The aim was to describe current reports in the scientific literature on sleep in the intensive care environment and sleep deprivation associated with painful experiences in premature infant. A systematic search was conducted for studies on sleep, pain, premature birth and care of the newborn. Web of Knowledge, MEDLINE, LILACS, Cochrane Library, PubMed, EMBASE, Scopus, VHL and SciELO databases were consulted. The association between sleep deprivation and pain generates effects that are observed in the brain and the behavioral and physiological activity of preterm infants. Polysomnography in intensive care units and pain management in neonates allow comparison with the first year of life and term infants. We have found few references and evidence that neonatal care programs can influence sleep development and reduce the negative impact of the environment. This evidence is discussed from the perspective of how hospital intervention can improve the development of premature infants.Keywords: sleep, pain, prematurity, polysomnography, neonatal intensive care.RESUMO O objetivo foi descrever o estado atual na literatura científica sobre privação do sono associado a experiências dolorosas no prematuro e o papel na evolução do sono em ambiente de terapia intensiva. Realizou-se uma busca sistemática para estudos sobre sono, dor, prematuridade e programas de atenção ao neonato. Foram consultados as bases Web-of-Knowledge, MEDLINE, LILACS, Biblioteca Cochrane, PubMed, EMBASE, Scopus, BVS e SciELO. A associação entre privação do sono e dor gera efeitos que são observados na atividade cerebral, fisiológica e comportamental dos prematuros. A polissonografia nas unidades intensivas e o manejo da dor em neonatos permitem comparação no primeiro ano de vida com crianças nascidas a termo. Encontraram-se poucas evidências de que programas de cuidado neonatal podem influenciar o desenvolvimento do sono e diminuir o impacto negativo do ambiente. Estas evidências são discutidas na perspectiva de como a intervenção hospitalar pode melhorar o desenvolvimento do prematuro.Palavras-chave: sono, dor, prematuridade, polissonografia, terapia intensiva neonatal.In recent decades there has been a considerable increase in the number of premature births and in the survival rate of these babies as a consequence of also increasing the effectiveness of intervention in Neonatal Intensive Care Unit (NICU). This relatively recent phenomenon has opened various fronts of research on the development of the fetus outside the uterus and its challenges. Among the areas that have aroused more interest and generated publications are the investigations on the development of sleep and pain perception and the future implications of sleep deprivation and exposure to pain at early ages. The uterine environment is suitable for the full growth and development of the human fetus site. The challenge of preterm birth and hospitalization in the NICU promotes an abrupt environmental difference for newborns which can bring challenges for future development. The inst...
All scale indicators were related to skin conductance activity in all periods, indicating pain perception. Facial tension was the most efficient indicator, while others varied in performance after painful events and possibly indicated stress after trauma. These results are discussed from a phenomenological approach and in an anxiety paradigm.
Heart rate variability (HRV), oxygen saturation variability (OSV) and skin conductance activity (SCA) are recognized physiological markers of acute pain. In order to verify which of them has the best correlation with psychophysical parameters of pain (intensity, reactivity, direction, regulation and slope), an observational prospective study was performed, including 41 healthy full term newborns. The measurements studied were the HRV, the OSV, and the following SCA variables: number of waves per second (NWps) and relative area under the curve of waves (AUC). The measurements were performed in periods labeled before, during, and after a heel prick. The variation measured for intensity between periods was significant for the NWps (p=0.001), AUC (p=0.03), HRV (p=0.001) and OSV (p=0.004). Also, the reactivity and direction were significant for all variables, except AUC. The regulation parameter was significant for the variables NWps (p<0.01), AUC (p<0.05), HRV (p<0.01) and OSV (p<0.01). The slope was statistically significant only for the OSV variable (p=0.000). We concluded that the responses of the SCA, HRV and OSV to painful events fit the psychophysical parameters of a physiological marker and serve as valuable measures for pain diagnostic working the use in accordance with the needs of the context.
The prevalence of preterm birth (PTB) is high worldwide, especially in developing countries like Brazil. PTB is marked by a stressful environment in intra- as well as extrauterine life, which can affect neurodevelopment and hormonal and physiological systems and lead to long-term negative outcomes. Nevertheless, little is known about PTB and related outcomes later on in childhood. Thus, the goals of the current study were threefold: (1) comparing cortisol and alpha-amylase (sAA) profiles, including cortisol awakening response (CAR), between preterm and full-term children; (2) evaluating whether preterm children are more responsive to acute stress and (3) assessing their memory skills and emotional and behavioral profiles. Basal cortisol and sAA profiles, including CAR of 30 preterm children, aged 6 to 10 years, were evaluated. Further, we assessed memory functions using the Wide Range Assessment of Memory and Learning, and we screened behavior/emotion using the Strengths and Difficulties Questionnaire. The results of preterm children were compared to an age- and sex-matched control group. One week later, participants were exposed to a standardized laboratory stressor [Trier Social Stress Test for Children (TSST-C)], in which cortisol and sAA were measured at baseline, 1, 10 and 25 min after stressor exposure. Preterm children had higher cortisol concentrations at awakening, a flattened CAR and an exaggerated response to TSST-C compared to full-term children. These alterations were more pronounced in girls. In addition, preterm children were characterized by more emotional problems and poorer memory performance. Our findings illustrate the long-lasting and in part sex-dependent effects of PTB on the hypothalamic-pituitary-adrenal (HPA) axis, internalizing behavior and memory. The findings are in line with the idea that early adversity alters the set-point of the HPA axis, thereby creating a more vulnerable phenotype.
Objective: To analyze the indicators of exclusive breastfeeding (EB) in Brasilia's University Hospital (BUH) during a 10-year interval and to verify associated factors to early weaning.Methods: A retrospective cross-sectional study was conducted by chart review of children attending the Pediatric Clinic during 1999 and 2008. The duration of exclusive breastfeeding was categorized at four months and four months or more. Prevalence ratios for early weaning (EB<4 months) were estimated with a model of Poisson regression and robust variance. Non-parametric Mann-Whitney test was used to compare the exclusive breastfeeding duration in the studied years.Results: Among 2,173 patients, 1,443 in 1999 and 730 in 2008. There was an increase from 110.7 to 123.6 days in the duration of EB. A significant association between maternal education and early weaning was shown, with a 12.6% higher prevalence in mothers with less than eight years of schooling compared to those with 11 or more years. No other associations were found in the study. Conclusions:Similarly to what was found in Brazilian capitals and Brasilia, there was an increase in the length of exclusive breastfeeding related to mother educational level. Nevertheless, the duration exclusive breastfeeding is still below the threshold of 180 days recommended by the World Health Organization. Key-words: breast feeding; weaning; risk factors. RESUMOObjetivo: Analisar os indicadores do aleitamento materno exclusivo (AME) do Hospital Universitário de Brasília (HUB) nos anos de 1999 e 2008 e identificar fatores associados a sua interrupção precoce Métodos: Estudo retrospectivo transversal com análise de prontuários de crianças atendidas nos anos 1999 e 2008 no Ambulatório de Pediatria, Crescimento e Desenvolvimento do HUB. A duração do AME foi dicotomizada em até quatro meses e quatro meses ou mais, estimando as razões de prevalência para o desmame precoce (AME<4 meses), utilizando-se um modelo de regressão de Poisson com variância robusta e o teste não paramétrico de Mann-Whitney para comparação do tempo de AME nos anos estudados.Resultados: Foi analisado um total de 2.173 pacientes, 1.443 referentes ao ano de 1999 e 730 referentes ao ano de 2008. Observou-se um incremento de 110,7 para 123,6 dias na duração do AME de 2008 em relação a 1999 (p<0,0001). O desmame precoce foi 12,6% maior em mães com até sete anos de estudo do que em mães com 11 ou mais anos de estudo (p<0,05). Os demais fatores analisados não mostraram relação estatística com o desmame precoce.Conclusões: Assim como o encontrado nas capitais brasileiras e Distrito Federal, verificou-se incremento no que diz respeito à duração do AME, associado positivamente ao nível educacional materno mais elevado. Convém ressaltar, porém, que a duração observada no estudo ainda se encontra abaixo dos 180 dias recomendados pela Organização Mundial de Saúde. Exclusive breastfeeding and factors related to early weaning: a comparative study between 1999 and 2008Palavras-chave: aleitamento materno; desmame; fatores de risc...
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