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Mimoso G. Neonatal Resuscitation: Peculiarities and Challenges. ACTA MEDICA PORT 2024; 37:317-319. [PMID: 38744233 DOI: 10.20344/amp.21415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Gabriela Mimoso
- Serviço de Neonatologia. Maternidade Bissaya Barreto. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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van Veenendaal NR, Labrie NH, Mader S, van Kempen AAMW, van der Schoor SRD, van Goudoever JB, Bertino E, Bhojnagarwala B, Bodrogi E, Bohlin K, Bracht M, Bührer C, Domellöf M, Embleton N, Endl C, Ertl T, Funke S, Gangi S, Garg S, Guimarães H, Haiden N, Koskinen E, Klingenberg C, Klisch O, Kobberup H, Kovalova OM, Krolak‐Olejnik B, Lapillonne A, Lee S, Lehtonen L, McKechnie L, Mimoso G, Molloy E, Moltu SJ, Mulder AL, Nádor C, Normann E, O'Brien K, Van Overmeire B, Pavlyshyn H, Pellicer A, Picaud J, Poets CF, Rabe H, Ryan E, Sadowska‐Krawczenko I, Salvesen B, Sanakova P, Sarapuk I, Schuler R, Senterre T, Strola P, Thomas M, Vento M, Voloshko V, Weis J, Wiedermannová H, Zabakas K. An international study on implementation and facilitators and barriers for parent‐infant closeness in neonatal units. Pediatr Investig 2022; 6:179-188. [PMID: 36203512 PMCID: PMC9523817 DOI: 10.1002/ped4.12339] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 05/31/2022] [Indexed: 11/11/2022] Open
Abstract
Importance Parent‐infant closeness and active parent participation in neonatal care are important for parent and infant health. Objective To give an overview of current neonatal settings and gain an in‐depth understanding of facilitators and barriers to parent‐infant closeness, zero‐separation, in 19 countries. Methods Neonatal intensive care unit (NICU) professionals, representing 45 NICUs from a range of geographic regions in Europe and Canada, were purposefully selected and interviewed June–December 2018. Thematic analysis was conducted to identify, analyze and report patterns (themes) for parent‐infant closeness across the entire series of interviews. Results Parent‐infant separation during infant and/or maternity care is very common (42/45 units, 93%), despite the implementation of family integrated care (FICare) practices, including parent participation in medical rounds (17/45, 38%), structured education sessions for parents (16/45, 36%) and structured training for healthcare professionals (22/45, 49%). NICU professionals encountered four main themes with facilitators and barriers for parent‐infant closeness on and between the hospital, unit, staff, and family level: Culture (jointly held characteristics, values, thinking and behaviors about parental presence and participation in the unit), Collaboration (the act of working together between and within different levels), Capacities (resources and policies), and Coaching (education to acquire and transfer knowledge and skills). Interpretation Implementing parent‐infant closeness in the NICU is still challenging for healthcare professionals. Further optimization in neonatal care towards zero‐separation and parent‐infant closeness can be achieved by enforcing the ‘four Cs for Closeness’: Culture, Collaboration, Capacities, and Coaching.
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Affiliation(s)
- Nicole R. van Veenendaal
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
| | - Nanon H.M. Labrie
- Department of Pediatrics and Neonatology OLVG Amsterdam The Netherlands
- Department of Language, Literature and Communication Vrije Universiteit Amsterdam Amsterdam The Netherlands
| | - Silke Mader
- European Foundation for Care of Newborn Infants Munich Germany
| | | | | | - Johannes B. van Goudoever
- Amsterdam UMC, location Vrije Universiteit and location University of Amsterdam Department of Pediatrics, Emma Children's Hospital Amsterdam The Netherlands
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Affiliation(s)
- Fábia Mota
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Pediatric Unit, Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal
| | - Nuno Oliveira
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Pediatric Unit, Centro Hospitalar do Baixo Vouga EPE, Aveiro, Portugal
| | - Margarida Fonseca
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gabriela Mimoso
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Abstract
Cerebral ultrasound (CUS) can be a valuable non-invasive diagnostic tool for brain involvement in Sturge-Weber syndrome (SWS). Literature discussing the relevance of ultrasound in SWS is, however, scarce.We report a case of a newborn with SWS and serious brain abnormalities diagnosed on the first day of life with a CUS.
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Affiliation(s)
- Ana Ferraz
- Pediatric Department, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Sofia Morais
- Neonatologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Gabriela Mimoso
- Neonatologia B, Maternidade Bissaya Barreto, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
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Abstract
A 39-week-old male newborn presented at birth with atrophic erythematous and purpuric skin lesions, in a typical right-sided segmental distribution. Lesions were persistent and unaffected by rewarming in the postpartum period. Postnatal echocardiogram showed a predominance of the right cavities and an upper atrial septal defect. Cerebral and abdominal ultrasound were normal along with ophthalmological examination. On follow-up, lower limbs asymmetry was noted. The right lower limb was shorter in length and had a smaller diameter. At 6 months, the right lower limb was 1.5 cm shorter than the left, most likely related to nutritive vessels malformations. The discrepancy was even more pronounced at the age of 9 months. This leg-length asymmetry can lead to severe functional limitations in the future.
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Affiliation(s)
- Joana Amaral
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Sara Peixoto
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Gabriela Mimoso
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
| | - Dolores Pereira
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Centro Hospitalar e Universitario de Coimbra EPE, Coimbra, Portugal
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Mimoso G, Oliveira G. [Neonatal Morbidity and Gestational Diabetes: Coincidence or Consequence of the 2011 Protocol]. ACTA MEDICA PORT 2017; 30:589-598. [PMID: 29025524 DOI: 10.20344/amp.8033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 04/02/2017] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Gestational diabetes is one of the diseases associated with pregnancy with higher rate of complications. Despite being a transitory condition, short and long term complications related to gestational diabetes have been described. There is scientific evidence to say that good metabolic control decreases perinatal complications. In 2011, new criteria was proposed for its diagnosis, which made possible its diagnosis during the 1st trimester of pregnancy. The aim of this study is to compare neonatal morbidity in two groups of women with gestational diabetes diagnosis before and after the latest Portuguese guidelines for diabetes and pregnancy were published (February 2011). MATERIAL AND METHODS We included all newborns born in Maternidade Bissaya Barreto whose mother, followed at our maternity between 2008 and 2013, had unifetal pregnancy complicated by diabetes. We used a perinatal database and analysed the impact of the new guidelines in perinatal morbidity over two periods of three years. RESULTS There were 774 women who met the inclusion criteria. We found that gestational diabetes was diagnosed earlier, insulin therapy was more frequent. Neonatal morbidity was increased, and there were more cases of neonatal hypoglycemia and congenital anomalies, and newborns became smaller for gestational age. DISCUSSION The increase in neonatal morbidity was associated with early diagnosis and rigorous metabolic control. CONCLUSION To analyse national data will be fundamental to understand this unexpected increase in morbidity.
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Affiliation(s)
- Gabriela Mimoso
- Serviço de Neonatologia. Maternidade Bissaya Barreto. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Guiomar Oliveira
- Departamento de Pediatria. Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal; Unidade de Neurodesenvolvimento e Autismo do Centro de Desenvolvimento da Criança e Centro de Investigação e Formação Clínica. Hospital Pediátrico de Coimbra. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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Abstract
Neonatal hyponatraemia is common, and related to significant morbidity and mortality. We report a case of a preterm newborn (gestational age of 36 weeks) with hyponatraemia, and with a prenatal diagnosis of cleft lip and palate, with a normal fetal karyotype. On the seventh day of life, a biochemical evaluation for jaundice and mild signs of dehydration showed hyponatraemia of 124 mmol/L. Investigation showed normal adrenal and thyroid functions, plasma hyposmolality (258 mOsm/kg); high urinary sodium (73 mmol/L) and high urinary osmolality (165 mOsm/kg). Despite oral sodium supplementation and fludrocortisone treatment, sodium levels remained between 124 and 130 mmol/L. Cranial ultrasound, brain MRI and renal ultrasound were normal. The diagnosis of hyponatraemia was unpredicted and the investigation was suggestive of reset osmostat, a subtype of the syndrome of inappropriate secretion of antidiuretic hormone, characterised by a subnormal threshold for antidiuretic hormone secretion.
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Affiliation(s)
- Beatriz Maia Vale
- Hospital Pediátrico, Centro Hospitalar Universitário de Coimbra, Portugal
| | - Sofia Morais
- Maternidade Bissaya Barreto do Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Joana Mesquita
- Maternidade Bissaya Barreto do Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Gabriela Mimoso
- Maternidade Bissaya Barreto do Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
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Abstract
Neonatal lupus erythematosus is a rare, passively acquired autoimmune disease, caused by maternal autoantibodies. The most common manifestations are skin rash and congenital heart block. Cutaneous manifestations may be present at birth, but often develop within a few weeks after delivery. Congenital heart block may present as bradycardia in utero or during physical examination at birth. Approximately 40-60% of mothers are asymptomatic when the infants are diagnosed. We present a case of a child, born with erythematosus lesions in the face, scalp, trunk, limbs and nodules/papules on the palmar and plantar surfaces. He also had hepatosplenomegaly and thrombocytopenia. Echocardiography showed hyperechoic lesions on the anterior papilar muscle of the left ventricle and on the lateral cusp of the tricuspid valve. The mother had unexplained fever and vasculitic lesions in her hands and feet. Antinuclear antibodies, anti-SSa/Ro and anti-SSb/La were positive in the mother and child, making the diagnosis of neonatal lupus.
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Affiliation(s)
- Sofia Morais
- Department of Neonatal Intensive Care Unit, Maternidade Bissaya Barreto, Coimbra, Portugal.
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Abstract
Rh isoimmunisation leads to haemolytic anaemia and hyperbilirubinaemia in the first h of life. Isolated early onset neonatal anaemia has rarely been reported. The authors describe the case of a term infant, born to an 'A' negative, second gravida mother. On the second day of life, pallor was noticed. His haemoglobin (Hb) was 6.8 g/dl, he had reticulocytosis and a positive direct antiglobulin test. However, he did not have a high total serum bilirubin (TSB) (87.2 μmol/l). He was transfused with red blood cells and kept under phototherapy for 3 days. Three weeks later, he received another transfusion for severe anaemia (Hb 6 5 g/dl). During this period, he was never jaundiced and the maximum level of TSB was 122 μmol/l. On follow-up, his Hb stabilised and he had no further problems. This report highlights the possibility of early onset anaemia without jaundice as the sole manifestation of Rh isoimmunisation.
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Affiliation(s)
- Juliana Roda
- Neonatal Intensive Care Unit, Maternidade Bissaya Barreto-CHC, Coimbra, Portugal.
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Ribeiro ML, Alloisio N, Almeida H, Gomes C, Texier P, Lemos C, Mimoso G, Morlé L, Bey-Cabet F, Rudigoz RC, Delaunay J, Tamagnini G. Severe hereditary spherocytosis and distal renal tubular acidosis associated with the total absence of band 3. Blood 2000; 96:1602-4. [PMID: 10942416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
Absence of band 3, associated with the mutation Coimbra (V488M) in the homozygous state, caused severe hereditary spherocytosis in a young child. Although prenatal testing was made available to the parents, it was declined. Because the fetus stopped moving near term, an emergency cesarean section was performed and a severely anemic, hydropic female baby was delivered. She was resuscitated and initially kept alive with respiratory assistance and hypertransfusion therapy. Cord blood smears revealed erythroblastosis, poikilocytosis, and red cells with stalk-like elongations. Band 3 and protein 4.2 were absent; spectrin, ankyrin, and glycophorin A were significantly reduced. Renal tubular acidosis was detected by the age of 3 months. Nephrocalcinosis appeared soon thereafter. After 3 years of follow-up the child is doing reasonably well on a regimen that includes regular blood transfusions and daily bicarbonate supplements. The long-term prognosis remains uncertain given the potential for hematologic and renal complications. (Blood. 2000;96:1602-1604)
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Affiliation(s)
- M L Ribeiro
- Unidade de Hematologia Molecular, Serviço de Hematologia, Centro Hospitalar de Coimbra, Coimbra, Portugal.
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Silva IS, Nunes C, Mimoso G, Castela E, Mesquita J. [Digoxin. The drug of choice for the in-utero treatment of paroxysmal supraventricular tachycardia]. ACTA MEDICA PORT 1997; 10:95-8. [PMID: 9245185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Fetal tachyarrhythmia may constitute a risk for the fetus, therefore early treatment is indicate for all cases of tachydysrhythmia, with or without hydrops, in order to prevent irreversible hydrops. A case report is described of supraventricular paroxysmal tachycardia with digoxin in utero therapy in which pharmacological intervention was successful. Some comments are regarding the experience of the multidisciplinary team at Bissaya-Barreto Maternity in the treatment and orientation of fetal tachydysrhythmias.
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Affiliation(s)
- I S Silva
- Serviço de Obstetrícia, Maternidade Bissaya-Barreto, Coimbra
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