FM-CUP-Artigos em Revistas Nacionais
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- Use of therapeutic hypothermia in sudden unexpected postnatal collapse : a retrospective studyPublication . Brito, Sara; Sampaio, Isabel; Dinis, Alexandra; Proença, Elisa; Vilan, Ana; Soares, Eunice; Pinto, Filomena; Tomé, Teresa; Graca, Andre M.Introduction: Sudden and unexpected postnatal collapse is a rare event with potentially dramatic consequences. Intervention approaches are limited, but hypothermia has been considered after postnatal collapse. The aim of this study was to analyse sudden and unexpected postnatal collapse cases that underwent therapeutic hypothermia in the five Portuguese hypothermia centres. Material and Methods: In this multicentre, retrospective and descriptive study, clinical, ultrasonography, amplitude-integrated electroencephalography and brain magnetic resonance findings of newborns with postnatal collapse that underwent therapeutic hypothermia are reported (2010 - 2018). Statistical analysis was performed by using IBM SPSS Statistics version 21. Results: Twenty-two cases of sudden and unexpected postnatal collapse were referred for therapeutic hypothermia (82% outborn), all ≥ 36 weeks, with Apgar 5´ ≥ 8. Collapse occurred during the first two hours in 73% (all < 24 hours), 50% during skin-to-skin care, 55% related to feeding and 23% during co-bedding. Moderate-severe encephalopathy and severe acidosis were observed (median: Thompson score 16, pH 6.90, base deficit 22 mmol/L). Amplitude-integrated electroencephalogram was abnormal in 95% and magnetic resonance imaging showed severe brain injury in 46%. The mortality rate was 50%. A possible cause was identified in 27%. Discussion: The incidence rate of 2.7 sudden cases of postnatal collapse per 100 000 births, is possibly under-estimated. All infants suffered the collapse in the first day, mostly within the first two hours, as reported before. Possible causes were identified in less than a third of cases, but multiple predisposing conditions were identified, suggesting that prevention may be possible. Newborn positioning and skin-to-skin care have been the most discussed practices. A significant proportion of infants had poor outcomes. Lower Thompson score, electroencephalogram amplitude normalization and normal magnetic resonance imaging seemed to indicate better outcomes. Although conclusive trials on therapeutic hypothermia after postnatal collapse are not available, its use has been considered individually. No severe adverse effects directly related to hypothermia were registered in this study, but the results do not allow drawing meaningful conclusions. Conclusion: In our national sample of 22 infants who suffered sudden and unexpected postnatal collapse and underwent therapeutic hypothermia, a significant proportion had poor outcomes. Absolute conclusions from our experience with hypothermia in postnatal collapse cannot be drawn, but systematic reporting of cases and long-term clinical evaluation would facilitate understanding of the real benefits of hypothermia. As this procedure has not been validated with clinical trials for this indication, its use should be considered on a case-by-case approach. The potentially avoidable nature of unexpected postnatal collapse is evident from its association with certain behaviours and risk factors. Surveillance practices during the first hours should be implemented, whilst the benefits of breastfeeding and skin-to-skin care should continue to be widely promoted.
- Therapeutic hypothermia for neonatal hypoxic-ischemic encephalopathy : 10-year experiencePublication . Sequeira, Ana Teresa; Gil, Joana; Sampaio, Isabel; Moniz, Carlos; Graca, Andre M.Introduction: Therapeutic hypothermia (TH) is the standard of care treatment for brain injury following perinatal hypoxia-ischemia in term infants. Accumulated evidence from clinical trials, systematic reviews and continuous experience shows a reduction in both mortality and long-term neurodevelopmental disability. The aim of our study was to: (i) present the 10-year experience of the neonatal intensive care unit (NICU) that pioneered hypothermia program in Portugal; (ii) evaluate the use of neurologic monitoring and (iii) describe outcomes and adverse events. Methods: Prospective observational study of neonates who underwent TH between November 2009 and October 2019 in a single tertiary level NICU. Results: 128 newborns were treated. 91% were outborn. The median gestational age was 39 weeks. 91% neonates needed advanced resuscitation, and 22% prolonged resuscitation (>10 minutes). On admission, 60% had severe, 26% had moderate and 14% had mild encephalopathy. Hypotension was the most common complication, affecting 66% of the newborns. 21 (16%) patients died during hospital stay. Expected outcome based on aEEG and MRI was favorable in 40%, intermediate in 32% and adverse in 28%. Discussion: Effectiveness and safety profile of TH was confirmed in our population. A national register would be important to achieve and maintain high homogenous and national wide standards of care.
- Cystic fibrosis : how we reach adult lifePublication . Serras, I.; Oliveira, J. A.; Pereira, L.; Barreto, C.
- Vacinas vivas em crianças com síndrome de DiGeorge/Deleção 22q11.2Publication . Miranda, Mariana; Martins, Andreia Teixeira; Carvalho, Sara; Serra-Caetano, Ana; Esteves, Isabel; Marques, José GonçaloChildren with DiGeorge syndrome/chromosome 22q11.2 deletion syndrome might have a variable degree of immunodeficiency, which may limit the use of live vaccines. The aim of this study was to review the adverse effects of live vaccines and possible relation with immune status in patients with DiGeorge Syndrome/partial 22q11.2 deletion syndrome.Material e Métodos: Foi realizado um estudo retrospetivo por revisão dos processos clínicos das crianças com deleção do cromossoma 22q11.2 e fenótipo de síndrome de DiGeorge, seguidos num centro de referência de imunodeficiências primárias. Foi realizada colheita de dados, incluindo: características demográficas; história médica; historial de vacinação com vacinas vivas; contagem de linfócitos T-CD4+ e respostas proliferativas linfocitárias a antigénios e mitogénios; reações adversas; falências vacinais. Resultados: Foram incluídas 23 crianças com síndrome de DiGeorge/deleção 22q11.2, 65,2% do sexo masculino e idade média de diagnóstico de 11,3 meses. Destas, 18 crianças (78%) receberam a vacina bacillus Calmette-Guérin: todas com evidência de atividade tímica; três apresentaram linfopénia T-CD4+ moderada e respostas proliferativas linfocitárias anormais; uma com respostas proliferativas linfocitárias anormais para mitogénios, quatro para derivado de proteína purificada e uma para toxóide tetânico. A vacina tríplice contra o sarampo, parotidite e rubéola foi administrada a 15 crianças, três com imunossupressão moderada e respostas proliferativas linfocitárias anormais. A vacina viva atenuada contra poliomielite foi administrada a quatro crianças sem imunossupressão e a vacina contra o rotavírus a três crianças, uma com imunossupressão moderada. Não foram reportadas reações adversas. Discussão: Estes dados estão de acordo com as conclusões de outros estudos internacionais. Conclusão: Na nossa amostra, as vacinas vivas atenuadas foram bem toleradas, incluindo em crianças com linfopénia T-CD4+ moderada e com respostas proliferativas linfocitárias a antigénios/mitogénios anormais.
- Children’s sleep habits questionnaire in two subpopulations from Cape Verde and Mozambique : exploratory and regression analysisPublication . Marques Carneiro, Inês; Fonseca, Pedro Teles Da; Ferreira, RosarioChildren's sleep habits are profoundly affected by socio-economic, cultural, and environmental factors. We aim to describe the sleep habits of pediatric sub-populations from Cape Verde and Mozambique using the Children's Sleep Habits Questionnaire, and to ascertain the determinants of the questionnaire's score. Material and Methods: We conducted cross-sectional surveys in surveillance appointments in Cape Verde and in a school in Maputo (Mozambique). The Cape Verde sample included 206 children (mean age: 6.5) and the Mozambique sample 454 children (mean age: 8). The Portuguese version of the Children’s Sleep Habits Questionnaire was used to evaluate the children’s sleep habits. The distributions of the questionnaire’s scores across different levels of the demographic variables were compared using the Mann-Whitney and the Kruskal-Wallis tests. We used regression models to quantify the relationship between the demographic variables and the questionnaire’s scores. Results: Cape Verde sample: Questionnaire median score: 50 (range 36 – 81). Prevalence of sleep problems: 29.9% (cut-off = 56). Prevalence of parent-reported sleep problems: 22.8%. Co-sleeping: 63%. Bedtime television: 30%. Daytime nap: 63%. Questionnaire scores are associated with the mother’s educational level, the children’s age group, and with the frequency of daytime napping. Mozambique Sample: Median Questionnaire score: 48 (range 35 – 77). Prevalence of sleep problems: 28.4% (cut-off: 52). Percentage of parent-reported sleep problems: 6.9%. Co-sleeping: 29%. Bedtime television: 33%. Daytime nap: 23%. Questionnaire scores are associated with the mother’s nationality, the father educational level, and with the frequency of bedtime television. Discussion: Parents tend to overestimate the quality of their children’s sleep. The prevalence of sleep disturbances and the cut-off values are higher than observed in previous studies, which may be due to the existence of different standards and cultural expectations across populations. Bedtime television, typically associated with more disturbed sleep, is frequent in both samples. Co-sleeping and daytime napping are frequent in the Cape Verde sample; wetting the bed is common and more prevalent than in previous studies. Bed-sharing increases the parents’ awareness of their children’s sleep quality, contributing to the high prevalence of parent-reported sleep problems. Conclusion: Parent-reported sleep problems underestimate the Children’s Sleep Habits Questionnaire results. This is not necessarily indicative of more disturbed sleep and might reflect differences in sleep behavior, childcare practice, and cognitions and attitudes towards the concept of ‘normal’ sleep.