Introduction: During the stay of a newborn in the intensive unit, the clinical care management can involve the placement of invasive medical devices that need to be controlled by x-ray. The main goal of this work is to make a narrative review about the quality of imaging acquisition for radiographic confirmation of invasive medical devices in the neonatal intensive care units, according to the literature and the author’s experience. Material and Methods: We carried out a narrative review of the literature. We search the documents in the scientific data bases: PubMed; Science Direct; Google Scholar and Portal RCAAP. Books from the authors' private collections were also consulted. Results: We included 39 scientific documents: 26 articles; four guidelines/recommendations/consensus and nine books/book’s chapters. Discussion: Interventional procedures such as the placement of intravascular catheters, nasogastric or endotracheal tubes are a regular practice in the Neonatal Intensive Care Unit. The accurate placement of these devices is essential and the role of the chest and abdominal radiographs it’s very important in the control of these devices. The technical challenges associated to the realization of the x-ray images require more attention to the position and level of exposure than on the adult population. Exposure parameters, imaging post-processing must be optimized, to be possible to evaluate the tip positioning and trajectory of medical devices. At the same time, the image must have good anatomical quality so that any lesion on the underlying organs can be identified. Conclusion: The fast radiographic recognition of incorrect placing of medical devices and their complications its essential for a quick intervention so that the care of newborn can be maintained.

BACKGROUND: Skin-to-skin care (SSC), often referred to as \'kangaroo care\' (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. OBJECTIVES: The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonatesThe secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants. SEARCH METHODS: For this update, we used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE via PubMed (1966 to 25 February 2016); Embase (1980 to 25 February 2016); and CINAHL (1982 to 25 February 2016). We also searched clinical trials\' databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA: Studies with randomisation or quasi-randomisation, double- or single-blinded, involving term infants (&ge; 37 completed weeks\' postmenstrual age (PMA) to a maximum of 44 weeks\' PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by healthcare professionals. DATA COLLECTION AND ANALYSIS: The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A mean difference (MD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. MAIN RESULTS: Twenty-five studies (n = 2001 infants) were included. Nineteen studies (n = 1065) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), three used intramuscular injection (n = 776), one used \'vaccination\' (n = 60), and one used tape removal (n = 50). The studies were generally strong and had low or uncertain risk of bias. Blinding of the intervention was not possible, making them subject to high risk, depending on the method of scoring outcomes.Seventeen studies (n = 810) compared SSC to a no-treatment control. Although 15 studies measured heart rate during painful procedures, data from only five studies (n = 161) could be combined for a mean difference (MD) of -10.78 beats per minute (95% CI -13.63 to -7.93) favouring SSC. Meta-analysis of four studies (n = 120) showed no difference in heart rate following the painful procedure (MD 0.08, 95% CI -4.39 to 4.55). Two studies (n = 38) reported heart rate variability with no significant differences. Two studies (n = 101) in a meta-analysis on oxygen saturation at 30 and 60 seconds following the painful procedure did not show a difference. Duration of crying meta-analysis was performed on four studies (n = 133): two (n = 33) investigated response to heel lance (MD = -34.16, 95% CI -42.86 to -25.45), and two (n = 100) following IM injection (MD = -8.83, 95% CI -14.63 to -3.02), favouring SSC. Five studies, one consisting of two substudies (n = 267), used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (MD -3.21, 95% CI -3.94 to -2.47), at 60 seconds (3 studies; n = 156) (MD -1.64, 95% CI -2.86 to -0.43), and at 90 seconds (n = 156) (MD -1.28, 95% CI -2.53 to -0.04); but at 120 seconds there was no difference (n = 156) (MD 0.07, 95% CI -1.11 to 1.25). No studies on return of heart rate to baseline level, cortisol levels, and facial actions could be combined for meta-analysis findings.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider (father, another female) on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC (n = 640) with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate (n = 95). SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but not different to breastfeeding. One study compared SSC alone and in combination with both sucrose and breastfeeding on heart rate (HR), NIPS scores, and crying time (n = 127). The combinations were more effective than SSC alone for NIPS and crying. Expressed breast milk was compared to SSC in one study (n = 50) and found both equally effective on PIPP scores. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. AUTHORS\' CONCLUSIONS: SSC appears to be effective as measured by composite pain indicators with both physiological and behavioural indicators and, independently, using heart rate and crying time; and safe for a single painful procedure. Purely behavioural indicators tended to favour SSC but with facial actions there is greater possibility of observers not being blinded. Physiological indicators were mixed although the common measure of heart rate favoured SSC. Two studies compared mother-providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. Studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed. Of interest would be to study synergistic effects of SSC with other interventions.

A Paralisia Cerebral (PC) é a causa mais comum de deficiência física grave na infância sendo a prematuridade um fator de risco significativo para PC. Apesar do tratamento farmacológico da PC ser amplamente estudado, poucas pesquisas correlacionam a administração de compostos neuroprotetores e a melhora dos parâmetros clínicos e a sobrevivência dos pacientes acometidos por essa doença. Entre as substâncias estudadas, a cafeína tem sido associada ao tratamento de distúrbios neurológicos, com potencial aplicação para prevenir a PC, especialmente aquelas cuja origem está em causas peri e pós-natais. O objetivo deste estudo foi revisar sistematicamente os efeitos da cafeína na prevenção da PC. Tendo como critérios de elegibilidade gestantes ou recém-nascidos prematuros em risco de desenvolver lesão cerebral, que fizeram uso de cafeína na forma de citrato de cafeína administrado nos primeiros dias de vida na criança ou exposição da gestante durante o período perinatal, ou administrados em períodos diferentes e comparados entre si. A comparação envolveu: crianças ou gestantes que não receberam a intervenção/exposição testada ou crianças ou gestantes que receberam doses diferentes àquela testada ou sem intervenção controle ou placebo. Os desfechos primários incluíram a incidência de PC. E os desfechos secundários foram aqueles relacionados ao desenvolvimento neurológico, desenvolvimento motor e cognitivo, além de desfechos relacionados ao crescimento e desenvolvimento. Os tipos de estudos incluídos foram ensaios clínicos controlados ou estudos de Coorte. A identificação dos estudos foi realizada nas bases de dados Medline, Embase, Cochrane Library, incluindo Cochrane Controlled Trials Register, Scopus e Web of Science, incluindo estudos publicados até 19 de abril de 2021. As listas de referências dos ensaios clínicos relevantes e revisões também foram consultadas. A qualidade metodológica dos estudos incluídos foi avaliada utilizando as ferramentas propostas pelo Instituto Joanna Briggs (Critical Appraisal tools for use in JBI Systematic Reviews – Checklist for Randomized Controlled Trials and Checklist for Cohort Studies). Cinco estudos, provenientes de sete publicações, foram incluídos nesta revisão: um ensaio clínico randomizado controlado por placebo (n =2006), um estudo de coorte prospectivo (n= 95.200) e cinco estudos de coorte retrospectivos publicados entre 2007 e 2019 e realizados na Austrália, Canadá e Noruega. As médias das semanas gestacionais no nascimento variaram de 25 a 28 semanas e os pesos ao nascer de 850g a 1010g. Um estudo não utilizou uma intervenção com cafeína, e avaliou o consumo de cafeína através de alimentos/bebidas fontes. Cinco estudos relataram efeito favorável da cafeína sobre o desfecho primário (incidência de PC). Em relação a segurança da intervenção o resultado ainda é inconclusivo pois os estudos não avaliaram os efeitos adversos, somente o ensaio clínico. Entre as limitações encontradas podemos relatar o número reduzido de estudos, a falta de uniformidade entre os estudos, e a heterogeneidade metodológica. Nesse sentido torna-se necessário cautela pois ainda não é possível chegar a uma conclusão sobre a segurança da intervenção. O efeito favorável pode existir, no entanto, ainda não pode ser confirmado devido à baixa força da evidência sobre o efeito da cafeína na PC.

Esophageal atresia is a congenital malformation characterized by lack of continuity of the esophagus, which may or may not be associated with communication with the trachea. Newborns with esophageal atresia have a good survival rate in developed countries, but there is still a high mortality rate in developing countries. The objective was to analyze the neonatal and maternal characteristics related to the occurrence of death in newborns with esophageal atresia. This is a descriptive, cross-sectional study with a quantitative approach. The data used are composed of the units' entry books and the charts of the newborn infants with diagnosis of esophageal atresia of a large public hospital of the Unified Health System (SUS) network of the central-western region, obtaining data from 2005 to 2015. Of the 45 newborns (NB) with esophageal atresia participants in the study, more than half died, the maternal age with the highest prevalence was 19 to 35 years, with mothers residing in the interior of Goiás, being mostly primipara, with single-fetus gestation with the resolution of gestation by cesarean section. The newborns presented gestational age <37 weeks and weight <2500g, being mostly males. The neonatal complications associated to the ventilatory system were those that had a higher occurrence among newborns with a diagnosis of esophageal atresia. Of the variables related to esophageal atresia, the most frequent type was esophageal atresia with distal tracheoesophageal fistula and the major association with another malformation was with the malformations of the cardiovascular system. A significant death rate was found, mainly in the post-neonatal period. Of the newborns who died most were premature and underweight at birth. We obtained a statistically significant association with death in hospitalized infants <7 days in the NICU, probably due to the severity of the associated diseases. We also found a statistically significant association with the length of hospital stay, with infants who have more malformations along with esophageal atresia, remaining an extended stay.

Objetivou-se determinar o tipo de máquina incubadora mais adequado para incubação de ovos de matrizes com diferentes idades, bem como o efeito da temperatura de incubação sobre a qualidade física e a resposta imune de pintos. Foram realizados três experimentos, sendo que no experimento I foram incubados 720 ovos, provenientes de matrizes com três idades diferentes (30 ou 42 ou 64 semanas), porém apenas cinco aves por tratamento foram utilizadas neste estudo. Os ovos foram distribuídos em delineamento inteiramente casualizado em esquema fatorial 3x2 (três idades x duas temperaturas de incubação).A temperatura da máquina para os grupos controle foi de 37,5 ºC constante durante todo o período e para os tratamentos com elevação da temperatura foi aplicada uma temperatura de 39,0 ºC por 6h durante o período de 10 a 18 dias de incubação. Foi avaliada a histomorfometria intestinal e de baço e bursa. Foram realizadas 4 fotografias de cada lâmina e 10 leituras por fotografia, totalizando 40 leituras por ave, e uma leitura como parcela experimental. No experimento II Foram utilizados 300 ovos, sendo que para a fase de incubação foi utilizado o delineamento inteiramente casualizado, com dois tratamentos (tipos de máquinas), com 150 repetições, sendo considerada a parcela experimental um ovo. Foi avaliada a qualidade física dos pintos eclodidos e análise histomorfométrica de órgãos linfoides e intestino delgado de dez aves por tratamento. Para o ensaio de desempenho, 200 pintos de um dia foram distribuídos em delineamento inteiramente casualizado, com 5 repetições e 20 aves por parcela experimental. No experimento III, os tratamentos foram uma combinação entre três idades de matrizes com dois tipos de máquina de incubar. Os ovos foram distribuídos em delineamento inteiramente casualizado em esquema fatorial 3x2 (três idades x duas máquinas de incubação) com 83 repetições, sendo a parcela experimental um ovo. Foram avaliados os parâmetros de incubação, embriodiagnóstico, escore de qualidade de pintos e histomorfometria da mucosa de fragmentos do intestino delgado. Para o ensaio de desempenho foram alojados 300 pintos machos oriundos dos mesmos tratamentos do ensaio de incubação e o delineamento experimental para a avaliação do desempenho foi inteiramente casualizado em esquema fatorial 3x2 (três idades x duas máquinas de incubação), com cinco repetições, sendo uma parcela constituída por 10 aves. Os dados foram submetidos a ANOVA e as médias comparadas pelo teste Tukey (5%) quando necessário. No experimento I a variação na temperatura da máquina de incubação afetou a qualidade de pintos neonatos, sobretudo para pintos originados de matrizes jovens. No experimento II o tipo de máquina de incubar não influenciou a resposta imune nem a qualidade do pinto neonato. No experimento III máquina de estágio único proporcionou pintos de um dia com melhor escore de qualidade.

Congenital toxoplasmosis is an infectious disease that results from the transplacental transfer of the protozoan Toxoplasma gondii to the concept and can cause serious fetal damage, its diagnosis and complex, and the sooner realized improves the prognosis of infection. The evaluation of IgG avidity is used as an indicator of recent infection mainly in the follow-up of pregnant women at risk, and to date it is not established for use in blood samples of newborns and in blood samples collected on filter paper. The general objective of this study was to evaluate the prognostic importance of the IgG avidity test in sera and in blood collected on RN filter paper in the indication of T. gondii congenital infection. Blood samples were collected on RN filter paper at the Hospital das Clínicas-UFG, Dona Íris Maternity Hospital, Goiânia-GO and Cais Nova Era, Aparecida de Goiânia-GO Serological screening for IgG and IgM antibodies was performed using the Elisa test (BIOLISA® toxoplasmosis IgG and IgM kit). From the total of 1277 samples, two IgM positive samples were detected, in 564 samples (44.1%) the presence of IgG was detected, and the ELISA ≥3.0, 57.67% (327 / 567), 177 pairs of mother and child recolects were performed to confirm the results obtained on filter paper and IgG avidity evaluation. In 167 pairs (94.36%) IgG detection was confirmed by demonstrating good sensitivity of the method, in 4 (2.40%) samples the IgG of the newborn presented low avidity of IgG antibody that is indicative of recent infection. In 17 samples the collection was performed simultaneously on filter paper and peripheral blood, in order to evaluate the efficacy of the avidity technique in filter paper samples, the agreement between the results was 100%. Screening of high IgG NB associated with the avidity test can be performed on filter paper and this method may contribute to the early detection and diagnosis of toxoplasmosis.

Vision is one of the human senses that help development since birth, being of paramount importance for cognitive, social, and motor skills. The World Health Organization (WHO) points out that the number of children with ophthalmic abnormalities should increase by about 200 million between 2000 and 2050. Dynamic pupillometry is an exam that captures immutable pupillary behavior, such as its change in involuntary size, aiming to diagnose eye disorders and diseases. Since these pathologies being severe in children and the potential of pupillometry analysis for their diagnosis, this work proposes a method for diagnosing ophthalmic abnormalities using machine learning techniques and intelligent algorithms. Thus, the method autonomously extracts pupillary information from pupillometry exams and applies a classifier model to distinguish newborns between normal and altered clinical conditions within the ophthalmological context. This model intends to be a trial screening method that could help health professionals diagnose newborns' ophthalmological abnormalities. In addition, an annotated benchmark, which was manually developed in this study, is available and presents the context and highlights the obstacles in working with pupillometry exams in newborns. The algorithms proposed by this work were evaluated and compared with the ElSe and ExCuSe algorithms, state-of-the-art algorithms in the subject of pupillary tracking applied to the scope of this study. In conclusion, it presented a classifier model capable of differentiating newborns with diseased diagnosis in the ophthalmic field with an accuracy close to 81% under the available dataset.

There are strategies and interventions with proven effectiveness for the adequate management of neonatal pain. However, the simple dissemination of knowledge at the end of a research and/or training do not guarantee the use of knowledge by health professionals in clinical practice, resulting in a gap between knowing and doing. Given the frequent and repeated exposure of newborns to painful procedures in the neonatal unit and the deleterious consequences of untreated pain, it is urgent to implement innovative actions that promote changes in clinical practice to transform the available evidence into action. Thus, the objective of this study was to evaluate the effect of a multifaceted Knowledge Translation (KT) intervention to improve the management of neonatal pain. It is a quasi-experimental study, with no control group, of pre- and posttest type, performed at the neonatal unit of a public maternity hospital in Goiás, Brazil, from February 2015 to March 2016. The intervention used was Evidence-Based Practice for Improving Quality (EPIQ), which was divided into two phases: preparation and implementation, and change. A Research and Practice Council consisting of health professionals of the neonatal unit led and facilitated the proposed changes. Implementation was carried out in three rapid cycles, with one target for each cycle being established. Several KT strategies were used in combination, according to what the goal and barriers indicated, such as: reminders, bedside training, videos, educational leaflets, auditing and feedback, clinical protocols and didactic presentation. In Cycle 1, all professionals were sensitized to the adequate management of neonatal pain, and 89.4% of the professionals considered it possible to use the presented strategies. In cycle 2, the PIPP-R and EDIN scales were used to assess pain. At the first audit of cycle 2, of the total of 64 painful procedures (aspiration, blood collection and catheter insertion), the PIPP-R scale was applied in 30.8% of these procedures and EDIN in 26.2%. In the second audit of cycle 2, from 38 painful procedures, the PIPP-R scale was registered in 23.7% and EDIN, 23.8%. In cycle 3, the goals of cycle 2 were maintained and 20% oral glucose administration was included for relief of acute pain during peripheral catheter insertion and blood collection. In the audit of cycle 3, glucose was administered in 29.6% from the total of 54 painful procedures. After the completion of the implementation process, a final audit was carried out for 25 days. From the total of 444 painful procedures, the PIPP-R scale was applied in 26.6% and the EDIN scale was applied 50.7%; and glucose was 17 administered in 25.1% of these procedures. We conclude that, while faced with a challenging context and with the multifaceted KT intervention used in this study (EPIQ), it was possible to observe a significant increase, by health professionals, in the use of scales to assess pain and oral glucose administration to relieve neonatal pain. However, strategies to improve and sustain these outcomes are needed to ensure that every newborn has their pain evaluated and treated.

Toxoplasmosis is a infectious disease worldwide occurrence of that has as etiologic agent the protozoan Toxoplasma gondii. The main clinical manifestation of toxoplasmosis is consolidated through vertical transmission. Despite major advances in the diagnosis and treatment of congenital toxoplasmosis (CT), the search for diagnostic tests to determine when the infection was acquired and the corresponding gestation stage still represents a clinical challenge to be overcome. The IgG avidity test evaluates the binding strength of IgG antibodies against T.gondii antigen, separating the low avidity antibodies produced in the initial stage of infection of high avidity antibody, indicative of chronic infection but is not yet elucidated the value of this test in the diagnosis of CT in newborn (NB). In this context, this study aims to evaluate the predictive value of IgG avidity test in the diagnosis of CT RB. Case-control study nested in follow-up cohort of children suspected of having been born with congenital toxoplasmosis (CT), from two Maternity reference public in the city of Goiânia, Goias (Brazil). The sample consisted of 88 mothers infected by Toxoplasma gondii (T.gondii) and their newborn (RB); being 48 acutely infected during pregnancy (AIP) and 40 chronically infected (CIP) and their newborn. We evaluated serum levels of specific IgM and IgG against T.gondii IgG avidity test, by Chemiluminescence. The data generated were computerized in the Excel program 2012. The statistic was made using GraphPadPrism software version 5.04 and SPSS-Statistical Package for the Social Sciences Version 21.0. The differences were considered statistically significant when the value of p < 0.05. This allowed classifying the RB in infected (with high avidity or low avidity) and non-infected (with high avidity). The RN of the AIP were divided in RB with low avidity (LA) and RN with high avidity (HA). The TC was checked on 66.66% (n = 32) of RB of the AIP, and 94.1% of RN with LA and 42.3% of RN with HA, were infected. Levels of IgG and IgM of RN with LA and its mothers were high and showed difference when compared with the RN with HA (p = 0.0001). The symptomatology of the CT was observed in 56.2% (n=9) of RN with LA and 31.3% (n=5) of RN with HA. NB with BA exposed to T.gondii have 15 times more likely to develop the TC that NB with AA. The avidity test had a specificity of 93.78% and 50.00% sensitivity. In this context, the avidity test could be used to aid detection of CT in RB.

Hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM) are leading causes of maternal and fetal-neonatal morbidity and mortality. Their effects are believed to be associated with umbilical cord macroscopic changes. This study aimed to examine the association of umbilical cord macroscopic changes and newborn outcomes in high-risk pregnancies. A descriptive cross-sectional study was conducted in a public maternity hospital affiliated to the Brazilian National Health System (SUS) in the city of Goiânia, central-west Brazil, between January and December 2012. Medical information on high- (HDP and GDM) and normal-risk (control) pregnancy women and their newborns was collected in the postpartum period as well as information on the macroscopic characteristics of the umbilical cord of these infants. A total of 265 umbilical cords were examined. Of these, 126 were from the high-risk pregnancy group (64 of children of mothers with HDP and 62 of those of mothers with GDM) and 139 from the control group (73 HDP and 66 GDM controls). The most common umbilical cord macroscopic changes included true knots and non-central cord insertion in newborns of mothers with HDP and cord less than 35 cm long, true knots, and non-central cord insertion in those of mothers with GDM. Maternal age ≥36 years was significantly associated with single umbilical artery (SUA) (p = 0.03) in the control group. No statistically significant association was found between umbilical cord macroscopic changes and clinical characteristics of newborns of high-risk pregnancy women.