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This study aimed to analyze the association between sociodemographic factors, maternal and neonatal characteristics and the time taken to introduce complementary feeding in low birthweight and preterm newborns. This is a prospective cohort study of 79 preterm newborns weighing less than or equal to 1,800g. Data were collected at the time of hospital discharge and at the 6th, 9th ,and 12th months of corrected gestational age (CGA), using a structured questionnaire to analyze the time taken to introduce complementary feeding and the texture of the foods introduced. Furthermore, the Survey of Well-being of Young Children (SWYC-BR) was used to assess the risk of developmental delay. Cox proportional hazards regression was used to analyze the variables. The introduction of complementary feeding was assessed in preterm newborns based on the median age of introduction of liquid foods (3.50; IQR: 2.50-5.00), followed by solid (4.70; IQR: 3.20-5.20) and soft foods (5.00; IQR: 4.50-5.50). There was also an association with gestational age (RR = 1.25; 95%CI: 1.02-1.52) throughout the process of food introduction. For solid and soft foods, those with the longest length of stay (RR = 1.03; 95%CI: 1.10-1.05) and on mixed breastfeeding (RR = 2.97; 95%CI: 1.24-7.09) delayed the introduction of complementary feeding the longest. For liquid foods, less severe preterm newborns (Score for Neonatal Acute Physiology and Perinatal Extension - SNAPPE II [RR = 0.96; 95%CI: 0.94-0.98]) and mothers who were breastfeeding at hospital discharge (RR = 11.49; 95%CI: 1.57-84.10) delayed the introduction of complementary feeding. Guidelines are needed to better advise professionals and parents and/or guardians on the ideal time to introduce feeding.

Background: The effects of SARS-CoV-2 gestational exposure on child development remain inconclusive., Aims: To analyze the effects of SARS-CoV-2 gestational exposure on neurodevelopment until 12 months., Study Design: Prospective cohort study conducted in five municipalities in Southeast Brazil from August 2021 to September 2022., Subjects: Infants were recruited from a serological survey performed during neonatal screening and followed up to 12 months old. We included 224 infants exposed to SARS-CoV-2 during pregnancy and 225 non-exposed, according to the serology results of the newborn as well as their mothers and the maternal antenatal RT-PCR results., Outcome Measures: Developmental assessments were performed at 6 and 12 months using the Survey of Wellbeing of Young Children-Brazilian Version (SWYC-BR). Children with suspected developmental delay (SDD) at 6 and 12 months were considered at high risk for developmental delay (HRDD). Additionally, risk factors associated with SDD were examined., Results: There were 111 children identified with SDD and 52 with HRDD. SARS-CoV-2 gestational exposure was not associated with SDD. Exposure in the first gestational trimester increased SDD risk by 2.15 times compared to the third. Cesarean delivery predicted SDD (OR 1.56; 95%CI 1.01-2.42) and HRDD (OR 1.91; 95%CI 1.04-3.48). Additionally, suspected maternal depression predicted SDD (OR 1.76; 95%CI 1.01-3.10)., Conclusion: SARS-CoV-2 gestational exposure did not increase the developmental delay risk. However, our findings suggest that the earlier the gestational exposure, the greater the developmental delay risk at 12 months. Cesarean delivery and suspected maternal depression increased the developmental delay risk, independent of virus exposure., Competing Interests: Declaration of competing interest Nothing to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: To describe the role of physiotherapists in assisting patients suspected to have or diagnosed with COVID-19 hospitalized in intensive care units in Brazil regarding technical training, working time, care practice, labor conditions and remuneration., Methods: An analytical cross-sectional survey was carried out through an electronic questionnaire distributed to physiotherapists who worked in the care of patients with COVID-19 in Brazilian intensive care units., Results: A total of 657 questionnaires were completed by physiotherapists from the five regions of the country, with 85.3% working in adult, 5.4% in neonatal, 5.3% in pediatric and 3.8% in mixed intensive care units (pediatric and neonatal). In intensive care units with a physiotherapists available 24 hours/day, physiotherapists worked more frequently (90.6%) in the assembly, titration, and monitoring of noninvasive ventilation (p = 0.001). Most intensive care units with 12-hour/day physiotherapists (25.8%) did not apply any protocol compared to intensive care units with 18-hour/day physiotherapy (9.9%) versus 24 hours/day (10.2%) (p = 0.032). Most of the respondents (51.0%) received remuneration 2 or 3 times the minimum wage, and only 25.1% received an additional payment for working with patients suspected to have or diagnosed with COVID-19; 85.7% of them did not experience a lack of personal protective equipment., Conclusion: Intensive care units with 24-hour/day physiotherapists had higher percentages of protocols and noninvasive ventilation for patients with COVID-19. The use of specific resources varied between the types of intensive care units and hospitals and in relation to the physiotherapists' labor conditions. This study showed that most professionals had little experience in intensive care and low wages.

Objective: The objective of this study is to compare feeding practices of low birthweight (LBW) infants, according to type of care received during and after hospital discharge: Kangaroo Care (KC) and Conventional Care (CC)., Methods: Prospective cohort study was conducted at a university hospital (Brazil) between 2019 and 2021. The sample consisted of 65 LBW infants (weight ≤ 1800 g)-46 in KC and 19 in CC. KC includes breastfeeding (BF) guidance and support to parents at hospital and after discharge. Data collection was performed at hospital discharge, and at the 4th and 6th month of corrected gestational age (CGA). Consumption of 27 foods was analyzed in the last 2 periods of the follow-up and expressed in relative frequency. Three indicators were analyzed: exclusive breastfeeding (EBF), mixed BF, and introduction of liquid and solid foods., Results: Groups had similar health characteristics, except for the weight at hospital discharge and the Score for Neonatal Acute Physiology - Perinatal (SNAPPE II) score that were lower in KC group. We found higher frequency of EBF among KC at hospital discharge (CC = 5.3% vs KC = 47.8%; P = 0.001). The higher frequency of mixed BF was observed in KC at 4 months of CGA (CC = 5.6% vs KC = 35.0%; P = 0.023), and at 6 months of CGA (CC = 0.0% vs KC = 24.4%; P = 0.048). Consumption of solid foods (4th month of CGA = 25.9%, 6th month of CGA = 91.2%) and liquids (4th month of CGA = 77.6%, 6th month of CGA = 89.5%) were similar between groups., Conclusions: In KC, SNAPPE II scores were lower and frequency of EBF was higher at hospital discharge and frequency of mixed BF was higher over 6 months. Early supply of infant formula, liquid and solid foods were similar in both groups., Competing Interests: The authors report no conflicts of interest., (Copyright © 2023 by European Society for European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.)

This article aims to evaluate the factors associated with a skin-to-skin contact time <180 min/day in newborns weighing up to 1,800 g during neonatal hospitalization. Prospective observational cohort study conducted in neonatal units of reference for the Kangaroo Method in Brazil. Data from 405 dyads (mother/child) were analyzed from May 2018 to March 2020. Maternal and neonatal explanatory variables were collected from medical records and interviews. Skin-to-skin contact was recorded in forms posted at the bedside, filled out by parents and staff. The outcome variable was the mean time of skin-to-skin contact < 180 min/day. Hierarchical modeling was performed by Poisson regression with robust variance. The variables associated with the outcome were "without easy access to the hospital", "without previous knowledge of the kangaroo method" and "having had morbidities during pregnancy". Mothers without easy access to the hospital and who are unaware of the kangaroo method should be priority targets for health policies to develop strategies that promote greater exposure to skin-to-skin contact during the hospitalization period of their children.

Objective: To describe the trend of participation in group and individual support by human milk banks (HMBs) provided between 2010 and 2019 in Brazil., Methods: Ecological study with data from participation in group and individual support provided by the HMBs between 2010 and 2019, available in the production report of the Brazilian Network of Human Milk Banks. The number of participation in group and individual support was expressed for Brazil and for Brazilian macroregions in absolute numbers. Trend analysis was performed from the analysis of index numbers, considering the year 2010 as a reference. It was calculated the ratio of the number of participation in group and individual support by HMBs for each macroregion and year., Results: There was an increase of 42% in participation in group support (300,595 in 2010 vs 425,570 in 2019) and an increase of 69% in individual support (1,157,038 in 2010 vs 1,962,162 in 2019). The North and Northeast macroregions had the highest growth rates in the provision of these services (122 and 131%, respectively), above the national growth rate in the study period. In contrast, the Midwest region showed a downward trend throughout this period, for both types of support. However, in the Midwest, there was a higher ratio of participation in groups by HMBs between 2010 and 2016 and for individual support by HMBs between 2010 and 2012., Conclusion: Individual and group support provided by the HMB as a strategy to support breastfeeding increased considerably in Brazil during the study period, especially in the North and Northeast regions., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

This serological survey, conducted in five Brazilian municipalities, evaluated the use of dried blood spots (DBS), obtained from newborns and their mothers, to detect SARS-CoV-2 IgG antibodies. DBS were obtained from 4,803 neonates aged up to seven days and their mothers, both asymptomatic, at public health care clinics during newborn screening. DBS were processed by ELISA to detect IgG antibodies against SARS-CoV-2 nucleocapsid antigen. Mothers of seropositive neonates were interviewed about sociodemographic characteristics and clinical and laboratory antecedents. Non-satisfactory samples, dyads with incomplete data, and vaccinated mothers were excluded. Of the 1,917 DBS dyads samples analyzed, 14.7% of neonates showed IgG antibodies against SARS-CoV-2. Among seropositive neonates, 73.2% of their mothers were also seropositive. More than half of the mothers with seropositive neonates denied clinical or laboratory suspicion of COVID-19 during pregnancy. Suspicion occurred in the third trimester for 24.6% of the mothers. This study tested an innovative strategy to improve the understanding of COVID-19 antibody dynamics during pregnancy and suggests the feasibility of a universal serological survey in puerperal women and neonates.

Objective: To analyze the association between phenotypic and genotypic characteristics and disease severity in individuals with cystic fibrosis treated at a reference center in Minas Gerais, Brazil., Methods: This is a retrospective study that collected clinical and laboratory data, respiratory and gastrointestinal manifestations, type of treatment, Shwachman-Kulczycki score, and mutations from the patients' medical records., Results: The sample included 50 participants aged one to 33 years, 50% of whom were female. Out of the one hundred alleles of the Cystic Fibrosis Transmembrane Conductance Regulator gene, the most prevalent mutations were DeltaF508 (45%) and S4X (18%). Mutation groups were only associated with pancreatic insufficiency (p=0.013) and not with disease severity (p=0.073). The latter presented an association with colonization by Pseudomonas aeruginosa and Staphylococcus aureus (p=0.007) and with underweight (p=0.036). Death was associated with age at diagnosis (p=0.016), respiratory symptomatology (p=0.013), colonization (p=0.024), underweight (p=0.017), and hospitalization (p=0.003)., Conclusions: We could identify the association of mutations with pancreatic insufficiency; the association of Staphylococcus aureus colonization and underweight with disease severity; and the lack of association between mutations and disease severity. Environmental factors should be investigated more thoroughly since they seem to have an important effect on disease severity.

Objective: Assess the mediating role of breastfeeding self-efficacy in the association between the Kangaroo Neonatal Intermediate Care Unit and exclusive breastfeeding., Method: Cross-sectional study nested in a cohort, carried out in the Neonatal Unit of a Brazilian university hospital between September 2018 and March 2020. The sample consisted of 114 newborns weighing ≤1800 g and their mothers who were divided into those who participated in the first and second stages of the Kangaroo Method and those who only passed through the first stage, categorized as the Conventional group. To assess the self-efficacy of breastfeeding, the Breastfeeding Self Efficacy Scale - Short-Form was used. The Mann-Whitney test was used to compare the breastfeeding self-efficacy score between the groups, and Fisher's exact test to compare rates of exclusive breastfeeding. The adjusted structural equation model was used to check for the mediating effect of breastfeeding self-efficacy. The significance level adopted was 5%., Results: The kangaroo group had a higher rate of exclusive breastfeeding at hospital discharge (p = 0.000). There was a positive association between having remained in the kangaroo (p = 0.003) and the breastfeeding self-efficacy score (p = 0.025) with the rate of exclusive breastfeeding at hospital discharge. Breastfeeding self-efficacy did not act as a mediator., Conclusion: The self-efficacy of breastfeeding and the stay of the low birth weight newborn baby in the kangaroo unit acted positively and independently in exclusive breastfeeding, and the self-efficacy of breastfeeding did not act as a mediator in this association., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Background: Nonpharmacological labor pain management methods (NPLPMM) are noninvasive, low-cost practices that may play a role in reducing the rates of unnecessary cesarean birth. We aimed to evaluate whether the NPLPMM is associated with the mode of birth., Methods: We conducted a retrospective cohort study with clinical records of all women admitted for birth from January 2013 to December 2017. Records of women who had spontaneous labor or received induction or augmentation of labor during hospitalization were eligible for the study. We estimated the risk ratios for cesarean birth in general linear models using the Poisson regression with adjustments for the following variables: age, ethnicity, schooling, parity, gestational age, previous cesarean birth, spontaneous labor before admission, or induction/augmentation of labor., Results: Within the total of 3,391 medical records, 40.1% had the use of a nonpharmacological labor pain management method registered. Cesarean rate among the study population was 44.2%. The use of NPLPMM decreased the risk of cesarean birth by 78% (OR = 0.22; 95% CI 0.19-0.26). History of a previous cesarean birth (RR = 2.63; 95% CI 2.35-2.64), the lack of use of NPLPMM (RR = 2.46; 95% CI 2.22-2.72), and primiparity (RR = 2.09; 95% CI 1.86-2.34) were the strongest risk factors for cesarean birth in the cohort., Discussion: The use of NPLPMM may be an effective strategy to reduce unnecessary cesarean birth. Further studies to identify the efficacy of each method may help health professionals to offer more appropriate methods at different stages of labor., (© 2022 Wiley Periodicals LLC.)

Objetive: To understand the role of exposure to skin-to-skin contact and its minimum duration in determining exclusive breastfeeding at hospital discharge in infants weighing up to 1,800g at birth., Methods: A multicenter cohort study was carried out in five Brazilian neonatal units. Infants weighing ≤ 1,800g at birth were eligible. Skin-to-skin contact time was recorded by the health care team and parents on an individual chart. Maternal and infant data was obtained from maternal questionnaires and medical records. The Classification Tree, a machine learning method, was used for data analysis; the tree growth algorithm, using statistical tests, partitions the dataset into mutually exclusive subsets that best describe the response variable and calculates appropriate cut-off points for continuous variables, thus generating an efficient explanatory model for the outcome under study., Results: A total of 388 infants participated in the study, with a median of 31.6 (IQR = 29-31.8) weeks of gestation age and birth weight of 1,429g (IQR = 1,202-1,610). The exclusive breastfeeding rate at discharge was 61.6%. For infant's weighting between 1,125g and 1,655g, exposed to skin-to-skin contact was strongly associated with exclusive breastfeeding. Moreover, infants who made an average > 149.6 min/day of skin-to-skin contact had higher chances in this outcome (74% versus 46%). In this group, those who received a severity score (SNAPPE-II) equal to zero increased their chances of breastfeeding (83% versus 63%)., Conclusion: Skin-to-skin contact proved to be of great relevance in maintaining exclusive breastfeeding at hospital discharge for preterm infants weighing 1,125g-1,655g at birth, especially in those with lower severity scores.

Objective: To evaluate the association between dose of skin-to-skin contact (SSC) per day and initiation time with the occurrence of deaths in newborns with weight up to 1800g., Method: Multicentric cohort in five Brazilian neonatal units, including newborns with a birth weight of ≤1800g. The time of SSC was registered in individual file, by the team or family during the hospitalization. Maternal and newborn data were obtained through questionnaires applied to mothers and in medical records. Classification Tree was used for data analysis., Results: The performance of the first SSC after 206h was significantly associated with death (p = 0.02). Although there was no association between SSC/day and death (p = 0.09), the number of deaths among those who performed more than 146.9 minutes/day was lower (3;1.5%) than among those who performed this practice for a shorter time (13;6.4%), a fact considered of great clinical importance. Early and late infections present statistically significant associations with the outcome. The chance of death was equal to zero when there was no early infection in the group with the longest duration of SSC. This probability was also equal to zero in the absence of late sepsis for the group with less than 146.9 minutes/day of SSC., Conclusions: The first SSC before 206 hours of life is recommended in order to observe a reduction in the risk of neonatal death. Staying in SSC for more than 146.9 min/day seems to be clinically beneficial for these neonates mostly when it was associated with the absence of infection., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2021 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

Objective: To compare mother-infant interaction between hospital discharge and at six months of corrected age of infants born ≤32 weeks and investigate the association between the onset of skin-to-skin contact and the difference in mother-infant interaction between discharge and six months of corrected age (CA) among preterm infants., Material and Methods: Prospective observational study, in which 72 mother-infant dyads were evaluated. Preterm newborns (born with gestational age ≤ 32 weeks of gestational age) from two public maternity hospitals were assessed by means of video macro analysis of the mother-infant interaction according to the parameters adopted by the Mother-Baby Observation Protocol 0-6 (POIMB), at hospital discharge and at six months of corrected gestational age. Such variables as socioeconomic conditions, depression and maternal anxiety were controlled. Multivariate model was built., Results: Onset skin-to-skin contact within three days of life increased by 1.30 points for the best interactive infant behavior at discharge for the six months of CA. In addition, in relation to the tuning of the mother-infant dyad, the initiation of skin-to-skin contact at 20 days of life reduced 1.0 point significantly. Multiparous mothers or those exposed to cigarette smoke performed worse in the development of the dyad., Conclusion: The preterm newborn should initiate skin-to-skin contact early and, whenever possible, by the third day of life to favor mother-infant interaction., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objective: To assess the prevalence of hypothermia in the delivery room, at admission, and 2 to 3 hours after admission in the neonatal intensive care unit (NICU), factors associated and possible relationship with morbidity and mortality in preterm infants with very low birth weight (VLBW)., Methods: Cross-sectional study with data collection based on a retrospective review of medical records and including infants born in 2016 and 2017, with birth weights <1500g, and gestational ages <34 weeks. Data about VLBW preterm infants, maternal data and temperature in the delivery room were analyzed. Hypothermia was considered when axillary temperature <36°C. For statistical analysis, the chi-square test or G test, canonical and Spearman correlation, and logistic regression were used., Results: 149 newborns (NB) were included in the study. The prevalence of hypothermia in delivery room, at admission to the NICU and 2 to 3 hours after admission was 25.8%, 41.5% and 40.2%, respectively. The temperature of NBs was directly proportional to gestational age (p<0.010), birth weight (p<0.010), and Apgar score (p<0.050). There was an inverse association with hypothermia in the delivery room and cesarean delivery (OR 0.25; p=0.016)., Conclusions: Hypothermia was a prevalent problem in the studied population. The neonatal temperature was directly proportional to gestational age, birth weight and Apgar score. Hypothermia was associated with maternal factors, such as cesarean delivery. It is necessary to implement and improve strategies for its prevention.

Preterm birth is a risk factor for problems in interactions with others. We compared the difference in socioemotional development between hospital discharge and at six months of corrected age of infants born ≤32 weeks and assessed the impact of maternal and infantile factors on socioemotional development rate within a 6 month's period. Mother-child dyads (n = 144) were assessed by the Mother-Baby Observation Protocol 0-6 months through a video microanalysis. Multivariate model was built. Neonatal, maternal and child factors were associated with interactive gaze, initiate contact, responsiveness, infantile vocalization, and thus contributed to the socioemocional development of preterm infants with their mothers., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objectives: To evaluate the impact of invasive mechanical ventilation associated with two serum inflammatory cytokines and clinical indicators, on the second day of life, as predictors of bronchopulmonary dysplasia in very low birth weight preterm infants. It was hypothesized that the use of invasive mechanical ventilation in the first hours of life is associated with biomarkers that may predict the chances of preterm infants to develop bronchopulmonary dysplasia., Methods: Prospective cohort of 40 preterm infants with gestational age <34 weeks and birth weight <1500 g. The following were analyzed: clinical variables; types of ventilator support used (there is a higher occurrence of bronchopulmonary dysplasia when oxygen supplementation is performed by long periods of invasive mechanical ventilation); hospitalization time; quantification of two cytokines (granulocyte and macrophage colony stimulating factor [GM-CSF] and eotaxin) in blood between 36 and 48 h of life. The preterm infants were divided in two groups: with and without bronchopulmonary dysplasia., Results: The GM-CSF levels presented a significantly higher value in the bronchopulmonary dysplasia group (p = 0.002), while eotaxin presented higher levels in the group without bronchopulmonary dysplasia (p = 0.02). The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin (100% sensitivity and 80% specificity; receiver operating characteristic area = 0.9013, CI = 0.7791-1.024, p < 0.0001)., Conclusions: The duration of invasive mechanical ventilation performed in the first 48 h of life in the very low birth weight infants is a significant clinical predictor of bronchopulmonary dysplasia. The use of continuous invasive mechanical ventilation was associated with increased ratios between GM-CSF and eotaxin, suggesting increased lung injury and consequent progression of the disease., (Copyright © 2020 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.)

The scope of this integrative review of the literature was to assess if the Kangaroo-Mother Care Method as implemented in Brazil, from the first stage to outpatient follow-up, has an influence on breastfeeding. Brazilian research published in national and international journals in Portuguese, English or Spanish in the leading research databases between the years 2000 to 2017 was included, with full articles available and theme related to the scope of this study. A total of 1328 articles were located and articles not conducted in Brazil, literature review articles and themes not related to the Kangaroo-Mother Care Method were excluded, with 21 studies eventually being selected. The research results indicated a positive influence of the Kangaroo-Mother Care Method on breastfeeding and establishing a mother-child bond. However, the third stage or outpatient follow-up proved not to be effective in maintaining breastfeeding. Greater participation of primary care in home care provided to preterm newborns is necessary, with a view to promoting exclusive breastfeeding up to six months of age and extended up to two years of age.

Objective: To identify the neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil that use cuffed tracheal tubes in clinical practice and to describe the characteristics related to the use of protocols and monitoring., Methods: To identify the intensive care units in Brazil, the Ministry of Health's National Registry of Health Facilities was accessed, and information was collected on 693 registered intensive care units. This was an analytical cross-sectional survey conducted through electronic questionnaires sent to 298 neonatal, pediatric and mixed intensive care units in Brazil., Results: This study analyzed 146 questionnaires (49.3% from neonatal intensive care units, 35.6% from pediatric intensive care units and 15.1% from mixed pediatric intensive care units). Most of the participating units (78/146) used cuffed tracheal tubes, with a predominance of use in pediatric intensive care units (52/78). Most of the units that used cuffed tracheal tubes applied a cuff pressure monitoring protocol (45/78). The use of cuff monitoring protocols was observed in intensive care units with a physical therapy service exclusive to the unit (38/61) and in those with a physical therapist present 24 hours/day (25/45). The most frequent cause of extubation failure related to the use of cuffed tracheal tubes in pediatric intensive care units was upper airway obstruction., Conclusion: In this survey, the use of cuffed tracheal tubes and the application of a cuff pressure monitoring protocol was predominant in pediatric intensive care units. The use of a monitoring protocol was more common in intensive care units that had a physical therapist who was exclusive to the unit and was present 24 hours/day.

Objective: The aim of this study was to describe practices for weaning from mechanical ventilation (MV), in terms of the use of protocols, methods, and criteria, in pediatric ICUs (PICUs), neonatal ICUs (NICUs), and mixed neonatal/pediatric ICUs (NPICUs) in Brazil., Methods: This was a cross-sectional survey carried out by sending an electronic questionnaire to a total of 298 NICUs, PICUs, and NPICUs throughout Brazil., Results: Completed questionnaires were assessed for 146 hospitals, NICUs accounting for 49.3% of the questionnaires received, whereas PICUs and NPICUs accounted for 35.6% and 15.1%, respectively. Weaning protocols were applied in 57.5% of the units. In the NICUs and NPICUs that used weaning protocols, the method of MV weaning most commonly employed (in 60.5% and 50.0%, respectively) was standardized gradual withdrawal from ventilatory support, whereas that employed in most (53.0%) of the PICUs was spontaneous breathing trial (SBT). During the SBTs, the most common ventilation mode, in all ICUs, was pressure-support ventilation (10.03 ± 3.15 cmH2O) with positive end-expiratory pressure. The mean SBT duration was 35.76 ± 29.03 min in the NICUs, compared with 76.42 ± 41.09 min in the PICUs. The SBT parameters, weaning ventilation modes, and time frame considered for extubation failure were not found to be dependent on the age profile of the ICU population. The findings of the clinical evaluation and arterial blood gas analysis are frequently used as criteria to assess readiness for extubation, regardless of the age group served by the ICU., Conclusions: In Brazil, the clinical practices for weaning from MV and extubation appear to vary depending on the age group served by the ICU. It seems that weaning protocols and SBTs are used mainly in PICUs, whereas gradual withdrawal from ventilatory support is more widely used in NICUs and NPICUs.

Background: Weaning a patient from mechanical ventilation is a complex procedure that involves clinical and contextual aspects. Mechanical ventilation also depends on the characteristics of health professionals who work in intensive care., Objective: This study described the organizational aspects associated with the physical therapist's performance in the weaning procedure from mechanical ventilation and extubation in neonatal, pediatric and mixed (neonatal and pediatric) intensive care units in Brazil., Methods: In order to identify the existing intensive care units in Brazil, data from the National Health Facilities Census was used to enable the researchers to obtain information about registered units. A cross-sectional survey was carried out by sending an electronic questionnaire to 298 neonatal, pediatric and mixed intensive care units in Brazil., Results: This study assessed questionnaires from 146 intensive care units (49.3% neonatal, 35.6% pediatric and 15.1% mixed). A total of 57.5% of these units applied mechanical ventilation weaning protocols, and a physical therapist frequently conducted this procedure (66.7%). However, the clinician responsible for conducting the weaning and deciding when to do extubation varied regardless of ICU patient age profile. Regardless of the type of hospital or the type of units, most of these had a dedicated physical therapist. However, physical therapy care 24h/7 days per week was predominantly in pediatric intensive care units (56.0%), and in public hospitals (45.9%). Moreover, when the physical therapist was available 24h/7 days per week, (s)he was responsible for the mechanical ventilation extubation decision and patients were successfully extubated on the first attempt., Conclusion: In this survey, intensive care units using physical therapy assistance 24h/7 days per week were associated with the use of a mechanical ventilation weaning protocol, an extubation decision and success commonly on the first attempt of extubation., (Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Background: The hammock positioning within the incubators simulates the intrauterine environment, however, there is little evidence of its benefits and possible risks., Objectives: The aim of this study was to assess the effects of hammock positioning on behavioral status, vital signs, and pain in very low birth weight preterm newborns., Methods: This is a quasi-experimental/case series study in which premature infants (<1500g) were positioned in supine for one hour in a hammock. The preterm newborns were assessed 10min before, during (2, 20, 40, and 60min), and 10min after hammock positioning with the Brazelton Neonatal Behavioral Assessment Scale, vital signs and pain by the Neonatal Facial Coding System., Results: 28 preterm infants between 28 and 36 weeks of gestational age were evaluated. Regarding the behavioral state, the preterm newborns progressively evolved to light or deep sleep during hammock positioning. There was a statistically significant reduction of the heart and respiratory rate from 2 to 60th minute in a hammock, which was maintained after the positioning. The oxygen saturation remained within normal values. No changes in pain scores were observed., Conclusion: The hammock positioning can be considered a safe method of positioning that can be used to reduce the stress levels in very low birth weight preterm newborns. We did not observe worsening in either pain or vital signs., (Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.)

Objective: To compare the neuropsychomotor development in the first year of life of premature infants with and without bronchopulmonary dysplasia., Methods: A cross-sectional retrospective study was conducted between January 1, 2014, and December 30, 2015, with premature infants weighing < 1,500g at birth and diagnosed with bronchopulmonary dysplasia at the corrected ages of 6 and 9 months, assessed using the DENVER II Developmental Screening Test. Quantitative variables were described as the means, medians and standard deviations. Variables with normal distribution were tested using Student's t test; otherwise, the Mann-Whitney test was used, considering significance at p-value < 0.05. Qualitative variables were expressed as frequencies and percentages. Logistic regression was used with odds ratio analysis to evaluate the effects of other variables as risk factors for changes in neuropsychomotor development., Results: Infants with bronchopulmonary dysplasia showed greater developmental delay compared with those without bronchopulmonary dysplasia (p-value = 0.001). The factors associated with a higher incidence of changes in neuropsychomotor development, in addition to bronchopulmonary dysplasia, were antenatal steroid, gender, birth weight, 5-minute Apgar score, Score for Neonatal Acute Physiology-Perinatal Extension, duration of oxygen therapy, duration of mechanical ventilation and length of hospital stay. Other variables may also have influenced the result, such as drug use by mothers of infants with bronchopulmonary dysplasia., Conclusion: Bronchopulmonary dysplasia associated with other pre- and postnatal factors may be considered a risk factor for delayed neuropsychomotor development in the first year of life in premature infants born weighing less than 1,500g.

Objective: To analyze the influence of the Kangaroo Position duration in the initial interactions between mothers and preterm infants., Methods: This is an exploratory prospective observational study that analyzed the mother-infant interaction during breastfeeding, before hospital discharge. All eligible newborns, with a gestational age of 28-32 weeks and a birth weight of 1,000-1,800 g from June 11 to September 31, 2014 were included. The films of the interaction were evaluated by the "Mother-Baby Interaction Protocol 0-6 months" tool. The duration of the Kangaroo Position during all the hospitalization period was correlated with the interaction between mother and preterm infant., Results: The longer the dyad spent time in the Kangaroo Position, the more the newborns made physical contact attempts with their mothers during breastfeeding (r=0.37; p=0.03); and the longer the time in the Kangaroo Position, the less the mothers talked to their children (r=-0.47; p=0.006)., Conclusions: Longer periods in the Kangaroo Position stimulates the initial exchanges of contact between preterm infant with his mother, which suggests a higher alert status of the newborn and a better availability for interactions with the mother during breastfeeding.