodemographic characteristics.ResultsThe utilisation of ENC items is low in Brazil. The factors associated with failure in pregnant woman reference were: pregnant adolescents (ORadj 1.17; 95% CI 1.06 to 1.29), ≤7 years of schooling (ORadj 1.47; 95% CI 1.22 to 1.78), inadequate antenatal care (ORadj 1.67; 95% CI 1.47 to 1.89). The non-use of corticosteroids was more frequently associated with the absence of an NICU (ORadj 3.93; 95% CI 2.34 to 6,66), inadequate equipment and medicines (ORadj 2.16; 95% CI 1.17 to 4.01). In caesarean deliveries, there was a less frequent use of a partograph (ORadj 4,93; 95% CI 3.77 to 6.46), early skin-to-skin contact (ORadj 3.07; 95% CI 3.37 to 4.90) and breast feeding in the first hour after birth (ORadj 2.55; 95% CI 2.21 to 2.96).ConclusionsThe coverage of ENC technologies use is low throughout Brazil and shows regional differences. We found a positive effect of adequate structure at health facilities on antenatal corticosteroids use and on partograph use during labour. We found a negative effect of caesarean section on early skin-to-skin contact and early breast feeding.
The distribution of neonatal care to Brazilian infants varied between the public and private sectors. The public sector offered less complex services for newborns at risk, and infants without obstetric risk were born in facilities with an NICU, creating the possibility of unnecessary intervention, especially in the private sector.
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