Desmame em recém-nascidos de muito baixo peso ao nascer no primeiro retorno ambulatorial após a alta hospitalar

Investigate intrahospital and neonatal determinants associated to the weaning of very low birth weight (VLBW) infants. Methods: 119 VLBW (<1500g) infants 81 were monitored from July 2005 through August 2006, from birth to the first ambulatory visit after maternity discharge. This maternity unit uses the Kangaroo Method and the Baby Friendly Hospital Initiative. Results: Out of 119 VLBW infants monitored until discharge, 88 (75%) returned to the facility, 22 (25%) were on exclusive breastfeeding (EB) and 66 (75%) were weaned (partial breastfeeding or formula feeding). Univariate analysis found an association between weaning and lower birth weight, longer stays in the NICU and longer hospitalization times, in addition to more prolonged enteral feeding and birth weight recovery period. Logistic regression showed length of NICU stay as being the main determinant of weaning. Conclusion: The negative repercussion on EB of an extended stay in the NICU is a significant challenge for health professionals to provide more adequate nutrition to VLBW infants

Estudos analíticos dos grafoelementos do eletroencefalograma em sono: fusos do sono, ondas agudas do vértex e o gradiente de freqüência e amplitude, como indicadores de comprometimento neurológico na criança

Innumerable studies have focused been reported on the sleep spindles (SS), Sharp Vertex Waves (SVW) and REM, NREM Sleep as indicators interpreting EEG patterns in children. However, Frequency and Amplitud Gradient (FAG) is rarely cited sleep parameter in children,that occurs during NREM Sleep. It was first described by Slater and Torres, in 1979, but has not been routinely evaluated in EEG reports. The aim of this study was to assess the absence of SS, SVW and FAG, as an indication of neurological compromise in children. The sample consisted of 1014 EEGs of children referred to the Clinical Neurophysiology Laboratory, Hospital Universitário de Brasília (HUB), from January 1997 to March 2003, with ages ranging from 3 months to 12 years old, obtained in spontaneous sleep or induced by choral hydrate. The study was transversal and analytical, in which, visual analysis of EEG traces was perfumed individually and independently by two electroencephalographers without prior knowledge of the EEG study or neurological findings. After EEG selection, the investigators analyzed the medical reports in order to define and correlate neurological pattern was classified according to the presence or absence of neurological compromise, as Normal Neurological Pattern (NNP), and Altered Neurological Pattern (ANP) respectively. From the visual analysis of the EEG(s), it was possible to characterize 6 parameters: 1- FAG present (64,1%); 2- FAG absent (35,9%); 3 - normal SS (87,9%); 4 - altered SS s (12,1%); 5 - normal SVW s (95,7%); 6 - altered SVW s (4,3%). The prevalence of well-formed FAG is found in the 3 months to 5 years age group in the children with NNF. FAG was totally absent from the age of 10 years. When comparing the three sleep graphielements, it was observed that SVW and SS were predominant in children with NNF. However, FAG absent was more prevalent in the ANF than in altered SS an SVW. The statistical analysis showed that there is a strong association of FAG absent, with isolated alteration, in ANF patients, in that the prevalence ratio was 6,60. The association becomes stronger when FAG absent + altered SS(s) is considered (RP= 6,68). Chi-square test, corrected by Yates technique, showed a highly significant relation for FAG ρ= 0,00000001, for error X of 5%, or else the 95% confidence interval (ρ<0,05). Thus, the FAG absent were more expressive in ANF patient than altered SS(s) and SVW(s). The association becomes stronger in order to establish a prognostic relation, when the FAG is combined with the SS. The results os this study allow us to affirm that the FAG, when absent at ages ranging from 3 months to 5 years , is an indication of neurological compromise. FAG is an age-dependent EEG parameter and incorporated systematically, in the interpretation criteria of the EEG of children s sleep, not only in the maturational point of view, but also neurological disturbances with encephalic compromise

Avaliação da presença de osteopatia decorremte do diabetes tipo 1 em criança e adolecentes do Rio Grande do Norte

Diabetes Mellitus (DM) and osteoposes are chronic diseases with great socioeconomic consequences, mainly due to the late complications and consequent disabilities. The potential effects of DM on bone metabolism remain a very conroversial issue, and disagreement exists with regard to the clinical implications of diabetic osteopenia and the mechanism of its ocurrence. The issue is further complicated by the contribuicion of the especific factors, such as duration of disease an dthe degree of metabolic control. The objective of this study is to identify the osteopathy in children and adolescents with DM 1 assisted in the hospital of pediatrics, UFRN, through biochemical markers of bone and mineral metabolism and the extent of bone mineral density. The study was composed by 74 diabetics type 1 patients (DM1) of both gender and aged 6 to 20 yars. Normoglicêmic group was composed by 97 healthy subjects of both genders, which showed the same age range of DM1, in addition to same socioeconomic class. These individuals qere students from the networks of public education in the city of Natal-RN, randomly invited to paticipate in our study. Both groups DM1 and NG were divided intofour subgroups, according to the classification of tanner , T1, T2, T3, T4 for achieving a benchmark. Diabetic individuals showed up with a poor glycemic control. the group DN1 T4 showed an incresead value for total protein, albumin, urea and microalbumiuria are predictors of grumelura injury in DM1 patients . The total alkaline phosphatase activitywas kept on high levels for both groups because they are in a stature development age. For osteocalcin there were decreased levels for groups Dm1 T1, T2, and T3 when compared to their NG (s), suggesting that this decrease could be associated with reduction in the number and/or differentiation os osteoblasts thereby contributing to reducing bone formation. There were no changes in the activity of TRAP. The serum concentrations of total and ionized calcium, phosphorus and magnesium were included within the RV. It was observed that the BMD (Z- SCORE ) has always been within the RV for both groups, despite to DM1 T4. Taking all together, our results support the hypothesis that children and adolescents with type 1 DM present the risk in the long run to suffer a reduction in the bone mass, associated to poor glicemic control and disease duration. It could limit the bone growth and increase the probality of development of osteopenia, as well as other complications surch as retinopathy and renal failure

Narrativas infantis: o que nos contam as crianças de suas experiências no hospital e na classe hospitalar

This dissertation focuses on the narratives of children hospitalized with chronic diseases. The overall goal is to deduce, from the look of the child health care, hospital class contributions to the process of school inclusion. The research is part of the qualitative ethnographical approach and is based on the principles and research methods (auto)biographical in education and schooling in hospital. Participated in the investigation 05(five) children, aged between 06 (six) and 12 (twelve) years of age, treated at the Center for Children s Onco-Hematology, Varela Santiago Children s Hospital in Natal-RN. The corpus used for the analysis comprises five (05) narrative interviews, 03 (three) drawings made by children as well as records in the researcher s field diary. The sources were collected during the months of August 2010 to February 2011. The analysis revealed that the inclusion of the hospital class, and ensure the right to education, contributes to the construction of strategies for coping with illness and hospitalization, as it promotes autonomy, comfort, playfulness and self-knowledge, the rand the world, easing the stress of hospitalization. The figure of the teacher took the class hospital in the voices of children, a reliever and minimizing the role of double exclusion that cause illness and hospitalization, showing the contributions to (re) construction of identity and subjectivity constitution strengthened. The children interviewed said that the hospital class leave the hospital more cheerful. The playfulness and learning experiences in the hospital are seen by children as actions that go beyond the physical treatment of the disease, since it provides them with acceptance and understanding of hospitalization and illness, to give them affective security and emotional. In conclusion, the narratives of children confirm that the service class hospital ensures continuity of schooling, but they reveal, namely, that this service provides them socialization among peers and with adults, strengthening the emotional, social and cognitive biopsychosocial perspective of attention

Hospital de Pediatria da UFRN: resgatando memórias na construção da história

This study deals with a historical, descriptive and exploratory approach aiming to recall the origin and trajectory of the Pediatrics Hospital at Universidade Federal do Rio Grande do Norte. This research also deals with the insertion of the nursing department in the same Hospital. This was realized through existing records and discourse collected through interview of professionals-doctors, nurses, midwifes, nursing attendants and psychologists. Thus, a network was established and consisted of qualified informants, composed through reference analysis. Data treatment and analysis was performed based on the collection of oral data. The data was considered according to the font s context, all of which depending on process of comprehension and interpretation. The research was based on the main theme, through oral history used in order to build a historical background. These main themes were then subdivided and other discourses were made present such as: the historical scene, the dream came true and the insertion of nursing, present in the history construction; all of which enabled the research. Thus, in this process, it was possible to identify the most important characters of the origin of children s health services organization and assistance at Rio Grande do Norte. It was possible to perceive that this institution aimed to initiate health services that dealt with an education for future generations. This was observed through the creation of the Faculty of Medicine of Natal and as a consequence, the installation of a Pediatrics Hospital that dealt with medical education. The research made evident that the nursing contributed for a structuring of quality health assistance towards children, even though the resources and working conditions were scarce, extensive work shifts and low professional qualification. It was observed that the there was change in the category s profile, once nurses were introduced in the service. Once this happened, changes in mentality, and innovative processes as well as professional conducts were established. The distinctive relation between acting and doing of doctors and nurses were also dealt with. Thus, the first item is done towards the idealization, projection and prescription. The second issue deals with concretization in realization of something that was not projected and realized, causing suffering and unsatisfaction. At the end, it was possible to confirm that oral history is a very rich element and it is possible through subjects that build history, through their perceptation of the facts and the context in that their are inside

Análise de qualidade da atenção à criança na estratégia saúde da família: o óbito infantil evitável como referência

Alma-Ata declaration bring the Primary Attention to the Health (PAH) as first level of health attention for individuals, family and community, which considers infant group as priority. Several initiatives that gave bases to integral attention to the children health formalized in the principles of Unique Health System. Family Health Strategy (FHS) comes to strengthen this attention, instituting new ways of work organization and professional practices that gave impact in their quality indicators. One of them is children mortality, showing decline in their values. Though, studies indicates persistence of avoidable infant deaths. In Natal RN, this reality is also perceptible leading to inquietudes, mainly at the space of services production, it means, which motivated the accomplishment of the present study intending to analyse the way that the organizational and structural processes as long as the professional practices in FHS interfered in the quality of children s health attention who died by avoidable death in the year of 2007 in municipal district of Natal-RN. It treats, therefore, to an exploratory and descriptive survey of cases study type, thar had as primary sources the oficial documents of MH, the family prontuary, pregnant card, child card and testimony obt ined from instrument of research elaborated based in investigation form of infant death by MH, applied to 10 mothers of children who had avoidable death. In analysis it was appealed silmultaneous triangulation of methods and sources, allowing a bigger aproximation from obtained informations. To elucidate the cases, the aspects studied were analyzed to the light of explicative model of Social Determinants of Health. Among individual and family aspects were highlighted the related to age, schooling, family habits and customs and mother s economic condition, besides of pregnancy age, newborn weight and associated diseases, which don t differ from literature about the theme. Reffering to the factors organizational and structural processes and professionals practice, highlihgted, the treatment given by the professionals, the territorialization and adscription of areas, the difficulty of having access to the services or sleepers and the reference and counterreference. But also, the ausence or few greet, the lack of communication, few assiduity and ponctuality by professionals in service, among others. In a general way mothers considers the attendance received in the hospital good and very good , opnions that in the Basic Attention weren t so favorable, in spite of many of predictible actions in this level have been performed in the studied cases. It is observed, therefore, that the social determinants of health has a strong influence in ocurrence of infant deaths, what implicates in a large actuation by Infant Mortality Committee from municipal district. This way, it becomes fundamental the reflection and evaluation about the effectiveness and execution by the processes of vigilance to health in FHUs; the rethink about the social determinants of health in a wide and articulate way to the services quality, to permanent education, to management in service, to the given attention and to the way how it is installed the popular participation and social control. To the professionals it is presented the great challenge to review their daily practice, their values, behaviors and commitment, which ones must be guided by logical of sharing, work in team, humanescence and alterity, not only by the accomplishment of a professional duty

Atuação dos profissionais de saúde no atendimento à criança vítima de violência

This study had the purpose of identifying the health professional performance during the care of children victimized by violence. Its objectives were the evaluation of how health professionals diagnose violence on the hospitalized child during the care process; the identification, according to the experience of each health professional, of the types of violence on the hospitalized child, the child's aggressors and the most frequent1y injured area in the body and the analysis of conducts adopted by health professionals upon the recognition of a violence case on a hospitalized child. The study was of the descriptive-exploratory type, using a quantitative approach, performed on Hospital da Criança Santo Antônio (HCSA) in Boa Vista - RR. The population consisted of 235 health professionals, with data collected from June to August 2006. The results show a clear predominance of the female gender, (76,17%); aged 31 to 35 (26,81%); married (45,96%). As for professional formation, 63,9% were nursing auxiliaries and technicians,16,2% physicians, 14,8% nurses, 3,9% social assistants and 2,1% psychologists; 45,96% had completed middle-level education, 51,06% of which coming from private education establishments and 48,94% from public education institutions.; 97,66 % have specialization or improvement courses on their area; 32,77% among 05 to 09 years of work time; 32,06(10 worked on pediatric infirmaries; 75,74% state they have experience with children victimized by violence; 96,22% consider themselves capable of identifying the types of violence suffered by children; 29,00% consider physical violence the most common kind; 91,57% sought to identify the aggressors; 27,72% consider the mother to be the child's main aggressor, 26,36% the father, and 22,28% the stepfather; 26,55% consider the limbs and pelvic waist to be the body region most affected by violence; 26,91% take the attitude of reporting to the nurse and 20,13% to the social service; 70,79% state that the conducts were performed as a team; 26,25% of the professionals consider that the social assistants helped the most on deciding which conduct to adopt; 76,40% state there was no one opposed to the performing of these conducts; but 23,60% that stated there was no one opposed to the performing of these conducts, 77,08% reveal that the family members were against the conducts taken by the team. We conclude that, the hea1th professionals who were part of the study, apparently are not adequate prepared to diagnose and report the violence on child. The results were more drastic when we related the physicians and the nurses' answers, considering that they give directed assistance to these victims social assistants and psychologists are the ones best prepared to conduct cases of child mistreatment. However, we are conscious of our responsibility with professional education not only in upper grade institution but also on the middle-level. We believe also, that a continued education program can help to improve the professional knowledge and improve the quality of care

O sistema de garantia dos direitos da criança e do adolescente: análise da trajetória e do processo de resolubilidade dos casos de violência doméstica sexual em Recife PE (2007-2011)

This work discourses about the child and adolescent s Guaranty System of Rights (GSR), on the intervention in cases of juvenile domestic sexual violence, in Recife. The course (trajectory) is analyzed, where circulate cases of sexual violence, until its resolution, in (GSR). Actually, the violence represents a serious problem of public health. Was thought about the difficulties and the limits that make GSR become a full field of contradictions and challenges for the effectiveness of the children and adolescents rights. Therefore, it was verified the treatments that are developed by GSR, how this system is structured and articulated and how occurs the resolution of the sexual violence cases against children and adolescents. Proceedings of the quantitative and qualitative research were used, was done observation, directed interview and analysis of documents. Thus, the field research was the visits in these institutions: Restauração Hospital, Police Management of the Child and Adolescent (PMCA) three Guardianship Councils, Dom Helder Camara Center of Studies and Social Action (CENDHEC) and the Tribunal of Childhood and Adolescence. The research subjects were seven professionals of GSR. The theoretical discussion is guided in reflections about the children and youth rights, in the violence theme and in the construction and institutionalization process of GSR. In this experiment, was noticed there are many difficulties for working together the GSR, because many obstacles are found when we call the responsible institutions, besides some violence cases happen again. This system is not totally institutionalized and articulated, faces structural problems, material, poorly qualified professionals, underinvestment, low transfer of public resources, among other difficulties, causing many losses in the implementation of public policies that enforce secured rights by legislation

Atenção à criança no período neonatal: chamada neonatal, Rio Grande do Norte, 2010

The neonatal period, which includes the first 27 da ys postpartum, is a vulnerability phase in child health, making it necessary for a greater mon itoring by health professional through actions that add value to the binomial mother/child and comprehensive care to the newborn. To this end, this study aimed to evaluate the care actions the neonato from the strategies recommended by the Ministry of Health. This is a cr oss-sectional study carried out from the database of the national survey of population base entitled "Call Neonatal: evaluation of prenatal care and to children younger than one year old in the North and Northeast regions". It used as the sample unit the mothers and children yo unger than 1-year-old, costal residents of Rio Grande do Norte, Natal, Brazil, who attended th e vaccination campaign on June 12, 2010 in nine municipality’s priority for the Pact to Red uce Infant and Neonatal Mortality. To compose the study variables were selected issues/ac tions regarding the neonatal period and socio-demographic factors, followed by a descriptiv e and inferential analysis. A sample of 837 mother/child pairs was obtained, being 57.6% in capital and 42.4% in the whole from the interiors, which was weighted to represent the muni cipalities of the State. It was predominated by mothers aged between 20-29 years, complete high school, not entitled to income transfer program and male children (51.2%). The frequency of the actions of the hospital ranged from 35% to 96% and those performed at the Basic Health Unit (BHU) from 57% to 91.2%. Most actions had an association with hospitals and publi c nature of the state capital (p<0.05). The results for most of the actions are recommended in the care programs and policies for children, and reveal the regional inequities in hea lth and the need for the involvement of services and professionals in search of comprehensi ve care for enabling better care through humanized practices during this increased vulnerabi lity period.

Impacto do Programa Saúde da Família sobre indicadores de saúde da criança em municípios de grande porte da região Nordeste do Brasil

The present study carried out in the context of the Baseline Studies of the PROESF was aimed at evaluating the impact of the Family Health Program (PSF) on indicators for child health in cities with more than 100,000 inhabitants in the Brazilian Northeast. Four cities were investigated. In each one, twenty censual sectors were selected randomly from areas covered by the PSF and compared with twenty sectors selected from areas not covered by the PSF on the basis of socioeconomic criteria. In most cases, no significant differences were found between the areas covered and not covered by the PSF. The only difference found was a significantly lower rate of hospital admissions due to diarrhea but this was on account of the Program of Community Health Agents. The PSF exerted no additional effect on the reduction of this indicator. It was also observed that the way by which the program is implemented in each city interferes directly in the results. Thus, there is no basis for considering the PSF per se ineffective or not differing from other programs with regard to its health care patterns. An evaluation of the PSF would necessarily have to include an analysis of the way the program is implemented and conducted in each case, besides considering its general socioeconomical and political characteristics.