Objective To compare the efficacy of oral sweet solutions to water or no treatment in infants aged 1-12 months during immunisation. Methods Randomised controlled trials (RCTs) were retrieved through internet searches or manual searches of reference lists. Search terms included newborn, infant, pain, sucrose and alternative names for sweet solutions. Summary estimates with 95% CIs were calculated and included relative risk (RR), risk difference (RD) and number needed to treat to benefit (NNTB) for dichotomous outcomes, and weighted mean differences (WMD) for continuous outcomes. Where pooling of results was not possible, a narrative summary of study results is presented. Results Of the 695 studies identified, 14 RCTs with 1674 injections met the inclusion criteria. Sucrose or glucose, compared to water or no treatment decreased crying during or following immunisation in 13 of the 14 studies. Infants receiving 30% glucose (three trials, 243 infants) had a decreased RR in crying incidence following immunisation (typical RR 0.80, 95% CI 0.69 to 0.93; RD -0.17, 95% CI -0.29 to -0.05; NNTB 6, 95% CI 3 to 20). With sucrose or glucose, there was a 10% WMD reduction in proportion of crying time (95% CI - 18 to - 2) and a 12 s reduction in crying duration (95% CI - 23 to -0.7 s). An optimal dose of sucrose or glucose could not be ascertained due to the varied volumes and concentrations used. Conclusion Infants aged 1-12 months administered sucrose or glucose before immunisation had moderately reduced incidence and duration of crying. Healthcare professionals should consider using sucrose or glucose before and during immunisation.; The Pain in Child Health Strategic Training Initiative[STP53885]; Canadian Institutes of Health Research (CIHR)[CTP-79854]; Canadian Institutes of Health Research (CIHR)[MOP-86605]; Canadian Institutes of Health Research (CIHR)[KRS91774]

Pós-graduação em Pediatria - FMB; Analisar os resultados iniciais da triagem auditiva neonatal, obtidos na maternidade antes da alta hospitalar, em recém-nascidos de dois hospitais públicos de Campo Grande, MS. Método: estudo de coorte transversal com 20044 recém-nascidos de dois hospitais no período de janeiro de 2002 a dezembro de 2005. Foram utilizadas as Emissões Otoacústicas Evocadas Transientes (EOAETs) e a Pesquisa do Reflexo Cócleo-palpebral (RCP). Os resultados dos testes foram classificados em passa e falha para as EOAETs e em presente ou ausente para o RCP. Foram analisados em relação ao(s): local de nascimento, tempo de vida no momento da avaliação, peso ao nascimento, sexo, tipo de parto, valores de Apgar, convênio assistencial e risco para deficiência auditiva segundo o Joint Committee Infant Hearing (JCIH). Resultados: Foram testados 95,96% dos recém-nascidos dos dois hospitais; nesta amostra 87,52% de recém-nascidos foram de baixo risco e 12,48% de alto risco para a deficiência auditiva. Houve predominância de respostas passa nas EOAETs para o sexo feminino e para o parto normal. Também foi observada relação de aumento de peso e aumento das respostas passa. Na população de baixo risco auditivo...

A rare case of hyperlipropoteinemia in a 35-day-old infant who presented not only high blood levels of cholesterol and triglycerides but also an ocular manifestation described as lipemia retinalis. The fundoscopic abnormality cleared as the levels of chilomicrons in plasma dropped. Lipemia retinalis is an important and reliable parameter of high levels of chilomicrons and triglycerides and should be considered as a significant clue while diagnosing.

OBJECTIVES: To compare the motor development of preterm infants whose gestational age had been corrected to 38-40 weeks with full term newborns using the Test of Infant Motor Performance (TIMP). METHODS: The cross-sectional study compared preterm infants (PT group), with a gestational age at birth of 28-33 weeks, at an equivalent age to full term newborns (FT group), who were assessed up to 48 hours after birth. The assessments were performed between December 2008 and April 2009 in a hospital nationally recognized for premature infant care in the city of Recife, PE, Brazil. The sample consisted of 92 infants, 46 in each group. The test was administered at age 38-40 weeks (or equivalent age in the PT group). RESULTS: In the 46 preterm infants studied, 26.1% were classified as atypical, while in the FT group 100% were classified as typical (p<0.001). Moreover, there was a significant difference in average raw TIMP score between the two groups, with the PT group being lower (p<0.001). CONCLUSION: According to TIMP performance, prematurity seems to be associated with impaired motor development.

Pulmonary artery pressure may be estimated non-invasively in the premature newborn infant because of its negative correlation with the time to peak velocity:right ventricular ejection time (TPV:RVET) ratio calculated from the pulmonary artery Doppler waveform. We studied 54 very low birthweight infants on days 1, 2, 3, 7, 14, 21, and 28 after birth. Thirty four infants developed chronic lung disease (CLD). Twenty did not and acted as controls. After correcting the TPV:RVET ratio for heart rate (TPV:RVET(c)), during the first 14 days the TPV:RVET(c) ratio rose progressively in both groups suggesting a fall in pulmonary artery pressure. This occurred at a significantly slower rate in the CLD group. From days 14 to 28 there was a significant fall in the ratio in the CLD group only, suggesting an increase in pulmonary artery pressure. Using CLD as the end point, a TPV:RVET(c) ratio < 0.54 on day 7 had a predictive value of 78% (sensitivity 73%, specificity 65%). This rose to a predictive value of 97% (sensitivity 88%, specificity 95%) on day 28. The non-invasive assessment of pulmonary artery pressure may be useful in the early clinical management of the very low birthweight infant at risk of developing CLD.

A female infant presented with severe hypernatremic dehydration and failure to thrive two weeks after birth. The diagnosis and management of the infant are described, highlighting the need for follow-up and support after early discharge of newborns.

OBJECTIVE: The present study addressed a National Health and Medical Research Council (NHMRC) recommendation that the outcome of neonates who are treated conventionally for respiratory problems be further investigated before setting up additional extracorporeal membrane oxygenation (ECMO) centres in Australia. METHODOLOGY: The cognitive and behavioural outcome of ECMO eligible infants who received conventional treatment for respiratory problems at birth was assessed in 18 infants aged 1.5-3 years (index group). ECMO was not available at either of the treating hospitals. Index children were compared to a matched control group of children who did not experience any major complications at birth. Children were assessed using either the Bayley or McCarthy scales of infant development and the Child Behavior Checklist. RESULTS: Overall, a mortality rate of 19% and a psychological morbidity rate of 18% suggest that children born with severe respiratory failure, who meet existing ECMO eligibility criteria, have a good prognosis when treated using conventional medical therapy. CONCLUSIONS: Improvements to conventional treatments indicate that ECMO eligibility criteria may need to be revised to identify accurately those infants who are at extreme risk of mortality if treated conventionally.

It has been asserted that hypoxic-ischemic encephalopathy (HIE) with cerebral swelling in the absence of marked trauma may be responsible for subural hemorrhage in the young. As this may have considerable implications in determining both the mechanism of death and the degree of force required to cause injury in certain cases of inflicted head injury in infancy, clarification is required. A retrospective study of 82 fetuses, infants, and toddlers with proven HIE and no trauma was undertaken from forensic institutes in Australia, the United Kingdom, Germany, Denmark, and the United States. The age range was 35 weeks gestation to 3 years, with a male to female ratio of 2:1. All cases had histologically confirmed HIE. Causes of the hypoxic episodes were temporarily resuscitated sudden infant death syndrome with delayed death (N = 30), drowning (N = 12), accidental asphyxia (N = 10), intrauterine/delivery asphyxia (N = 8), congenital disease (N = 6), aspiration of food/gastric contents (N = 4), inflicted asphyxia (N = 3), epilepsy (N = 1), dehydration (N = 1), drug toxicity (N = 1), complications of prematurity (N = 1), and complications of anesthesia (N = 1). The initiating event was not determined in 4 instances. In no case was there macroscopic evidence of subdural hemorrhage. In this study no support could be given to the hypothesis that HIE in the young in the absence of trauma causes subdural hemorrhage.; Roger W. Byard...

Objective: To determine the significance of bruises in cases of infant death to ascertain if their presence was associated with other injuries or homicide. Design Retrospective: cohort study. Setting: Forensic Science South Australia, Adelaide, South Australia, Australia. Patients: 135 infants aged between 7 and 364 days autopsied over a 9-year period from June 1999 to May 2008. Outcome measures: Coronial forensic autopsy reports. Methods: Examination of autopsy reports to determine how many infants had bruising and whether bruising was associated with other injuries or lesions of concern. Cause and manner of death were also recorded. Results There were 83 boys and 52 girls. Twenty-one infants (15.6%) had one or more bruises, and 114 had no bruises. In the group of 21 infants with bruises, 17/21 had other injuries/lesions (81%), with 5/21 homicides (24%). Of the 114 non-bruised infants, only 9 (8%) had other injuries/lesions with only 4 homicides (3.5%). The incidence of other injuries/lesions was significantly higher in bruised infants compared with the non-bruised group (p<0.001), as was the occurrence of homicide (p=0.003). Bruises were found in 15.6% of infants presenting to coronial autopsy, with a sensitivity of 65% and a specificity of 96% as markers for other injuries (positive predictive value 0.81; negative predictive value 0.92). At <6 months of age...

OBJECTIVE: The aim of the present study was to evaluate the effect of persistent snoring in the first year of life on developmental outcomes. METHODS: As part of a longitudinal study of snoring and sleep in infancy, we identified 13 children (10 males) who commenced snoring shortly after birth and continued to snore frequently (≥ 3 nights/week) at 6 and 12 months of age and 78 controls (31 males) who were reported by parents to never snore in the absence of a cold. Infants were assessed with the Bayley Scales of Infant and Toddler Development Edition III and parents completed demographic and sleep questionnaires. RESULTS: Infants reported to snore frequently from the first month of life and who continued to snore frequently until 12 months of age had significantly lower cognitive development scores (mean=94.2; SD=3.9) compared to controls (mean=100.6; SD=3.7) (F (1, 96)=40 6, p<0.001; η(p)(2)=0.32). CONCLUSION: Persistent frequent snoring from the first month of life was associated with lower cognitive development scores at 12 months of age. It is possible that this deficit will become worse with age.; http://www.elsevier.com/wps/find/journaldescription.cws_home/620282/description#description; A.M. Piteo, K. Lushington, R.M. Roberts...

O objetivo deste estudo foi avaliar a repercussão da fisioterapia respiratória com a técnica de aumento do fluxo expiratório (AFE) na hemodinâmica cerebral de RNPT. Trata-se de um estudo prospectivo observacional em que foram incluídos 40 neonatos prematuros com idade gestacional menor ou igual a 34 semanas entre 8-15 dias de vida, clinicamente estáveis. Foram excluídos RN com malformações cardíacas, diagnóstico de lesão cerebral e em uso de drogas vasoativas. A avaliação da hemodinâmica cerebral foi realizada por exames de ultrassonografia com estudo da dopplerfluxometria cerebral realizados antes, durante e depois da sessão de AFE, que durou cinco minutos. Foram avaliadas as velocidades de fluxo sanguíneo cerebral (velocidade de fluxo no pico sistólico-VFPS, velocidade de fluxo diastólica final- VFFD e velocidade média de fluxo-VMF) e os índices de resistência (IR) e pulsatilidade (IP) na artéria pericalosa. Em seguida foram avaliadas variáveis maternas e neonatais que poderiam influenciar a hemodinâmica cerebral em conjunto com a manobra respiratória nos diferentes tempos analisados. Para descrever o perfil da amostra, segundo as variáveis em estudo, foram realizadas tabelas de frequência (frequência absoluta e percentual) das variáveis qualitativas e estatística descritiva para as variáveis quantitativas...

Background Regular antenatal care for women with a multiple pregnancy is accepted practice, and while most women have an increase in the number of antenatal visits, there is no consensus as to what constitutes optimal care. 'Specialised' antenatal clinics have been advocated as a way of improving outcomes for women and their infants. Objectives To assess, using the best available evidence, the benefits and harms of 'specialised' antenatal clinics compared with 'standard' antenatal care for women with a multiple pregnancy. Search strategy We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (October 2006), the Cochrane Central Register of Controlled Trials (CENTRAL)(The Cochrane Library 2005, Issue 4), and PubMed (January 1966 to January 2006). Selection criteria Randomised controlled trials with reported data that compared outcomes in mothers and babies who received 'specialised' antenatal care with outcomes in mothers and babies who received 'standard' antenatal care. Data collection and analysis Both review authors independently assessed trial quality and extracted data. Main results There are no included studies. Authors' conclusions There is no information available from randomised controlled trials to support the role of 'specialised' antenatal clinics for women with a multiple pregnancy compared with 'standard' antenatal care in improving maternal and infant health outcomes. The value of 'specialised' multiple pregnancy clinics in improving health outcomes for women and their infants requires evaluation in appropriately powered and designed randomised controlled trials; Dodd JM...

A congenital peribronchial myofibroblastic tumor (CPMT) is a rare benign tumor arising from the lungs. Although CPMT is a benign tumor, it is characterized by rapid growth, and is easily misdiagnosed during the prenatal period when the symptoms are nonspecific. The authors present a rare case of CPMT in a premature infant, which was detected at 28 weeks on ultrasonography (US) but resolved at a later stage of pregnancy. The knowledge concerning the diagnosis and management of CPMT is reviewed. Herein, the authors report of a 30-minute-old premature newborn infant in whom a pulmonary mass was discovered 1 month before delivery. Maternal prenatal US demonstrated a 0.8 × 1 cm well-defined oval-shaped mass in the left hemithorax in the 28th week of gestational age. The pulmonary mass, however, was not apparent on repeat US examination at 32 weeks. The child was delivered by cesarean section at 34 weeks estimated gestational age. Chest radiography and computed tomography revealed a mass-like lesion in the left lower pulmonary lobe. The chest computed tomography characteristics of the tumor included large size (4 cm), an irregular margin, and surrounding ground-glass opacity, which led to misdiagnosis as a malignant tumor. The patient underwent a left inferior lung lobectomy and was pathologically diagnosed with CPMT. He is currently alive 12-month postresection with no evidence of disease recurrence.

Behçet's disease is reported in a newborn infant of a mother with the disease. The mother had recurrent orogenital ulcers, pustulonecrotic skin lesions, arthritis, thrombophlebitis, and colonic ulcers. Shortly after birth the infant presented with transient orogenital ulcerations and pustular cutaneous lesions. On healing, depressed scars developed which were very similar to those of the mother. The finding of circulating immune complexes in the mother's serum gives some support to the hypothesis that the infant's transient illness was caused by transplacental passage of maternal antibodies.

O Ministério da Saúde recomenda e incentiva a Atenção Humanizada ao recém-nascido de baixo peso utilizando-se o Método Mãe-Canguru (MMC) nas unidades integrantes do Sistema Único de Saúde (SUS). O objetivo deste estudo foi avaliar e comparar as respostas fisiológicas entre o MMC e a posição prona (PP), em recém-nascidos pré-termo (RNPT). Foi feito um estudo de intervenção, realizado entre setembro e outubro de 2009, composto por 20 RNPT, de ambos os sexos, com idade gestacional entre 24 a 36 semanas, estáveis hemodinamicamente, sendo classificados como grupo I (MMC) e grupo II (PP). Foram consideradas as variáveis: frequência cardíaca (FC), frequência respiratória (FR), saturação periférica de oxigênio (SatO2) e temperatura corporal (T). As mensurações foram realizadas por três dias consecutivos, antes e 60 min após a aplicação das técnicas. No grupo PP, a FR aferida antes foi significativamente maior do que a aferida após a intervenção, nos 1º e 3º dias (p; The Ministry of Health recommends and looks forward to the Humanized Attention of low weight newborn babies using the Kangaroo-Mother Care Method (MCM) in Unified Health System units. The aim of this work was to evaluate and compare the physiological responses between the MMC and the Prone Position (PP) in pre-term newborn babies (PNB). Intervention study...

Testicular neoplasms are uncommon tumors of childhood. These tumors comprise the germ cell tumors, and other tumors that may originate from histological testicular components, which are unrelated to the germinal lineage. Among the latter are the sex cord-stromal tumors (SCST), an important entity in newborns. SCSTs comprise, among others, granulosa cell tumors, which are more common in the ovary, but in rare cases may develop in the testis. The prognosis is excellent since it is universally benign. Diagnosis, which is sometimes challenging, is usually made after orchiectomy and pathological examination, which is characterized by morphological features and positive expression of inhibin, calretinin, and vimentin, and negative for alpha-fetoprotein. The authors present the case of a newborn with a right enlarged testis detected during the first examination after birth. Ultrasonography showed a heterogeneous solid/cystic mass in the right testis, without retroperitoneal lymphadenopathy. A right inguinal orchiectomy was performed 21 hours after birth. Pathologic examination revealed a juvenile granulosa cell tumor of the right testicle. After 4 years of follow-up, as expected, the child presented an uneventful outcome.

INTRODUCTION: Preconception care includes any intervention to optimize a woman's health before pregnancy with the aim to improve maternal, newborn and child health (MNCH) outcomes. Preconception care bridges the gap in the continuum of care, and addresses pre-pregnancy health risks and health problems that could have negative maternal and fetal consequences. It therefore has potential to further reduce global maternal and child mortality and morbidity, especially in low-income countries where the highest burden of pregnancy-related deaths and disability occurs. METHODS: A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconception care for adolescents, women and couples of reproductive age on MNCH outcomes. A comprehensive strategy was used to search electronic reference libraries, and both observational and clinical controlled trials were included. Cross-referencing and a separate search strategy for each preconception risk and intervention ensured wider study capture. RESULTS: Women who received preconception care in either a healthcare center or the community showed improved outcomes, such as smoking cessation; increased use of folic acid; breastfeeding; greater odds of obtaining antenatal care; and lower rates of neonatal mortality. CONCLUSION: Preconception care is effective in improving pregnancy outcomes. Further studies are needed to evaluate consistency and magnitude of effect in different contexts; develop and assess new preconception interventions; and to establish guidelines for the provision of preconception care.; Sohni V Dean...

A música tem sido aplicada para o equilíbrio de energias alteradas pelo stress do mundo moderno. Este estudo objetivou verificar o efeito da música no trabalho de parto e no recém-nascido, quando submetido às mesmas melodias ouvidas por suas mães na gestação. Gestantes, usuárias de Unidades Básicas de Saúde, foram submetidas a sessões de sensibilização musical a partir do quinto mês de gestação. Durante o trabalho de parto, a parturiente foi submetida às melodias selecionadas por ela, com interrupções de 30 minutos a cada duas horas. Os dados foram coletados em três entrevistas realizadas após o parto, em diferentes momentos, e o discurso obtido foi analisado qualitativamente. Constatou-se, pelo conteúdo das falas, que a música minimizou os desconfortos do trabalho de parto e facilitou a adaptação do bebê nos primeiros meses de vida.; La música ha sido aplicada para el equilibrio de las energías alteradas por el estrés del mundo moderno. Este estudio tuvo por objetivo verificar el efecto de la música en el trabajo de parto y en el recién nacido cuando es expuesto a las mismas melodías oídas por sus madres durante el embarazo. Mujeres embarazadas atendidas en Unidades Básicas de Salud fueron expuestas a períodos de sensibilización musical a partir del quinto mes de embarazo. Durante el trabajo de parto...

The pre-term newborn care at neonatal units, which makes continued use of orogastric probes have drawn our attention to an apparent alteration in probes flexibility upon removal thereof for routine replacement at approximately 72 hours. Due to the lack of elements explaining such facts and information as to whether or not such findings are additional risks to the health condition of such children, the main objective of this study was as follows: to compare the flexibility of vinyl-made gastric probes use for pre-term newborn at 24 48 and 72 hours.; A assistência ao recém-nascido pré-termo (RN-PT) em unidade neonatal, fazendo uso contínuo de sonda orogástrica, tem nos despertado para a aparente alteração da flexibilidade da sonda, percebida durante a remoção das mesmas para a substituição habitual, com cerca de 72 horas. Na ausência de elementos que esclareçam tal fato e de subsídios para considerá-la, ou não, como risco adicional à condição de saúde destas crianças, este estudo teve como principal objetivo: comparar a flexibilidade das sondas gástricas de natureza vinílica, usadas por recém-nascidos pré-termo em períodos de 24, 48 e 72 horas.

As teorias são proposições elaboradas para avaliar a assistência de enfermagem, possibilitando às enfermeiras considerá-las e incorporá-las na prática profissional. O trabalho objetivou refletir, criticamente, sobre a utilidade na prática de conceitos da Teoria Humanística de Enfermagem, numa dissertação de mestrado. O estudo é descritivo-reflexivo, realizado em 2004, e utilizou o modelo de análise de teorias de Meleis. Desse modelo, foi recortado o segmento "crítica da teoria", com ênfase no item "utilidade", para servir de suporte analítico. Da análise crítica, percebeu-se que "utilidade" do relacionamento interpessoal e do diálogo é notório, e estes podem ser praticados no cotidiano da Unidade de Terapia Intensiva Neonatal, valorizando a relação humana afetiva, situação essencial no ato de cuidar pelo enfermeiro. Conclui-se que a prática do enfermeiro deve ser norteada por referenciais teóricos, filosóficos e metodológicos responsáveis por levarem o profissional a uma crítica reflexiva do ser e do fazer.; Las teorías son propuestas elaboradas para evaluar la atención de enfermería, posibilitando a las enfermeras considerar e incorporarlas en su práctica profesional. La finalidad de este trabajo fue reflexionar críticamente sobre la utilidad práctica de los conceptos de la Teoría Humanística de Enfermería...