Avalia����o da concentra����o de vitamina A materna e de neonatos prematuros e a termo

Vitamin A is an essential nutrient for many physiological processes such as growth and development, so that their adequate nutritional state is essential during pregnancy and lactation. Lactating women and children in breastfeeding are considered risk groups for vitamin A deficiency and some factors may increase the risk of vitamin A deficiency, such as prematurity. The aim of this work was to evaluate the vitamin A concentration in preterm and term lactating women and newborns by determination of retinol in maternal serum, umbilical cord serum and breast milk collected until 72 hours postpartum. 182 mothers were recruited and divided into preterm group (GPT; n = 118) and term group (GT, n = 64). In preterm group were also analyzed transition milk (7th-15th day; n = 68) and mature milk (30th-55th day; n = 46) samples. Retinol was analyzed by high-performance liquid chromatography (HPLC). Maternal retinol concentration in serum was 48.6 �� 12.3 ��g/dL in GPT and 42.8 �� 16.3 ��g/dL in the GT (p <0.01). Cord serum retinol was 20.4 �� 7.4 ��g/dL in GPT and 23.2 �� 7.6 ��g/dL in GT (p> 0.05). Among newborns, 43% of premature and 36% of term had low levels of serum retinol in umbilical cord (<20 ��g/dL). In colostrum, the retinol in preterm and term groups had an average of 100.8 �� 49.0 ��g/dL and 127.5 �� 65.1 ��g/dL, respectively (p <0.05). The retinol average in preterm milk increased to 112.5 �� 49.7 ��g/dL in transition phase and decreased to 57.2 �� 23.4 ��g/dL in mature milk, differing significantly in all stages (p <0.05). When comparing with the recommendation of vitamin A intake (400 ��g/day) GT colostrum reached the recommendation for infants, but in GPT the recommendation was not achieved at any stage. Mothers of premature infants had higher serum retinol than mothers at term; however, this was not reflected in serum retinol of umbilical cord, since premature had lower concentration of retinol. Such condition can be explained due to lower maternal physiological hemodilution and placental transfer of retinol to the fetus during preterm gestation. Comparison of retinol in colostrum showed lower concentrations in GPT; however the transition phase there was a significant increase of retinol content released by the mammary gland of preterm mothers. This situation highlights a specific physiological adaptation of prematurity, likely to more contribute to formation of hepatic reserves of retinol in premature infants.

Seguran��a do paciente em terapia intensiva neonatal: identifica����o e an��lise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Seguran��a do paciente em terapia intensiva neonatal: identifica����o e an��lise de eventos adversos

The patient safety is a major concern in health services for its global dimension, as evidenced by the fragility of care processes that predispose an occurrence of adverse events. These events in a neonatal intensive care unit are considered serious and hazardous to lives of newborns. The present study aimed to identify and analyze adverse events in a neonatal intensive care unit based in Trigger Tool. It is an epidemiological, cross-sectional , exploratory, retrospective study with quantitative, descriptive and analytical approach, performed in 2015 at a school hospital. The sample was not probabilistic, involving 116 newborns who met the eligibility criteria. Data collection was performed by retrospective review of medical records, using a specific kind of "trigger" instrument, composed of sentinel events in neonatology, adapted from the American model used by the Vermont-Oxford Network. Data were analyzed using descriptive and inferential statistics. The chi-square test for linear trend was used to assess the associations between the variables of interest. The research received a favorable agreement from Ethics Committee of the Federal University of Rio Grande do Norte, under number 1055533, and Presentation Certificate for Ethics Assessment 43894515.6.0000.5537. The results show among investigated newborns, 110 experienced at least one adverse event during their stay, with a total of 391 medical records analyzed and rate of 3.37 events per patient. Prevailed the preterm newborns with low birth weight, from mother who had hypertensive diseases during pregnancy and urinary tract infection. The average hospitalization time was 25 days, associated with hospital-acquired infections events (p = 0.01). Among the identified adverse events stood out the events related to thermoregulation disorders (39.0%), with prevalence of hypothermia (26.0%), followed by health care-related infections (16.4%) and blood glucose disorders, hypoglycemia (9.00%) and hyperglycemia (6.64%). Most of these incidents were classified in categories E and F, which represents that there was damage small proportion. Due to these damages come from the care practice with newborn, 78% were classified as avoidable. There was statistically significant association between the variable birth weight with infections (p = 0.006) as well as peri/intraventricular bleeding (p = 0.02), hypoglycemia (p = 0.021), hyperglycemia (p = 0.001), hyperthermia (p = 0.39) and death (p=0,02). Gestational age was associated with seizures (p = 0.002), hyperglycemia (p=0.017) e hyperthermia (p=0.027). The security institution culture was reported by the health workers as intermediate, even though the number of adverse events found in only one unit of service indicates that there is much to be done. Thus the high rate of adverse events identified in the neonatal intensive care unit reinforces the necessity to elaborate specific preventive strategies for this risk environment.

Impacto na epidemiologia da sepse tardia ap��s a mudan��a do protocolo de antimicrobianos em uma UTIN de um servi��o universit��rio

Advances in neonatology resulted in reducing the mortality rate and the consequent increase in survival of newborn pre terms (PTN). On the other hand, there was also a considerable increase in the risk of developing health care-related infection (HAI) in its most invasive, especially for bloodstream. This situation is worrying, and prevent the occurrence of it is a challenge and becomes one of the priorities in the Neonatal Intensive Care Unit (NICU). Sepsis is the main cause of death in critical neonates and affects more than one million newborns each year, representing 40% of all deaths in neonates. The incidence of late sepsis can reach 50% in NICUs. Currently the major responsible for the occurrence of sepsis in developed countries is the coagulase negative Staphylococcus (CoNS), followed by S. aureus. The cases of HAIs caused by resistant isolates for major classes of antimicrobial agents have been increasingly frequent in the NICU. Therefore, vancomycin has to be prescribed more frequently, and, today, the first option in the treatment of bloodstream infections by resistant Staphylococcus. The objectives of this study were to assess the impact on late sepsis in epidemiology III NICU after the change of the use of antimicrobials protocol; check the frequency of multiresistant microorganisms; assess the number of neonates who came to death. This study was conducted in NICU Level III HC-UFU. three study groups were formed based on the use of the proposed late sepsis treatment protocol, with 216 belonging to the period A, 207 B and 209 to the C. The work was divided into three stages: Period A: data collected from neonates admitted to the unit between September 2010 to August 2011. was using treatment of late sepsis: with oxacillin and gentamicin, oxacillin and amikacin, oxacillin and cefotaxime. Period B: data were collected from March 2012 to February 2013. Data collection was started six months after protocol change. Due to the higher prevalence of CoNS, the initial protocol was changed to vancomycin and cefotaxime. Period C: data were collected from newborns inteerne in the unit from September 2013 to August 2014. Data collection was started six months after the protocol change, which occurred in March 2013. From the 632 neonates included in this study, 511 (80,8%) came from the gynecology and obstetrics department of the HC-UFU. The mean gestational age was 33 weeks and the prevailing sex was male (55,7%). Seventy-nine percent of the studied neonates were hospitalized at the NICU HC-UFU III because of complications related to the respiratory system. Suspicion of sepsis took to hospitalization in the unit of 1,9% of newborns. In general, the infection rate was 34,5%, and the most frequent infectious sepsis syndrome 81,2%. There was a tendency to reduce the number of neonates who died between periods A 11 and C (p = 0,053). From the 176 cases of late sepsis, 73 were clinical sepsis and 103 had laboratory confirmation, with greater representation of Gram positive bacteria, which corresponded to 67.2% of the isolates and CoNS the most frequent micro-organism (91,5%). There was a statistically significant difference in the reduction of isolation of Gram positive microorganisms between periods A and C (p = 0,0365) as well as in reducing multidrug-resistant CoNS (A and B period p = 0,0462 and A and C period, p = 0,158). This study concluded that: the CoNS was the main microorganism responsible for the occurrence of late sepsis in neonates in the NICU of HC-UFU; the main risk factors for the occurrence of late sepsis were: birth weight <1500 g, use of PICC and CUV, need for mechanical ventilation and parenteral nutrition, SNAPPE> 24 and length of stay more than seven days; the new empirical treatment protocol late sepsis, based on the use of vancomycin associated cefepime, it was effective, since promoted a reduction in insulation CoNS blood cultures between the pre and post implementation of the Protocol (A and C, respectively); just as there was a reduction in the number of newborns who evolved to death between periods A and C.

Gesta����o ap��s gastroplastia para tratamento de obesidade m��rbida: s��rie de casos e revis��o da literatura

Objetivo: relatar a evolu����o de uma s��rie de casos de gesta����o em mulheres previamente submetidas �� cirurgia de bypass g��strico para tratamento de obesidade grave. M��todos: cinco casos consecutivos de gravidez ap��s gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas �� cirurgia de Capella. Aspectos cl��nicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o per��odo gestacional e ap��s o parto. Foi realizada revis��o da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gesta����es observadas foram ��nicas e n��o ocorreram complica����es obst��tricas, durante o seguimento pr��-natal e parto. Tamb��m n��o houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclus��o: nossos dados sugerem que a gravidez ap��s gastroplastia �� segura para a m��e e feto. Entretanto, em virtude do limitado volume de informa����o dispon��vel sobre o tema, investiga����es adicionais s��o necess��rias para estabelecer recomenda����es apropriadas com rela����o ao seguimento dessas gesta����es _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Efeito da idade materna sobre os resultados perinatais

Objetivo: analisar a rela����o entre a idade materna e a ocorr��ncia de resultados perinatais adversos na popula����o do Rio Grande do Norte. M��todos: foram analisados os registros oficiais de 57.088 nascidos vivos no Estado do Rio Grande do Norte no ano de 1997. Os dados foram obtidos do Sistema de Informa����o sobre Nascidos Vivos do Minist��rio da Sa��de. A popula����o estudada foi dividida em Grupos I, II e III, segundo a faixa et��ria materna: 10 a 19, 20 a 34 e 35 anos ou mais, respectivamente. As vari��veis analisadas foram: dura����o da gesta����o, peso ao nascer e tipo de parto. A an��lise estat��stica foi realizada utilizando-se o teste c2. Resultados: observamos uma maior incid��ncia de parto pr��-termo no Grupo I (4,3 %), em compara����o ao Grupo II (3,7%) (p = 0,0028). A taxa de cesariana foi menor nos Grupos I e III, em compara����o ao Grupo II (p<0,0001). Evidenciamos freq����ncia significativamente maior de recém-nascidos de baixo peso nos Grupos I (8,4%) e III (8,3%), quando comparados ao Grupo II (6,5%) (p<0,0001). Conclus��es: a gravidez nos extremos da vida reprodutiva esteve associada com maior freq����ncia de parto pr��-termo e baixo peso ao nascer, entretanto, com rela����o ao tipo de parto, foi observada maior freq����ncia de parto normal do que no grupo de gestantes com idade entre 20 e 34 anos

Gesta����o ap��s gastroplastia para tratamento de obesidade m��rbida: s��rie de casos e revis��o da literatura

relatar a evolu����o de uma s��rie de casos de gesta����o em mulheres previamente submetidas �� cirurgia de bypass g��strico para tratamento de obesidade grave. M��todos: cinco casos consecutivos de gravidez ap��s gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas �� cirurgia de Capella. Aspectos cl��nicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o per��odo gestacional e ap��s o parto. Foi realizada revis��o da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gesta����es observadas foram ��nicas e n��o ocorreram complica����es obst��tricas, durante o seguimento pr��-natal e parto. Tamb��m n��o houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclus��o: nossos dados sugerem que a gravidez ap��s gastroplastia �� segura para a m��e e feto. Entretanto, em virtude do limitado volume de informa����o dispon��vel sobre o tema, investiga����es adicionais s��o necess��rias para estabelecer recomenda����es apropriadas com rela����o ao seguimento dessas gesta����es

Gesta����o ap��s gastroplastia para tratamento de obesidade m��rbida: s��rie de casos e revis��o da literatura

Objetivo: relatar a evolu����o de uma s��rie de casos de gesta����o em mulheres previamente submetidas �� cirurgia de bypass g��strico para tratamento de obesidade grave. M��todos: cinco casos consecutivos de gravidez ap��s gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas �� cirurgia de Capella. Aspectos cl��nicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o per��odo gestacional e ap��s o parto. Foi realizada revis��o da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gesta����es observadas foram ��nicas e n��o ocorreram complica����es obst��tricas, durante o seguimento pr��-natal e parto. Tamb��m n��o houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclus��o: nossos dados sugerem que a gravidez ap��s gastroplastia �� segura para a m��e e feto. Entretanto, em virtude do limitado volume de informa����o dispon��vel sobre o tema, investiga����es adicionais s��o necess��rias para estabelecer recomenda����es apropriadas com rela����o ao seguimento dessas gesta����es _________________________________________________ABSTRACT Purpose: we report a small series of pregnant women who underwent gastric bypass surgery for severe obesity, with a review of the literature on this topic. Methods: five consecutive cases of pregnancy after gastroplasty between 2001 and 2004 were evaluated, and clinical, laboratory and therapeutic features were considered. Patients were 30 to 34 years old and all had been submitted to gastroplasty by the Capella technique. The outcomes for both the pregnant woman and the fetus were evaluated. A search of the English language literature was done through MEDLINE and Web of Science databases with the following terms: gastroplasty, gastric bypass surgery, bariatric surgery, and pregnancy. Results: all 5 pregnancies were singleton. No major obstetric complications were observed and there were no premature or lowbirth weight infants. Conclusion: our data suggest that pregnancy following gastroplasty is safe for mother and fetus. However, since information about this topic is limited, further investigations are required to establish appropriate recommendations concerning the follow-up of these pregnancies

Efeito da idade materna sobre os resultados perinatais

Objetivo: analisar a rela����o entre a idade materna e a ocorr��ncia de resultados perinatais adversos na popula����o do Rio Grande do Norte. M��todos: foram analisados os registros oficiais de 57.088 nascidos vivos no Estado do Rio Grande do Norte no ano de 1997. Os dados foram obtidos do Sistema de Informa����o sobre Nascidos Vivos do Minist��rio da Sa��de. A popula����o estudada foi dividida em Grupos I, II e III, segundo a faixa et��ria materna: 10 a 19, 20 a 34 e 35 anos ou mais, respectivamente. As vari��veis analisadas foram: dura����o da gesta����o, peso ao nascer e tipo de parto. A an��lise estat��stica foi realizada utilizando-se o teste c2. Resultados: observamos uma maior incid��ncia de parto pr��-termo no Grupo I (4,3 %), em compara����o ao Grupo II (3,7%) (p = 0,0028). A taxa de cesariana foi menor nos Grupos I e III, em compara����o ao Grupo II (p<0,0001). Evidenciamos freq����ncia significativamente maior de recém-nascidos de baixo peso nos Grupos I (8,4%) e III (8,3%), quando comparados ao Grupo II (6,5%) (p<0,0001). Conclus��es: a gravidez nos extremos da vida reprodutiva esteve associada com maior freq����ncia de parto pr��-termo e baixo peso ao nascer, entretanto, com rela����o ao tipo de parto, foi observada maior freq����ncia de parto normal do que no grupo de gestantes com idade entre 20 e 34 anos

Proposta de processo de enfermagem em unidade de interna����o obst��trica: hist��ricos, diagn��sticos e cuidados de enfermagem �� luz de horta fundamentada em nanda

O presente estudo teve como objetivo geral elaborar uma proposta de processo de enfermagem contemplando hist��ricos de enfermagem, diagn��sticos de enfermagem, prescri����o de cuidados de enfermagem para gestantes e pu��rperas em Unidade de Interna����o Obst��trica �� luz de Horta, fundamentada em NANDA e, como objetivos espec��ficos: identificar os dados cl��nico-obst��tricos mais frequentes das gestantes em Unidade de Interna����o Obst��trica; identificar os dados cl��nico-obst��tricos mais frequentes das pu��rperas em Unidade de Interna����o Obst��trica; identificar os diagn��sticos de enfermagem a partir dos dados cl��nico-obst��tricos mais frequentes das gestantes em Unidade de Interna����o Obst��trica; identificar os diagn��sticos de enfermagem a partir dos dados cl��nico-obst��tricos mais frequentes das pu��rperas em Unidade de Interna����o Obst��trica; elaborar modelos de hist��rico de enfermagem e de prescri����o de cuidados de enfermagem para os diagn��sticos de enfermagem identificados; e obter o consenso dos enfermeiros assistenciais da Unidade de Interna����o Obst��trica sobre a proposta constru��da. Trata-se de pesquisa qualitativa, descritiva e explorat��ria, realizada em uma Unidade de Interna����o Obst��trica de um hospital universit��rio do Sul do Brasil. Realizou-se uma consulta documental em 148 prontu��rios, com vistas �� identifica����o dos diagn��sticos e cuidados de enfermagem, baseados, respectivamente, na taxonomia II da North American Diagnosis Association 2009-2011 e da Nursing Intervention Classification. Desenvolveu-se um modelo de hist��rico de enfermagem para gestante/pu��rpera e outro para o rec��m-nascido. No total, identificaram-se 26 diagn��sticos de enfermagem, assim distribu��dos: nove direcionados ��s gestantes; nove, ��s pu��rperas; dois, ao bin��mio m��e/filho; seis, ao rec��m-nascido. A an��lise foi realizada por meio da apresenta����o da proposta constru��da e discuss��o com base em autores da ��rea. Com isso, almeja-se contribuir para direcionar o cuidado de enfermagem ��s necessidades das gestantes, pu��rperas, bin��mios m��e/filho e recém-nascidos nesse microcen��rio, favorecendo a educa����o em sa��de, a identifica����o precoce e a preven����o de complica����es. Permanecem lacunas quanto ��s necessidades psicoespirituais, visto que elas n��o foram abordadas nos resultados. Assim, essa proposta de Processo de Enfermagem em Unidade Obst��trica contemplando hist��ricos, diagn��sticos e cuidados de enfermagem mant��m em aberto o aperfei��oamento do modelo, visando �� inclus��o de outros diagn��sticos de enfermagem, de forma a aproximar-se de um cuidado mais hol��stico.

Gesta����o ap��s gastroplastia para tratamento de obesidade m��rbida: s��rie de casos e revis��o da literatura

relatar a evolu����o de uma s��rie de casos de gesta����o em mulheres previamente submetidas �� cirurgia de bypass g��strico para tratamento de obesidade grave. M��todos: cinco casos consecutivos de gravidez ap��s gastroplastia ocorridos entre 2001 e 2004 foram avaliados. As pacientes tinham idade entre 30 e 34 anos e todas haviam sido submetidas �� cirurgia de Capella. Aspectos cl��nicos, laboratoriais e do acompanhamento materno e fetal foram considerados, durante o per��odo gestacional e ap��s o parto. Foi realizada revis��o da literatura internacional, por meio das bases de dados MEDLINE e Web of Science, utilizando os seguintes unitermos: gastroplasty, gastric bypass surgery, bariatric surgery e pregnancy. Resultados: todas as gesta����es observadas foram ��nicas e n��o ocorreram complica����es obst��tricas, durante o seguimento pr��-natal e parto. Tamb��m n��o houve registro de recém-nascidos prematuros ou de baixo peso ao nascimento. Conclus��o: nossos dados sugerem que a gravidez ap��s gastroplastia �� segura para a m��e e feto. Entretanto, em virtude do limitado volume de informa����o dispon��vel sobre o tema, investiga����es adicionais s��o necess��rias para estabelecer recomenda����es apropriadas com rela����o ao seguimento dessas gesta����es

KANGAROO CARE: MATERNAL PERCEPTION OF THE EXPERIENCE IN THE NEONATAL INTENSIVE CARE UNIT

Objective: To investigate the maternal perception of the experience in the first phase of the Kangaroo Mother Care Method in the Neonatal Intensive Care Unit (NICU). Methods: Descriptive, exploratory and qualitative study, conducted in the period from August to October 2014, with 10 mothers of newborn preterm (NP) infants, who were admitted to the Maternity School Assis Chateaubriand (MEAC) in Fortaleza, Brazil, and had received skin-to-skin contact through the Kangaroo Care Method during hospitalization in the NICU. Data was collected by semi-structured interview, directed by guiding questions. Content analysis was used for processing the data, being established four categories: ���The bond and the attachment���, ���Maternal competence���, ���The fear of losing the baby��� and ���The importance of the multidisciplinary team���. Results: The Kangaroo Care Method is a safe and pleasurable practice for mothers and relatives, in addition to providing social and psychoaffective benefits, found in the imagery of the method institutionalization and in the mothers��� experience when properly supported. The meanings of the maternal feelings of apprehension as a result of the first physical contact with the hospitalized child can be evidenced. Regarding the evaluation of its clinical practice, this method has provided better development of the newborn infant and a reduction in hospital stay. Conclusion: The study shows relevance, since the evidence of the maternal perception of this method supports its establishment as a mandatory practice in maternity hospitals, in view of the benefits to the mother and the neonate.

Desenvolvimento de metodologias alternativas para quantifica����o de micronutrientes em produtos de nutri����o infantil

As farinhas infantis, alimentos que se destinam a recém-nascidos e crian��as at�� �� idade pr��-escolar, devem satisfazer todas as necessidades nutricionais que se verificam durante o per��odo de crescimento e desenvolvimentos f��sico e mental desta faixa et��ria. Desta forma, s��o frequentemente adicionadas pr��misturas de vitaminas e minerais durante a sua produ����o (fortifica����o), de maneira a que a quantidade adicionada e a composi����o do produto final sejam concordantes com a legisla����o comunit��ria em vigor. A implementa����o, na linha de produ����o, de m��todos alternativos de an��lise ���amigos do ambiente��� e pass��veis de obter resultados r��pidos acerca da composi����o nutricional dos produtos alimentares, mesmo antes destes serem embalados, permite redu����es de tempo, custos e um melhor controlo do processo de produ����o. A espectroscopia FT-NIR e a espectroscopia de XRF s��o t��cnicas que permitem a quantifica����o de micronutrientes e possuem caracter��sticas fundamentais ao controlo r��pido de processos. Neste trabalho foram desenvolvidos modelos de calibra����o para quantifica����o de zinco, por espectroscopia de XRF, em tr��s receitas de pr��-misturas de vitaminas e minerais. Constru��ram-se dois modelos de calibra����o, um com um R2 de 0,990 e um SEC de 26,624 mg/100g e outro com um R2 de 0,927 e um SEC de 18,838 mg/100g. Estes resultados indicam que os modelos de calibra����o constru��dos s��o adequados e podem ser usados na determina����o r��pida do teor de zinco em pr��-misturas de vitaminas e minerais. Foram tamb��m verificadas as rectas de calibra����o existentes para quantifica����o de c��lcio e ferro por espectroscopia de XRF e quantifica����o de vitamina C por espectroscopia FT-NIR para aplica����o nas novas receitas de pr��-misturas de vitaminas e minerais.

Conhecimentos e dificuldades das m��es face �� amamenta����o

Enquadramento: Devido �� elevada preval��ncia de abandono precoce da amamenta����o, diversas institui����es (e.g., OMS, UNICEF) t��m-se preocupado em proteger, promover e apoiar o aleitamento materno um pouco por todo o mundo, defendendo a sua exclusividade durante os primeiros seis meses de vida do beb��, complementado a partir dessa idade pela introdu����o de alimentos e mantido at�� aos 2 anos de idade ou mais, se esse for o desejo da m��e. Objetivos: Avaliar os conhecimentos das m��es sobre a amamenta����o; identificar as dificuldades vivenciadas pelas m��es em rela����o �� amamenta����o; analisar a rela����o entre as vari��veis sociodemogr��ficas e obst��tricas das m��es e os seus conhecimentos e dificuldades sobre a amamenta����o. Metodologia: Estudo quantitativo, descritivo, anal��tico, correlacional e de corte transversal, conduzido numa amostra n��o probabil��stica de 100 m��es de recém-nascidos e/ou lactentes at�� 1 ano de vida, internadas no servi��o de obstetr��cia, neonatologia, pediatria e urg��ncia de uma Unidade Local de Sa��de do Norte do Pa��s. As inquiridas tinham idade m��nima de 16 e m��xima de 43 anos (M=30,77; Dp=6,356). Foi utilizado um question��rio de carateriza����o sociodemogr��fica e um question��rio de autorrelato da viv��ncia das m��es sobre a amamenta����o, desenvolvido por Sousa (2014). Resultados: Os principais resultados mostraram que 50% das m��es consideram possuir bons conhecimentos relativos �� amamenta����o, por��m, apenas 39% foram classificadas com bons conhecimentos, enquanto 52% revelaram dificuldades elevadas. Os conhecimentos foram avaliados tendo por base a sinaliza����o correta da import��ncia da amamenta����o na primeira hora de vida do beb�� por 93% das m��es, exclusiva at�� aos 6 meses (28%), a composi����o do leite materno e composi����o imunol��gica 93%, a maioria das m��es considerou saber identificar os sinais da pega correta. Relativamente ao hor��rio da amamenta����o, 62% ainda considera correto amamentar de tr��s em tr��s horas e 14% defende que o beb�� deve mamar 10 minutos em cada mama. Os conhecimentos relacionaram-se significativamente com as m��es com ensino superior (x2=17,828; p=0,00) e nas que se encontram a amamentar atualmente (UMW=278,000; p=0,01). As dificuldades mais prevalentes associaram-se ��s fissuras (56,4%), ingurgitamento mam��rio (38,5%), mastite (3,8%), dor (40%) e dificuldade na pega (60%), tendo-se constatado diferen��as estatisticamente significativas associadas ao ingurgitamento mam��rio, �� mastite e abcesso mam��rio. Exerce influ��ncia nas dificuldades das m��es, ter sido informada pelo obstetra (UMW=324,000; p=0,02) e n��o ter expectativas na primeira amamenta����o (UMW=521,500; p=0,01). Conclus��o: O estudo revela bons conhecimentos globais mas dificuldades elevadas, sendo estas as comumente referenciadas noutros estudos. Face a isto, mantem-se necess��rio apoiar nas dificuldades vividas durante a amamenta����o, adequando as estrat��gias de promo����o, prote����o e apoio ao AM, para que os resultados possam ser bem-sucedidos. Palavras-chave: aleitamento materno, conhecimentos, dificuldades.

Avalia����o da suplementa����o materna com megadose de vitamina A sobre os n��veis de retinol e alfa-tocoferol no colostro

The vitamins A and E are recognizably important in the initial stages of life and the newborn depends on nutritional adequacy of breast milk to meet their needs. These vitamins share routes of transport to the tissues and antagonistic effects have been observed in animals after supplementation with vitamin A. This study aimed to verify the effect of maternal supplementation with vitamin A megadose (200,000 UI) in the immediate post-partum on the concentration of alpha-tocopherol in colostrum. Healthy parturient women attended at a public maternity natalensis were recruited for the study and divided into two groups: control (n = 37) and supplemented (n = 36). Blood samples of colostrum and milk were collected until 12 hours after delivery. The women of the supplemented group was administered a retynil palmitate capsule and 24 hours after the first collection was obtained the 2nd sample of colostrum in two groups for analysis of retinol and alpha-tocopherol in milk. The mean retinol concentration of 50,7 �� 14,4 ��g/dL (Mean �� standard deviation) and alpha-tocopherol of 1217.4 �� 959 mg/dL in the serum indicate the nutritional status biochemical appropriate. Supplementation with retynil palmitate resulted in increase not only retinol levels in the colostrum of the supplemented group (p = 0.002), but also the concentration of alpha-tocopherol (p = 0.04), changing from 1456.6 �� 1095.8 mg/dL to 1804.3 �� 1432.0 mg/dL (milk 0 and 24 respectively) compared to values in the control group, 984.6 �� 750.0 mg/dL and 1175.0 �� 730.8 mg/dL. The women had different responses to supplementation, influenced by baseline levels of retinol in colostrum. Those with previous by low levels of retinol in colostrum (<60 mg/dL) had increased the concentration of alpha-tocopherol in milk, whereas those with adequate levels (> 60 mg/dL), showed a reduction after supplementation. Supplementation with retinol palmitate is an important intervention in situations of high risk for vitamin A deficiency, when considering the need to maternal supplementation, since the excess vitamin can offer unfavorable interactions between nutrients essential for the mother-child group