RESUMO Objetivo: Verificar a utilização e identificar as vantagens dos métodos moleculares para diagnóstico de infecções congênitas no líquido cefalorraquidiano de neonatos. Fontes de dados: A revisão foi registrada na base PROSPERO (International Prospective Register of Systematic Reviews) sob CRD42021274210. A busca bibliográfica foi realizada nas bases de dados PubMed, Biblioteca Virtual em Saúde/ Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde (BVS/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, e EBSCOhost. A busca foi feita no período de agosto a outubro de 2021 e atualizada em dezembro de 2022, respeitando as orientações do Preferred Reporting Items for Systematic Reviews e Meta-Analyises (PRISMA). A sequência da seleção dos estudos foi: 1) Remoção de duplicatas; 2) Exame de títulos e resumos; 3) Recuperação dos textos completos potencialmente relevantes; e 4) Avaliação do texto completo conforme critérios de elegibilidade por dois autores independentes. O critério de inclusão considerou ensaios clínicos randomizados e não randomizados, estudos longitudinais, transversais, revisados por pares, estudos em humanos, publicados em inglês, espanhol, italiano e português, com recém-nascidos de até 28 dias que sofreram neuroinfecções congênitas pelos agentes toxoplasmose, rubéola, citomegalovírus, herpes simples (TORCH), e outros como Treponema pallidum, Zika, parvovírus B-19, varicela zoster, Epstein-Barr, e SARS-CoV-2, diagnosticadas por reação em cadeia de polimerase (PCR). Dois avaliadores extraíram as seguintes informações: autor, ano de publicação, nacionalidade, sujeitos, tipo de estudo, métodos, resultados e conclusão. Síntese dos dados: O patógeno mais estudado foi Herpes Simples. Muitos artigos relataram somente sintomas iniciais inespecíficos, motivando a coleta de líquido cefalorraquidiano e realização da PCR para investigação etiológica. Conclusões: Os métodos moleculares são eficazes para detectar o genoma do patógeno no líquido cefalorraquidiano, o que pode impactar na evolução clínica e no prognóstico neurológico. Objetivo neonatos International CRD42021274210 CRD PubMed LatinoAmericano Latino Americano BVS/BIREME, BVSBIREME BVS/BIREME , BVS BIREME (BVS/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyises Meta Analyises PRISMA. PRISMA . (PRISMA) 1 duplicatas 2 resumos 3 relevantes 4 independentes longitudinais transversais pares humanos inglês espanhol português recémnascidos recém nascidos toxoplasmose rubéola citomegalovírus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV 2, SARS-CoV-2 PCR. (PCR) informações autor publicação nacionalidade sujeitos estudo conclusão Simples inespecíficos etiológica Conclusões neurológico CRD4202127421 (BVS/BIREME (EMBASE 20 (PRISMA (TORCH B1 B-1 SARS-CoV- (PCR CRD420212742 B- SARS-CoV CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Objective: To verify the use and identify advantages of molecular methods for congenital infections diagnosis in cerebrospinal fluid of neonates. Data source: The review was registered in the International Prospective Register of Systematic Reviews (PROSPERO), under CRD42021274210. The literature search was performed in databases: PubMed, Virtual Health Library/ Latin American and Caribbean Center on Health Sciences Information (VHL/BIREME), Scopus, Web of Science, Excerpta Medica database (EMBASE), Cochrane, ProQuest, and EBSCOhost. The search was carried out from August to October 2021 and updated in December 2022, respecting the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The selection sequence was: 1) Duplicate title removal; 2) Examination of titles and abstracts; 3) Full-text retrieval of potentially relevant reports; and 4) Evaluation of the full text according to eligibility criteria by two independent authors. Inclusion criteria considered randomized and non-randomized control trials, longitudinal, cross-sectional, and peer-reviewed studies in humans, published in English, Spanish, Italian, and Portuguese, with newborns up to 28 days old who had congenital neuroinfections by toxoplasmosis, rubella, cytomegalovirus, herpes simplex (TORCH), and others such as Treponema pallidum, Zika, parvovirus B-19, varicella zoster, Epstein-Barr, and SARS-CoV2, diagnosed by polymerase chain reaction (PCR). Two evaluators extracted the following information: author, year of publication, nationality, subjects, study type, methods, results, and conclusion. Data synthesis: The most studied pathogen was herpes simplex. Several articles reported only nonspecific initial symptoms, motivating the collection of cerebrospinal fluid and performing PCR for etiological investigation. Conclusions: Molecular methods are effective to detect pathogen genomes in cerebrospinal fluid, which can impact clinical evolution and neurological prognosis. Objective neonates source PROSPERO, PROSPERO , (PROSPERO) CRD42021274210 CRD databases PubMed Library VHL/BIREME, VHLBIREME VHL/BIREME VHL BIREME (VHL/BIREME) Scopus Science EMBASE, EMBASE (EMBASE) Cochrane ProQuest EBSCOhost 202 2022 MetaAnalyses Meta Analyses PRISMA (PRISMA guidelines 1 removal 2 abstracts 3 Fulltext Full reports 4 authors nonrandomized non trials longitudinal crosssectional, crosssectional cross sectional, sectional cross-sectional peerreviewed peer reviewed humans English Spanish Italian Portuguese toxoplasmosis rubella cytomegalovirus TORCH, TORCH (TORCH) pallidum Zika B19, B19 B 19, 19 B-19 zoster EpsteinBarr, EpsteinBarr Epstein Barr, Barr Epstein-Barr SARSCoV2, SARSCoV2 SARSCoV SARS CoV2, CoV2 CoV SARS-CoV2 PCR. . (PCR) information author publication nationality subjects type results conclusion synthesis symptoms investigation Conclusions prognosis (PROSPERO CRD4202127421 (VHL/BIREME (EMBASE 20 (TORCH B1 B-1 SARS-CoV (PCR CRD420212742 B- CRD42021274 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

RESUMO Objetivo: Realizar a adaptação transcultural e avaliar a validade de conteúdo do Neonatal Medical Index (NMI) para o contexto brasileiro. Métodos: A adaptação transcultural foi realizada em seis etapas, incluindo tradução, síntese das traduções, retrotradução, submissão a um comitê de especialistas, teste da versão pré-final e avaliação do autor original. O comitê de especialistas avaliou a equivalência entre as versões com base na porcentagem de concordância, e a validade de conteúdo foi avaliada por meio do índice de validade de conteúdo (IVC) para cada item da escala (I-IVC) e para a escala geral (S-IVC) em termos de representatividade e clareza. Os participantes da versão pré-final também avaliaram o IVC quanto à clareza. Resultados: Após duas rodadas de avaliação do comitê de especialistas obteve-se 98% de concordância, atestando a equivalência entre as versões do instrumento, valores máximos para representatividade I-IVC e S-IVC/Ave (1,00) e altos valores para clareza I-IVC (todos os itens ≥0,97) e S-IVC/Ave (0,98). Os membros do comitê de especialistas definiram que a versão brasileira do instrumento se chamaria Índice Clínico Neonatal (NMI-Br). O NMI-Br alcançou altos valores de IVC para clareza (todos I-IVC ≥0,86 e S-IVC/Ave=0,99) entre os participantes da versão pré-final. Conclusões: O NMI-Br é a versão brasileira do NMI, obtido em rigoroso processo de validação transcultural, contando com valores adequados de validade de conteúdo. Objetivo NMI (NMI brasileiro Métodos etapas tradução traduções retrotradução préfinal pré final original concordância (IVC IIVC I (I-IVC SIVC S (S-IVC Resultados obtevese obteve 98 SIVC/Ave SIVCAve IVC/Ave Ave 1,00 100 1 00 (1,00 todos ≥0,97 097 0 97 0,98. 098 0,98 . (0,98) NMIBr. NMIBr Br (NMI-Br) 086 86 ≥0,8 SIVC/Ave=0,99 SIVCAve099 IVC/Ave=0,99 99 S-IVC/Ave=0,99 préfinal. final. Conclusões 9 IVCAve 1,0 10 (1,0 ≥0,9 09 0,9 (0,98 (NMI-Br 08 8 ≥0, SIVC/Ave=0,9 SIVCAve09 IVCAve099 IVC/Ave=0,9 S-IVC/Ave=0,9 1, (1, 0, (0,9 ≥0 SIVC/Ave=0, SIVCAve0 IVCAve09 IVC/Ave=0, S-IVC/Ave=0, (1 (0, ≥ SIVC/Ave=0 IVCAve0 IVC/Ave=0 S-IVC/Ave=0 ( (0 SIVC/Ave= IVC/Ave= S-IVC/Ave=

ABSTRACT Objective: To perform a cross-cultural adaptation and assess the content validity of the Neonatal Medical Index (NMI) for the Brazilian context. Methods: The cross-cultural adaptation was completed in six steps, including translation, synthesis of translations, back translation, submission to an expert committee, testing of the prefinal version, and appraisal by the original author. The expert committee assessed the equivalence between versions based on the percentage of agreement, and content validity was evaluated using the content validity index (CVI) for each item of the scale (I-CVI) and for the overall scale (S-CVI) in terms of representativeness and clarity. Participants of the prefinal version also evaluated the CVI for clarity. Results: After two evaluation rounds of the expert committee it was attained 98% agreement, attesting to the equivalence between the instrument versions, maximum values for representativeness I-CVI and S-CVI/Ave (1.00), and high values for clarity I-CVI (all items ≥0.97) and S-CVI/Ave (0.98). The expert committee members defined that the Brazilian version of the instrument would be called Índice Clínico Neonatal (NMI-Br). The NMI-Br reached high values of CVI for clarity (all I-CVI ≥0.86 and S-CVI/Ave=0.99) among the participants of the prefinal version. Conclusions: The NMI-Br is the Brazilian version of the NMI, obtained in a rigorous cross-cultural validation process, counting with adequate values of content validity. Objective crosscultural cross cultural NMI (NMI context Methods steps translation translations author agreement (CVI ICVI I (I-CVI SCVI S (S-CVI Results 98 SCVI/Ave SCVIAve CVI/Ave Ave 1.00, 100 1.00 , 1 00 (1.00) all ≥0.97 097 0 97 0.98. 098 0.98 . (0.98) NMIBr. NMIBr Br (NMI-Br) 086 86 ≥0.8 SCVI/Ave=0.99 SCVIAve099 CVI/Ave=0.99 99 S-CVI/Ave=0.99 Conclusions process 9 CVIAve 10 1.0 (1.00 ≥0.9 09 0.9 (0.98 (NMI-Br 08 8 ≥0. SCVI/Ave=0.9 SCVIAve09 CVIAve099 CVI/Ave=0.9 S-CVI/Ave=0.9 1. (1.0 0. (0.9 ≥0 SCVI/Ave=0. SCVIAve0 CVIAve09 CVI/Ave=0. S-CVI/Ave=0. (1. (0. ≥ SCVI/Ave=0 CVIAve0 CVI/Ave=0 S-CVI/Ave=0 (1 (0 SCVI/Ave= CVI/Ave= S-CVI/Ave= (

Resumo Objetivos: avaliar a associação entre o tempo para iniciar o primeiro contato pele a pele (CPP) e o tempo diário praticado com a taxa de sepse tardia em recém-nascidos ≤1.800g. Métodos: coorte multicêntrica realizada em unidades neonatais de três regiões geográficas brasileiras. O CPP foi registrado em ficha individual pela equipe e pais do recém-nascido. Dados maternos e neonatais foram obtidos por questionários aplicados às mães e em prontuários médicos. A análise dos dados foi realizada por algoritmo da árvore de classificação, que dividiu o conjunto de dados em subconjuntos mutuamente exclusivos que melhor descreveram a variável resposta. Resultados: 405 recém-nascidos participaram do estudo, com média de 31,3±2,7 semanas de idade gestacional e mediana de peso ao nascer 1.412g (IQ=1.164-1.605g). Realizar o primeiro CPP com até 137h de vida (≤5,7 dias) foi associado a menor taxa de sepse tardia (p=0,02) para recém-nascidos que fizeram CPP diário de 112,5 a 174,7 min/dia (1,9 a 2,9h/dia), com redução na taxa de sepse (39,3% para 27,5%). Além disso, a duração do CPP>174,7min/dia (>2,9h/dia) foi relevante (p<0,001) para os recém-nascidos >1.344g, com redução nesse desfecho (21,1% para 6%). Conclusões: o CPP mostrou-se importante para redução das taxas de sepse tardia em recém-nascidos pré-termo, especialmente quando realizado de forma oportuna (≤5,7 dias) e prolongada (>2,9h/dia). Objetivos (CPP recémnascidos recém nascidos 1800g g 1 800g ≤1.800g Métodos brasileiras recémnascido. recémnascido nascido. nascido recém-nascido médicos classificação resposta Resultados 40 estudo 31327 31 3 2 7 31,3±2, 1412g 412g IQ=1.1641.605g. IQ11641605g IQg IQ=1.164 1.605g . IQ 164 605g (IQ=1.164-1.605g) h ≤5,7 57 5 (≤5, dias p=0,02 p002 p 0 02 (p=0,02 1125 112 112, 1747 174 174, mindia min dia 1,9 19 9 (1, 2,9h/dia, 29hdia hdia 2,9h/dia , 9h 2,9h/dia) 39,3% 393 39 (39,3 27,5%. 275 27,5% 27 27,5%) disso CPP1747mindia CPPmindia 7min >2,9h/dia (>2,9h/dia p<0,001 p0001 001 (p<0,001 1344g 344g >1.344g 21,1% 211 21 (21,1 6%. 6 6% 6%) Conclusões mostrouse mostrou se prétermo, prétermo pré termo, termo pré-termo >2,9h/dia. 4 3132 31,3±2 1641 IQ=1.1641.605g IQ1164 IQ=1.16 1605g 16 (IQ=1.164-1.605g ≤5, (≤5 p=0,0 p00 (p=0,0 11 17 1, (1 39,3 (39, 27,5 p<0,00 p000 00 (p<0,00 21,1 (21, 313 31,3± IQ116 IQ=1.1 ≤5 (≤ p=0, p0 (p=0, ( 39, (39 27, p<0,0 (p<0,0 21, (21 31,3 IQ11 IQ=1. ≤ p=0 (p=0 (3 p<0, (p<0, (2 31, IQ1 IQ=1 p= (p= p<0 (p<0 IQ= (p p< (p<

Abstract Objectives: to evaluate the association between the time to initiate the first skin-to-skin contact (SSC) and the daily practice time with the rates of late-onset sepsis in newborns ≤1,800g. Methods: a multicentric cohort study was carried out at the neonatal units located in three Brazilian geographic regions. The SSC time was recorded in individual files by the hospital staff and the newborn’s parents. Maternal and neonatal data were obtained from medical records and through questionnaires applied to the mothers. Data analysis was carried out using a tree algorithm classification, which divided the data set into mutually exclusive subsets that best described the variable response. Results: 405 newborns participated in the study, with an average of 31.3 ± 2.7 weeks and 1,412g (QR=1,164-1,605g) as a median birth weight. The first SSC was carried out within 137 hours of life (≤5.7 days) was associated with a lower rate of late sepsis (p=0.02) for newborns who underwent daily SSC of 112.5 to 174.7 min/day (1.9 to 2.9h/day), with a reduction in the sepsis rate from 39.3% to 27.5%. Furthermore, the duration of SSC >174.7min/day (>2.9h/day) was relevant (p<0.001) for newborns who weighed >1,344g, with a reduction in this rate from 24.1% to 6%. Conclusions: SSP has been proven to be significant in reducing late-onset sepsis rates in preterm newborns, especially when carried out in a timely manner (≤5.7 days) and prolonged (>2.9h/day). Objectives skintoskin skin (SSC lateonset onset 1800g g 1 800g ≤1,800g Methods regions newborn s parents mothers classification response Results 40 313 31 3 31. 27 2 7 2. 1412g 412g QR=1,1641,605g QR11641605g QRg QR=1,164 1,605g QR 164 605g (QR=1,164-1,605g weight 13 ≤5.7 57 5 (≤5. days p=0.02 p002 p 0 02 (p=0.02 1125 112 112. 1747 174 174. minday min day 1.9 19 9 (1. 2.9h/day, 29hday hday 2.9h/day , 9h h 2.9h/day) 393 39 39.3 275 27.5% Furthermore 1747minday 7min >2.9h/day (>2.9h/day p<0.001 p0001 001 (p<0.001 1344g 344g >1,344g 241 24 24.1 6 6% Conclusions >2.9h/day. . 4 1641 QR1164 QR=1,16 1605g 16 ≤5. (≤5 p=0.0 p00 (p=0.0 11 17 1. (1 39. 27.5 p<0.00 p000 00 (p<0.00 24. QR116 QR=1,1 ≤5 (≤ p=0. p0 (p=0. ( 27. p<0.0 (p<0.0 QR11 QR=1, ≤ p=0 (p=0 p<0. (p<0. QR1 QR=1 p= (p= p<0 (p<0 QR= (p p< (p<

ABSTRACT Objective: To evaluate temporal trends in the use of dexamethasone for the treatment of bronchopulmonary dysplasia in very-low-birth-weight preterm infants. Methods: A cohort study was conducted using an electronic database and medical records of all very low-birth-weight preterm infants admitted to a university tertiary neonatal unit between 2006 to 2022. The main outcome was the use of systemic dexamethasone to treat bronchopulmonary dysplasia, regardless of the dose or duration of treatment. Annual rates were evaluated using the Cochran-Armitage test. Results: A total of 1,691 very-low-birthweight preterm infants were admitted during the study period, with a median birth weight of 1100 g (interquartile range [IQR] 850-1300g) and a median gestational age of 29 weeks (IQR= 27-31g). Infants exposed to dexamethasone were smaller (birth weight: 765 versus 1134g, p<0.001) and more immature (gestational age: 28 versus 31 weeks, p<0.001). The overall rate of dexamethasone use was 9.6% (annual variation 6.7% to 13.9%) and remained stable over the study period (p=0.287), including in infants aged <32 weeks (12.0%; p=0.203) and <28 weeks (24.6%; p=0.851). Mechanical ventilation and mortality rates remained stable at 58.8% (p=0.435) and 14.5% (p=0.078), respectively. However, the birth rate at <28 weeks of gestation increased (28.8%, annual variation of 16.0% to 43.8%, p<0.001). Conclusion: Approximately one in 10 preterm very low-birth-weight infants and one in four of those <28 weeks received dexamethasone, with a trend towards stable use over time, despite a significant trend towards an increase in extreme preterm newborn infants. Objective verylowbirthweight low Methods lowbirthweight 200 2022 CochranArmitage Cochran Armitage test Results 1691 1 691 1,69 birthweight 110 interquartile IQR [IQR 8501300g 850 1300g 850-1300g 2 IQR= (IQR 2731g. 2731g 27 31g . 27-31g) 76 1134g p<0.001 p0001 p 0 001 3 p<0.001. 96 9 6 9.6 67 7 6.7 13.9% 139 13 p=0.287, p0287 p=0.287 , 287 (p=0.287) 32 <3 12.0% 120 12 (12.0% p=0.203 p0203 203 <2 24.6% 246 24 (24.6% p=0.851. p0851 p=0.851 851 p=0.851) 588 58 8 58.8 p=0.435 p0435 435 (p=0.435 145 14 5 14.5 p=0.078, p0078 p=0.078 078 (p=0.078) respectively However 28.8%, 288 (28.8% 160 16 16.0 438 43 43.8% Conclusion time 20 202 169 69 1,6 11 85 27-31g p<0.00 p000 00 9. 6. 13.9 p028 p=0.28 (p=0.287 < 12.0 (12.0 p=0.20 p020 24.6 (24.6 p085 p=0.85 58. p=0.43 p043 (p=0.43 14. p007 p=0.07 07 (p=0.078 28.8% (28.8 16. 4 43.8 1, p<0.0 p00 13. p02 p=0.2 (p=0.28 12. (12. 24. (24. p08 p=0.8 p=0.4 p04 (p=0.4 p=0.0 (p=0.07 28.8 (28. 43. p<0. p0 p=0. (p=0.2 (12 (24 (p=0. (p=0.0 28. (28 p<0 p=0 (1 (2 (p=0 p< p= ( (p= (p

Resumo O objetivo deste artigo é avaliar os fatores associados ao tempo de contato pele a pele < 180 min/dia em recém-nascidos com peso até 1.800 g durante a internação neonatal. Estudo observacional tipo coorte prospectivo conduzido em unidades neonatais de referência no Brasil. Foram analisados dados de 405 díades (mãe/filho), no período de maio de 2018 a março de 2020. As características da mãe e do recém-nascido foram coletadas em prontuários e entrevistas, a realização do contato pele-a-pele era registrada em fichas anexadas ao leito, preenchidas pela equipe e pelos pais. A variável desfecho foi o tempo médio diário de contato pele-a-pele inferior a 180 minutos. Foi realizada modelagem hierarquizada utilizando a regressão de Poisson com variância robusta para cálculo das razões de prevalência. As variáveis que permaneceram independentemente associadas foram: “não ter fácil acesso ao hospital” (morar longe ou ter dificuldade de transporte), “não possuir conhecimento prévio sobre o método canguru” e “ter apresentado morbidades durante a gestação”. Mães sem fácil acesso ao hospital e que desconhecem o método canguru devem ser alvos prioritários das políticas de saúde para desenvolver estratégias que promovam maior exposição ao contato pele a pele durante o período de internação de seus filhos. 18 mindia min dia recémnascidos recém nascidos 1800 1 800 1.80 neonatal Brasil 40 mãe/filho, mãefilho mãe/filho , filho (mãe/filho) 201 2020 recémnascido nascido entrevistas peleapele leito pais minutos prevalência não morar transporte, transporte transporte) gestação. gestação . gestação” filhos 80 1.8 4 (mãe/filho 20 202 8 1. 2

Abstract 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. skintoskin skin <18 minday min day 1800 1 800 1,80 Brazil 40 mother/child motherchild mother child (mother/child 201 2020 interviews Skintoskin Skin bedside staff 18 variance hospital, , hospital” having pregnancy. pregnancy . pregnancy” children <1 80 1,8 4 20 202 8 1, 2

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes. Objective INTERGROWTH21st INTERGROWTHst INTERGROWTH 21st st IG . (IG21) Methods (BNRN VLBW (VLBW tertiarycare tertiary care hospitals Outcome (CNMM inhospital hospital death 4 enterocolitis smallforgestationalage small gestational age SGA (SGA rd SGA3 (SGA3 th SGA10 (SGA10 BW largeforgestationalage large LGA (LGA BMI logbinomial log binomial Results 4072 072 4,07 included BNRN/IG21 BNRNIG21 BNRNIG (BNRN/IG21) 145 1 45 1.4 0.92–2.31/1.60 092231160 0.92–2.31 /1.60 0 92 31 60 (0.92–2.31)/1.6 1.27–2.02 127202 27 02 (1.27–2.02 090 90 0.9 0.55–1.47/1.05 055147105 0.55–1.47 /1.05 55 47 05 (0.55–1.47)/1.0 0.55–1.99 055199 99 (0.55–1.99 165 65 1.6 1.08–2.51/1.58 108251158 1.08–2.51 /1.58 08 51 58 (1.08–2.51)/1.5 1.28–1.96 128196 28 96 (1.28–1.96 stunting 148 48 1.02–2.17 102217 17 (1.02–2.17 variable >95% 95 (>95% 7090%, 7090 70 90% , (70-90%) Conclusion IG2 outcomes (IG21 SGA1 (SGA1 407 07 4,0 BNRN/IG2 BNRNIG2 (BNRN/IG21 14 1. 0.92–2.31/1.6 09223116 092231 0.92–2.3 160 /1.6 9 6 (0.92–2.31)/1. 1.27–2.0 12720 (1.27–2.0 09 0. 0.55–1.47/1.0 05514710 055147 0.55–1.4 105 /1.0 5 (0.55–1.47)/1. 0.55–1.9 05519 (0.55–1.9 16 1.08–2.51/1.5 10825115 108251 1.08–2.5 158 /1.5 (1.08–2.51)/1. 1.28–1.9 12819 (1.28–1.9 1.02–2.1 10221 (1.02–2.1 >95 (>95 7090% 709 7 (70-90% (IG2 40 BNRN/IG (BNRN/IG2 0.92–2.31/1. 0922311 09223 0.92–2. /1. (0.92–2.31)/1 1.27–2. 1272 (1.27–2. 0.55–1.47/1. 0551471 05514 0.55–1. 10 (0.55–1.47)/1 0551 (0.55–1. 1.08–2.51/1. 1082511 10825 1.08–2. 15 (1.08–2.51)/1 1.28–1. 1281 (1.28–1. 1.02–2. 1022 (1.02–2. >9 (>9 (70-90 (IG (BNRN/IG 0.92–2.31/1 0922 0.92–2 /1 (0.92–2.31)/ 1.27–2 127 (1.27–2 0.55–1.47/1 0.55–1 (0.55–1.47)/ 055 (0.55–1 1.08–2.51/1 1082 1.08–2 (1.08–2.51)/ 1.28–1 128 (1.28–1 1.02–2 102 (1.02–2 (> (70-9 0.92–2.31/ 092 0.92– / (0.92–2.31) 1.27– 12 (1.27– 0.55–1.47/ 0.55– (0.55–1.47) (0.55– 1.08–2.51/ 108 1.08– (1.08–2.51) 1.28– (1.28– 1.02– (1.02– ( (70- 0.92 (0.92–2.31 1.27 (1.27 0.55 (0.55–1.47 (0.55 1.08 (1.08–2.51 1.28 (1.28 1.02 (1.02 (70 (0.92–2.3 1.2 (1.2 0.5 (0.55–1.4 (0.5 1.0 (1.08–2.5 (1.0 (7 (0.92–2. (1. (0. (1.08–2. (0.92–2 (1 (0 (1.08–2 (0.92– (1.08– (0.92 (1.08 (0.9

Resumen Objetivo Describir el inicio, duración, lugar y quién realiza el contacto piel con piel en unidades neonatales brasileñas. Métodos Estudio multicéntrico descriptivo, longitudinal, realizado de mayo de 2018 a marzo de 2020, en cinco unidades neonatales de referencia del Método Canguro en Brasil, que incluyó recién nacidos de hasta 1800 g de peso. Las características maternas y de los recién nacidos fueron recopiladas en historias clínicas y entrevistas. La práctica del contacto piel con piel fue registrada en tarjetas anexadas a la cama, completadas por el equipo y por los padres. El análisis se realizó mediante estadística descriptiva. Resultados Se incluyeron 405 recién nacidos, 51,4 % de sexo masculino, mediana de 31,4 semanas de edad gestacional y de 1412 g de peso al nacer. Con relación al tiempo de realización del contacto piel con piel, la mediana de la frecuencia del contacto diario fue 1,5 veces (IIQ: 1,2 - 2,4), el tiempo/día fue de 147 min/día (IIQ: 106,7 - 263,0) y la realización del primer contacto a los cinco días de vida (IIQ:4,0-8,0). El mayor tiempo de contacto/día fue realizado por las madres, con una mediana de 137,8 min/día (IIQ:95,6-232,1) y la segunda etapa del Método Canguro, la Unidad de Cuidados Intermedios Canguro, fue el lugar donde se realizó el contacto por mayor tiempo, con una mediana de 184,4 min/día (IIQ:124,7-455,4). Conclusión En las unidades analizadas, el contacto piel con piel se practica de forma intermitente, pocas veces por día, predominantemente por las madres y con mayor tiempo de exposición en la segunda etapa. Es necesario buscar medios que permitan más encuentros entre madre/padre-hijo y que ofrezcan condiciones de mayor permanencia de los progenitores en el hospital. inicio duración brasileñas descriptivo longitudinal 201 2020 Brasil 180 entrevistas cama padres descriptiva 40 514 51 4 51, masculino 314 31 31, 141 nacer 15 1 5 1, IIQ (IIQ 12 2 2,4, 24 2,4 , 2,4) tiempodía día 14 mindía min 1067 106 7 106, 263,0 2630 263 0 IIQ4,08,0. IIQ4080 4,0 8,0 . 8 (IIQ:4,0-8,0) contactodía 1378 137 137, IIQ95,6232,1 IIQ9562321 95,6 232,1 95 6 232 (IIQ:95,6-232,1 1844 184 184, IIQ124,7455,4. IIQ12474554 124,7 455,4 124 455 (IIQ:124,7-455,4) analizadas intermitente madre/padrehijo madrepadrehijo madre/padre hijo madre padre hospital 20 202 18 3 2, 10 263, 26 IIQ4 08 IIQ4,08,0 IIQ408 4, 80 8, (IIQ:4,0-8,0 13 IIQ95 6232 IIQ95,6232, IIQ956232 956 95, 2321 232, 9 23 (IIQ:95,6-232, IIQ124 7455 IIQ124,7455,4 IIQ1247455 1247 124, 4554 455, 45 (IIQ:124,7-455,4 padrehijo madrepadre IIQ4,08, IIQ40 (IIQ:4,0-8, IIQ9 623 IIQ95,6232 IIQ95623 (IIQ:95,6-232 IIQ12 745 IIQ124,7455, IIQ124745 (IIQ:124,7-455, IIQ4,08 (IIQ:4,0-8 62 IIQ95,623 IIQ9562 (IIQ:95,6-23 IIQ1 74 IIQ124,7455 IIQ12474 (IIQ:124,7-455 IIQ4,0 (IIQ:4,0- IIQ95,62 IIQ956 (IIQ:95,6-2 IIQ124,745 IIQ1247 (IIQ:124,7-45 IIQ4, (IIQ:4,0 IIQ95,6 (IIQ:95,6- IIQ124,74 (IIQ:124,7-4 (IIQ:4, IIQ95, (IIQ:95,6 IIQ124,7 (IIQ:124,7- (IIQ:4 (IIQ:95, IIQ124, (IIQ:124,7 (IIQ:95 (IIQ:124, (IIQ:9 (IIQ:124 (IIQ:12 (IIQ:1

Resumo Objetivo Descrever o início, duração, local e quem realiza o contato pele a pele em unidades neonatais brasileiras. Métodos Estudo multicêntrico descritivo, longitudinal, realizado de maio de 2018 a março de 2020, em cinco unidades neonatais referência para o Método Canguru no Brasil, que incluiu recém-nascidos com peso até 1800g. As características maternas e dos recém-nascidos foram coletadas em prontuários e entrevistas. A prática do contato pele a pele era registrada em cartões anexados ao leito, preenchidos pela equipe e pelos pais. A análise ocorreu por meio de estatística descritiva. Resultados Foram incluídos 405 recém-nascidos, 51,4% do sexo masculino, mediana de idade gestacional de 31,4 semanas e de peso ao nascimento de 1.412g. Em relação ao tempo de realização do contato pele a pele, a mediana da frequência do contato diário foi de 1,5 vezes (IIQ: 1,2 - 2,4), o tempo/dia de 147 min/dia (IIQ: 106,7 - 263,0) e a realização do primeiro contato aos cinco dias de vida (IIQ:4,0-8,0). O maior tempo de contato/dia foi realizado pelas mães, com mediana de 137,8 min/dia (IIQ:95,6-232,1) e a segunda etapa do Método Canguru, Unidade de Cuidados Intermediários Canguru, foi o local onde se realizou por maior tempo o contato, com mediana de 184,4 min/dia (IIQ:124,7-455,4). Conclusão Nas unidades avaliadas, o contato pele a pele é praticado de forma intermitente, poucas vezes por dia, predominantemente pelas mães e com maior tempo de exposição na segunda etapa. É necessário buscar meios que possibilitem mais encontros entre mãe/pai-filho e que dê condições de maior permanência dos genitores no hospital. início duração brasileiras descritivo longitudinal 201 2020 Brasil recémnascidos recém nascidos 1800g g entrevistas leito pais descritiva 40 recémnascidos, nascidos, 514 51 4 51,4 masculino 314 31 31, 1412g 1 412g 1.412g 15 5 1, IIQ (IIQ 12 2 2,4, 24 2,4 , 2,4) tempodia dia 14 mindia min 1067 106 7 106, 263,0 2630 263 0 IIQ4,08,0. IIQ4080 4,0 8,0 . 8 (IIQ:4,0-8,0) contatodia 1378 137 137, IIQ95,6232,1 IIQ9562321 95,6 232,1 95 6 232 (IIQ:95,6-232,1 1844 184 184, IIQ124,7455,4. IIQ12474554 124,7 455,4 124 455 (IIQ:124,7-455,4) avaliadas intermitente mãe/paifilho mãepaifilho mãe/pai filho mãe pai hospital 20 202 51, 3 2, 10 263, 26 IIQ4 08 IIQ4,08,0 IIQ408 4, 80 8, (IIQ:4,0-8,0 13 IIQ95 6232 IIQ95,6232, IIQ956232 956 95, 2321 232, 9 23 (IIQ:95,6-232, 18 IIQ124 7455 IIQ124,7455,4 IIQ1247455 1247 124, 4554 455, 45 (IIQ:124,7-455,4 paifilho mãepai IIQ4,08, IIQ40 (IIQ:4,0-8, IIQ9 623 IIQ95,6232 IIQ95623 (IIQ:95,6-232 IIQ12 745 IIQ124,7455, IIQ124745 (IIQ:124,7-455, IIQ4,08 (IIQ:4,0-8 62 IIQ95,623 IIQ9562 (IIQ:95,6-23 IIQ1 74 IIQ124,7455 IIQ12474 (IIQ:124,7-455 IIQ4,0 (IIQ:4,0- IIQ95,62 IIQ956 (IIQ:95,6-2 IIQ124,745 IIQ1247 (IIQ:124,7-45 IIQ4, (IIQ:4,0 IIQ95,6 (IIQ:95,6- IIQ124,74 (IIQ:124,7-4 (IIQ:4, IIQ95, (IIQ:95,6 IIQ124,7 (IIQ:124,7- (IIQ:4 (IIQ:95, IIQ124, (IIQ:124,7 (IIQ:95 (IIQ:124, (IIQ:9 (IIQ:124 (IIQ:12 (IIQ:1

Abstract Objective To describe the beginning, duration, location and who makes skin-to-skin contact in Brazilian neonatal units. Methods This is a descriptive, longitudinal multicenter study, carried out from May 2018 to March 2020, in five reference neonatal units for Kangaroo Mother Care in Brazil, which included newborns weighing up to 1,800 grams. Maternal and newborn characteristics were collected from medical records and interviews. Skin-to-skin contact was recorded on cards attached to the bed, filled in by the team and fathers. Analysis occurred through descriptive statistics. Results We included 405 newborns, 51.4% male, median gestational age of 31.4 weeks and birth weight of 1,412 grams. Regarding skin-to-skin contact time, the median daily contact frequency was 1.5 times (IQR: 1.2 - 2.4), the time/day was 147 min/day (IQR: 106.7 - 263.0) and the first contact at five days of life (IQR:4.0-8.0). The longest contact time/day was performed by mothers, with a median of 137.8 minutes per day (IQR:95.6-232.1), and the second stage of kangaroo Mother Care, kangaroo Intermediate Care Unit, was the place where contact was performed for the longest time, with a median of 184.4 minutes per day (IQR:124.7-455.4). Conclusion In the units assessed, skin-to-skin contact is practiced intermittently, a few times a day, predominantly by mothers and with longer exposure time in the second stage. It is necessary to seek ways that allow more encounters between mother/father-child and that gives conditions of greater permanence of fathers in the hospital. beginning duration skintoskin skin study 201 2020 Brazil 1800 1 800 1,80 grams interviews Skintoskin Skin bed statistics 40 514 51 4 51.4 male 314 31 31. 1412 412 1,41 15 5 1. IQR (IQR 12 2 2.4, 24 2.4 , 2.4) timeday 14 minday min 1067 106 7 106. 263.0 2630 263 0 IQR4.08.0. IQR4080 4.0 8.0 . 8 (IQR:4.0-8.0) 1378 137 137. IQR95.6232.1, IQR9562321 95.6 232.1 95 6 232 (IQR:95.6-232.1) Unit 1844 184 184. IQR124.7455.4. IQR12474554 124.7 455.4 124 455 (IQR:124.7-455.4) assessed intermittently mother/fatherchild motherfatherchild mother/father child mother father hospital 20 202 180 80 1,8 51. 3 141 41 1,4 2. 10 263. 26 IQR4 08 IQR4.08.0 IQR408 4. 8. (IQR:4.0-8.0 13 IQR95 6232 IQR95.6232.1 IQR956232 956 95. 2321 232. 9 23 (IQR:95.6-232.1 18 IQR124 7455 IQR124.7455.4 IQR1247455 1247 124. 4554 455. 45 (IQR:124.7-455.4 fatherchild motherfather 1, IQR4.08. IQR40 (IQR:4.0-8. IQR9 623 IQR95.6232. IQR95623 (IQR:95.6-232. IQR12 745 IQR124.7455. IQR124745 (IQR:124.7-455. IQR4.08 (IQR:4.0-8 62 IQR95.6232 IQR9562 (IQR:95.6-232 IQR1 74 IQR124.7455 IQR12474 (IQR:124.7-455 IQR4.0 (IQR:4.0- IQR95.623 IQR956 (IQR:95.6-23 IQR124.745 IQR1247 (IQR:124.7-45 IQR4. (IQR:4.0 IQR95.62 (IQR:95.6-2 IQR124.74 (IQR:124.7-4 (IQR:4. IQR95.6 (IQR:95.6- IQR124.7 (IQR:124.7- (IQR:4 IQR95. (IQR:95.6 IQR124. (IQR:124.7 (IQR:95. (IQR:124. (IQR:95 (IQR:124 (IQR:9 (IQR:12 (IQR:1

Abstract Objectives: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Method: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals’ knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. Results: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. Conclusion: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed. Objectives pre/postintervention prepostintervention pre/post pre post Pediatrics Method 6 Piauí 43 region structuring 1 201 2019 evaluated Results 10 courses 70 284 28 4 28. 806 80 80.6 833 83 3 83.3 posttraining 955 95 5 95.5 rate significantly 726 72 72.6 recorded 47 resuscitated Conclusion rooms observed postintervention prepost 20 7 2 8 80. 83. 9 95. 72.

Abstract 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.

Resumo O objetivo deste artigo é avaliar os fatores associados ao tempo de contato pele a pele < 180 min/dia em recém-nascidos com peso até 1.800 g durante a internação neonatal. Estudo observacional tipo coorte prospectivo conduzido em unidades neonatais de referência no Brasil. Foram analisados dados de 405 díades (mãe/filho), no período de maio de 2018 a março de 2020. As características da mãe e do recém-nascido foram coletadas em prontuários e entrevistas, a realização do contato pele-a-pele era registrada em fichas anexadas ao leito, preenchidas pela equipe e pelos pais. A variável desfecho foi o tempo médio diário de contato pele-a-pele inferior a 180 minutos. Foi realizada modelagem hierarquizada utilizando a regressão de Poisson com variância robusta para cálculo das razões de prevalência. As variáveis que permaneceram independentemente associadas foram: “não ter fácil acesso ao hospital” (morar longe ou ter dificuldade de transporte), “não possuir conhecimento prévio sobre o método canguru” e “ter apresentado morbidades durante a gestação”. Mães sem fácil acesso ao hospital e que desconhecem o método canguru devem ser alvos prioritários das políticas de saúde para desenvolver estratégias que promovam maior exposição ao contato pele a pele durante o período de internação de seus filhos.

RESUMO Objetivo: Analisar a prevalência, as complicações e as condições de alta dos recém-nascidos ≥35 semanas com diagnóstico de sepse neonatal precoce. Métodos: Estudo transversal, com coleta retrospectiva de dados. Incluíram-se todos recém-nascidos com 35 semanas ou mais de idade gestacional, com diagnóstico de sepse precoce em um período de quatro anos (janeiro/2016 a dezembro/2019) em uma unidade neonatal nível III. Os diagnósticos realizaram-se segundo os critérios da Agência Nacional de Vigilância Sanitária e os episódios classificados segundo a confirmação microbiológica e o sítio de infecção. As complicações avaliadas foram: choque, distúrbio de coagulação e sequelas do sistema nervoso central. Também se avaliaram as condições de alta. Os dados coletados foram analisados utilizando estatística descritiva. Resultados: No período, 46 recém-nascidos apresentaram sepse precoce, correspondendo a 1,8% das internações e a uma prevalência de 4/1.000 nascidos vivos. Em três pacientes a sepse foi confirmada por culturas (0,3/1.000 nascidos vivos), respectivamente por S. pneumoniae, S. epidermidis e S. agalactiae. Quanto ao sítio de infecção, foram 35 casos de infecção primária da corrente sanguínea, 7 casos de pneumonia e 4 de meningite. A maior parte dos pacientes (78,3%) possuía pelo menos um fator de risco para sepse, e todos apresentaram-se sintomáticos. Não houve óbito. Complicações ocorreram em 28,2% dos casos, especialmente choque (10 casos – 21,7%). Conclusões: A prevalência de sepse neonatal precoce comprovada foi baixa. Apesar da ocorrência comum de complicações, não houve óbitos.

ABSTRACT Objective: To analyze the incidence, complications, and hospital discharge status in newborns with ≥35 weeks of gestational age with early neonatal sepsis. Methods: This is a cross-sectional, retrospective study. Cases of early-onset sepsis registered from January 2016 to December 2019 in neonates with gestational age of 35 weeks or more were reviewed in a level III neonatal unit. The diagnoses were performed based on the criteria by the Brazilian Health Regulatory Agency (Anvisa), and the episodes were classified according to microbiological classification and site of infection. The following complications were evaluated: shock, coagulation disorders, and sequelae of the central nervous system. The conditions at hospital discharge were also assessed. The collected data were analyzed with the descriptive analysis. Results: In the period, early neonatal sepsis occurred in 46 newborns, corresponding to 1.8% of all newborns admitted to the neonatal unit, with a prevalence of 4/1,000 live births. Culture confirmed sepsis ocurred in three patients (0.3/1,000 live births), with the following agents: S. pneumoniae, S. epidermidis and S. agalactiae. As to site of infection, there were 35 cases of primary bloodstream infection, seven cases of pneumonia and four cases of meningitis. Most patients (78.3%) had at least one risk factor for sepsis, and all were symptomatic at admission. There were no deaths. Complications occurred in 28.2% of the cases, especially shock (10 cases – 21.7%). Conclusions: The prevalence of proven early neonatal sepsis was low. Despite the common occurrence of complications, there were no deaths.

ABSTRACT 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.

ABSTRACT 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.

Abstract Objective This study aimed to evaluate annual trends of early neonatal sepsis and antimicrobial use in very low birth weight infants for 12 years, as well as to identify microbiological agents, antimicrobial sensitivity profiles, and association with early neonatal death. Method This was a retrospective cohort study including 1254 very low birth weight infants admitted from 2006 to 2017. Four groups were evaluated: culture-confirmed sepsis; presumed neonatal sepsis; ruled out neonatal sepsis group; and infants not exposed to antibiotics. Results The medians of gestational age and birth weight were 29 weeks (27-31) and 1090 g (850-1310), respectively. The rates of culture-confirmed sepsis, presumed neonatal sepsis, ruled out neonatal sepsis, and not exposed to antibiotics were 1.3, 9.0, 15.4, and 74.3%, respectively. From the initial group of newborns whose antimicrobial treatment was administered for sepsis’ suspicion, it was possible to discontinue antibiotic in 44%. The culture-confirmed sepsis rates remained stable (p = 0.906). Significant tendencies of decreasing presumed sepsis rates (p < 0.001) and increased ruled out neonatal sepsis/not exposed to antibiotics rates (p < 0.001) were observed. Streptococcus agalactiae and enteric Gram-negative rods were the predominant agents and most of them were sensitive to crystalline penicillin/ampicillin (88.2%) and to ampicillin and/or amikacin. Early death occurred in 10.8%, specifically in the culture-confirmed sepsis and presumed neonatal sepsis groups. Conclusion The confirmed sepsis rate was low and remained stable. There was a significant downward trend in the presumed neonatal sepsis rate and a significant upward trend in the ruled out neonatal sepsis group. The rate of not exposed to antibiotics infants was high, also presenting a significant downward trend. The identified bacteria were those commonly found and showed usual antimicrobial susceptibility patterns. Death predominantly occurred in groups that received antibiotic treatment.

The low contamination by SARS-CoV-2 in pregnant women, puerperal women and even newborns (NB), does not prevent the presence of concern in families and health teams in Neonatal Units (NU). We must be aware of the different requests that arise in the face of Covid-19 threats, in the hospital environment. We understand that, together with the fear of contamination, the restrictions imposed by isolation and social distancing, with the consequent withdrawal of family and social support networks, an important support for the parents of NBs during hospitalization, creates space for the emergence of insecurity and even restlessness in many families. Not being able to count on this support in the formation of parenting, the parents only have their son, still a baby, and the health team to help them in this process. In light of this, the proposals of Humanized Care for the Newborn - Kangaroo Method, in Brazil, evaluated the indication of adaptations in their guidelines, guaranteeing the protection of all psychic/emotional/biological phenomena that this child and his family go through in this evolutionary moment. Thus, comprehensive and individualized care for this population starts to count even more with the support of the internal networks present in the NU, facilitated by the professionals of the psychology team. Support for the narratives of different family histories that discover new paths for the formation of their affective bonds, in this very special moment, receives a more careful look in the period of this pandemic. Proposals for psycho-affective management towards the newborn and his family are presented, ensuring skin-to-skin contact, differentiated support to parents, especially the maternal figure, and interaction with the health team at the present moment in the routines of neonatal units, establishing protection for future moments in this family history.

A baixa contaminação pelo SARS-CoV-2 em gestantes, puérperas e mesmo nos recém-nascidos (RN), não impede a presença de preocupação nas famílias e nas equipes de saúde da Unidades Neonatais (UN). É preciso estarmos atentos às diferentes solicitações que surgem diante das ameaças da Covid-19, neste espaço hospitalar. Entendemos que, aliadas ao temor de contaminação, as restrições impostas pelo isolamento e distanciamento social, com a consequente retirada das redes de apoio familiares e sociais, uma importante sustentação aos pais dos RN durante a internação, cria espaço para o surgimento de insegurança e até desassossego em muitas famílias. Não podendo contar com este suporte na formação da parentalidade, os pais possuem apenas o filho, ainda bebê, e a equipe de saúde para ajudá-los neste processo. Diante disto, as propostas da Atenção Humanizada ao Recém-Nascido - Método Canguru, no Brasil, avaliou a indicação de adaptações em suas orientações, garantindo a proteção de todos fenômenos psíquicos/emocionais/biológicos que percorrem esta criança e sua família neste momento evolutivo. Assim, o cuidado integral e individualizado a esta população passa a contar ainda mais com o apoio das redes internas presentes nas UN, facilitadas pelos profissionais da equipe de psicologia. O apoio às narrativas das diferentes histórias familiares que descobrem novos percursos para a formação de seus laços afetivos, neste momento tão especial, recebe um olhar mais cuidadoso no período desta pandemia. São apresentadas propostas de manejos psico-afetivos para com o recém-nascido e sua família, garantindo o contato pele a pele, o acolhimento diferenciado aos pais, especialmente da figura materna, e a interação com a equipe de saúde no momento presente das rotinas das unidades neonatais estabelecendo proteção para momentos futuros desta história familiar.

RESUMO Objetivo: Analisar o valor preditivo da General Movements Assessment para o diagnóstico de alterações do neurodesenvolvimento em recém-nascidos pré-termo. Fonte de dados: Foi realizada uma revisão sistemática da literatura utilizando as bases de dados: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed) e Excerpta Medica Database (EMBASE). Os artigos foram filtrados por idioma, ano de publicação, população de interesse, utilização do Método Prechtl de avaliação e presença das variáveis relacionadas ao valor preditivo da escala. O Quality Assessment of Diagnostic Accuracy Studies 2 foi utilizado para avaliar a metodologia dos artigos. Foi realizado o cálculo de sensibilidade, especificidade, Diagnostic Odds Ratio, razão de verossimilhanças positiva e negativa e parâmetro de acurácia. Síntese dos dados: Foram incluídos seis artigos dentre os 342 encontrados. A escala, quando realizada no período Writhing Movements, possui bom poder discriminativo para o desfecho paralisia cerebral, com valores elevados de sensibilidade e acurácia. Quando realizada no período Fidgety Movements, possui maior valor preditivo para paralisia cerebral, com valores elevados em todas as medidas de acurácia diagnóstica. O risco de viés foi considerado elevado na seleção de pacientes e no fluxo e momento da avaliação. Desse modo, a escala tem potencial para detectar indivíduos que evoluíram com alterações do neurodesenvolvimento, porém, os artigos apresentaram limitações quanto à seleção dos sujeitos e à forma de avaliação do desfecho neurológico. Conclusões: Apesar dos altos valores preditivos descritos para identificação de alterações neurológicas, novas pesquisas são necessárias, devido à heterogeneidade dos estudos e ao método de avaliação a longo prazo do neurodesenvolvimento.

ABSTRACT Objective: To discuss the predictive value of the General Movements Assessment for the diagnosis of neurodevelopment disorders in preterm newborns. Data source: We conducted a systematic literature review using the following databases: Scientific Electronic Library Online (SciELO), National Library of Medicine, National Institutes of Health (PubMed), and Excerpta Medica Database (EMBASE). The articles were filtered by language, year of publication, population of interest, use of Prechtl’s Method on the Qualitative Assessment of General Movements, and presence of variables related to the predictive value. The Quality Assessment of Diagnostic Accuracy Studies 2 was used to assess the methodology of the included studies. Sensitivity, specificity, Diagnostic Odds Ratio, positive and negative likelihood ratio, and parameter of accuracy were calculated. Data synthesis: Six of 342 articles were included. The evaluation of Writhing Movements is a good indicator for recognizing cerebral palsy, as it has high values for the sensitivity and accuracy parameters. The evaluation of Fidgety Movements has the strongest predictive validity for cerebral palsy, as it has high values in all measures of diagnostic accuracy. The quality assessment shows high risk of bias for patient selection and flow and timing of the evaluation. Therefore, the scale has potential to detect individuals with neurodevelopment disorders. However, the studies presented limitations regarding the selection of subjects and the assessment of neurological outcomes. Conclusions: Despite the high predictive values of the tool to identify neurological disorders, research on the subject is required due to the heterogeneity of the current studies.