Background: To evaluate the association between delays in obstetric care and neonatal near-miss mortality events and death in a public maternity referral center. Methods: This case-control study enrolled 142 neonates, meeting the near-miss criteria of 5-min Apgar < 7, weight < 1500 g, gestational age < 32 weeks, and use of mechanical ventilation or congenital malformation, as well as 284 controls (without the near-miss criteria), at a ratio of 1:2. After follow-up, the following outcomes were reclassified: survival of the neonatal period without the near-miss criteria (true "controls"), "near-miss," and "neonatal death." Maternal sociodemographic characteristics, prenatal care, and pregnancy resolution were evaluated. Pearson's chi-square and Fisher's exact tests were used. Simple logistic regression was performed to determine the association between the three delay factors with near-miss outcomes and/or neonatal death. The variables that had maintained values of p < 0.05 were subjected to multinomial logistic regression. Results: Comparisons revealed the following associations: for controls and near-miss events, delayed access to health services due to a lack of specialized services (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.8-5.1) and inappropriate conduct with the patient (OR, 12.1; 95% CI, 1.3-108.7); for controls and death, absent or inadequate prenatal care (OR, 3.3; 95% CI, 1.6-7.1) and delayed access to health services due to a lack of specialized services (OR, 2.5; 95% CI, 1.1-5.6); and for near-miss events and death, absent or inadequate prenatal care (OR, 2.2; 95% CI, 1.0-5.0). Logistic regression for the combined outcome (near-miss plus neonatal deaths) revealed absent or inadequate prenatal care (OR, 1.9; 95% CI, 1.2-2.8), lack of specialized services (OR, 2.8; 95% CI, 1.7-4.5), and improper conduct with the patient (OR, 10.6; 95% CI, 1.2-91.8). Conclusions: The delays in obstetric care associated with the presence of near-miss and/or neonatal death included absent or inadequate prenatal care, delayed access to health services due to a lack of specialized services, and inappropriate conduct with the patient.

The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.

A cross-sectional study conducted with 28 mother-infant dyads, users of a Family Health Center of Fortaleza-CE, Brazil, that aimed to identify the nursing diagnoses of breastfeeding, their frequency of occurrence, defining characteristics, and the value of maternal confidence based on the breastfeeding self-efficacy scale. Data collection happened during September and October 2010, using interviews, anamnesis, and physical examination of the dyad. The most prevalent diagnosis was Effective breastfeeding (50%). The breastfeeding self-efficacy scale revealed significance in the presence of the nursing diagnoses Effective breastfeeding and the absence of Interrupted breastfeeding. Although the diagnosis Effective breastfeeding presented a significant occurrence, we verified the need for effective actions of nurses in the breastfeeding process.

Objectives: to evaluate factors associated with neonatal near miss and death in reference hospitals. Methods: this case-control study included 364 cases and 728 controls among 4,929 births. Cases were identified by Apgar < 7 at 5 minutes, weight < 1500 g, gestational age <32 weeks, mechanical ventilation or congenital malformation. After follow-up, outcomes were reclassified into: true controls, near miss and neonatal death. Hierarchically, variables with a p-value < 0.20 were included in the multiple logistic regression. Results: the neonatal near miss rate was 54.1 per 1,000 live births, and the near-miss-to-death ratio was 2.75. Between the control and near miss groups, the predictor variables were neonatal intensive care admission [OR = 35.6 (16.7 - 75.9)] and central venous access [OR= 74.8 (29.4 - 190.4)]. Between the control and death groups, neonatal intensive care admission [OR = 100.4 (18.8 - 537.0)] and central venous access [OR = 12.7 (3.7 - 43.2)] were significant. Between the near miss and death groups, only Apgar < 7 at 5 minutes [OR = 4.1 (1.6 - 10.6)] and vasoactive drug use [OR = 42.2 (17.1 - 104.5)] were significant. Conclusion: factors associated with a greater chance of near miss and/or neonatal death were: Apgar score <7 at 5 minutes, neonatal intensive care confinement, having central venous access, and use of vasoactive drugs.

outcomes. Event rates over time will be estimated within each treatment group using the Kaplan-Meier method.Results: In total, 70 patients were included in the analysis. Median age was 61y (33-83), 56% female, 34% right-sided tumors, and 56% received 2 or more prior chemotherapy lines. Overall, median PFS was 5.2 months (m) (CI 95% 4.1-8.5) and median OS (mOS) was 10.3 m (CI 95% 6.5-20.2). BRAF MAF was >5% in 14 pts (35%), <5% in 10 pts (25%), and undetectable in 16 pts (40%) with a mOS of 4.2 m, 17.1 m (HR 0.21, p<0.001), and 17.5 m (HR 0.15, p<0.001), respectively. In the multivariate analysis the most parsimonious model included five factors: ECOG, presence of liver metastases, CEA, NLR levels, and BRAF MAF. We stratified patients into three risk prognostic groups based on their number of presenting risk factors. These three prognostic groups showed differentiated OS outcomes, with a median OS of 5.1 m, 8.4 m (HR 0.26, p<0.001), and 21.8 m (HR 0.05, p<0.005), respectively. Added to this, WES analysis showed a clinical benefit of targeted therapy in those tumors with a BRAF/EGFR gain as well as an enrichment of response in RNF43 mutated tumors. Conclusions: Our preliminary data suggest that cfDNA BRAF MAF may constitute a significant tumor load surrogate with correlation with overall survival. cfDNA BRAF MAF and WES could help to identify three subgroups of patients with different prognostic and predictive features that could potentially have therapeutic implications.Legal entity responsible for the study: The author.

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Objective: The aim was to analyze the factors associated with neonatal near miss (NNM) in twin pregnancies in a public referral maternity unit in Brazil. Material and Methods: This retrospective, cross-sectional study included 697 twin newborns. Cases of fetal and neonatal deaths were excluded. Neonates were divided into those meeting NNM criteria (5 min Apgar score <7, birth weight <1,500 g, gestational age at delivery <32 weeks, use of mechanical ventilation or congenital malformation, transfer before 28 days of life) and those who did not. In the bivariate analysis, the chi-square and Fisher’s exact tests were used. Variables with a p-value ≤0.20 were subjected to the multiple analyses, which followed the Poisson regression model. Results: The cohort consisted of 130 (18.7%) neonates meeting NNM criteria and 567 (81.3%) with no NNM criteria after multiple analyses, the following variables were associated with NNM: no previous pregnancy, prevalence ratio (PR): 1.38 [95% confidence interval (CI), 1.03-1.85]; >3 previous pregnancies, PR: 1.93 (95% CI, 1.38-2.69); premature rupture of membranes, PR: 1.50 (95% CI, 1.70-2.12); intrauterine growth restriction, PR: 2.28 (95% CI, 1.53-3.33); premature labor, PR: 1.63 (95% CI, 1.13-2.35); resuscitation in the delivery room, PR: 1.80 (95% CI, 1.24-2.62); and transfusion of blood products, PR: 4.44 (95% CI, 3.14-6.28). Conclusion: The study findings indicate that having had 0 or >3 previous pregnancies, premature rupture of the membranes, intrauterine growth restriction, resuscitation in the delivery room, premature labor, and transfusion of blood products were associated with NNM in twin pregnancies.

Objetivo: Analisar as evidências científicas brasileiras acerca de critérios usados para identificação de casos de near miss neonatal. Método: Estudo de revisão integrativa nas bases de dados Pubmed/Medline, Scielo e Lilacs. Foram incluídos artigos originais de autoria brasileira que abordassem critérios para identificação de near miss neonatal; texto completo; publicados em português, inglês ou espanhol; período de publicação compreendido entre 2007 a 2017; com apresentação consistente dos resultados, métodos e população. Os termos de busca foram: near miss, neonatal, mortalidade neonatal e morbidade neonatal nas versões português e inglês. Resultados: Cinco estudos contemplaram a revisão, dois estudos transversais, dois estudos de coorte e um estudo descritivo de base de dados. Observou-se inexistência de uma definição para determinar o near miss neonatal. Os marcadores Apgar de 5 minutos < 7 e ventilação mecânica parecem mais concordantes entre os autores; variações ocorrem entre as idades gestacionais e os pesos de nascimento. Conclusões: Houve uma mostra restrita, ainda que crescente, de estudos nacionais, estes não apresentaram consenso sobre os critérios, mas alguns marcadores comuns mostraram-se capazes de identificar e predizer o near miss neonatal, notadamente os baixos peso ao nascer, idade gestacional e Apgar do quinto minuto de vida.