Breastfeeding prevalence in newborns of mothers with COVID-19: a systematic review

OBJECTIVES

to compare exclusive breastfeeding prevalence versus artificial feeding in newborns of mothers with COVID-19.

METHODS

a systematic review of prevalence, according to JBI. Searches in PubMed®, Embase, CINAHL, LILACS and Web of Science™ databases in August 2021. Cross-sectional, longitudinal or cohort studies were selected, without language and time limitations that showed breastfeeding prevalence or that allowed calculation.

RESULTS

fifteen articles published in 2020 and 2021, cohort (60%) or cross-sectional (40%) were analyzed. The average of exclusive breastfeeding in mothers with COVID-19 was 56.76% (CI=39.90-72.88), and artificial breastfeeding, 43.23% (CI = 30.99 - 55.88), without statistically significant differences.

CONCLUSIONS

despite the recommendations for maintaining breastfeeding, there was a reduction worldwide, when compared to periods prior to the pandemic. With advances in science, these rates have improved, showing the impact of evidence on practices. As limitations, study sources are cited. It is recommended to carry out new studies. PROSPERO registration CRD42021234486.

Construction and validation of a clinical simulation scenario on umbilical cord stump care

OBJECTIVE

To develop and validate clinical simulation scenario for teaching women in their puerperium and their families about care for the newborn's umbilical cord stump.

METHOD

Methodological study in two stages: 1 - elaboration of the checklist of the procedure for cleaning the umbilical cord and of the clinical case; and 2 - development of the simulated scenario. A Content Validity Index of 0.8 was adopted as the valid range of agreement.

RESULTS

After validation, the case was validated, being approved by 100% of the experts. All items of the simulation scenario obtained agreement scores above 0.91.

CONCLUSION

The validated scenario can be used in different contexts: teaching of Neonate Nursing, training teams, and teaching women in their puerperium and their families, who were the target of the study. Considering the benefits of simulation, we believe the simulation here will contribute to better and safer care.

Construção e validação de cenário de simulação clínica sobre o cuidado com o coto umbilical

RESUMO Objetivo: Desenvolver e validar cenário de simulação clínica para ensino de puérperas e familiares sobre cuidados com o coto umbilical do recém-nascido. Método: Estudo metodológico em duas fases: 1 - construção de checklist do procedimento de higienização do coto umbilical, elaboração e validação semântica do caso clínico com 11 experts em simulação e área materno-infantil; 2 - desenvolvimento e validação do cenário junto a 11 experts em simulação e em neonatologia/pediatria. O Índice de Validade de Conteúdo de 0,8 foi adotado como relevante alcance de concordância. Resultados: Após construção do caso, realizou-se validação, aprovada por 100% dos experts. Todos itens do cenário simulado obtiveram escores de concordância superiores a 0,91. Conclusão: O cenário validado pode ser utilizado em diferentes contextos: ensino da Enfermagem Neonatal, capacitação de equipes e, aprendizagem de puérperas e familiares, alvos do estudo. Vistos benefícios da simulação, acredita-se na sua contribuição para melhoria assistencial e cuidado seguro.

Vertical transmission and COVID-19: a scoping review

OBJECTIVE

Analyze available evidence related to SARS-CoV-2 infection and vertical transmission.

METHODS

Scoping review, according to the Joanna Briggs Institute and PRISMA-ScR. Searches were conducted in five electronic databases to find publications about coronavirus infection and vertical transmission. Data were extracted, analyzed and synthesized by three independent researchers using a descriptive approach.

RESULTS

The search resulted in 76 publications. After selective steps, 15 articles - retrospective descriptive or case studies - were analyzed, all in English. In order to track the infection, specimens were collected from neonates through nasal swabs and C-reactive protein from breast milk, cord blood, amniotic fluid, placenta and vaginal secretion was analyzed. A small percentage of neonates tested positive for COVID-19, but these cases were not attributed to vertical transmission.

CONCLUSION

Vertical transmission could not be demonstrated. Research protocol registered with the Open Science Framework (https://osf.io/fawmv).

COVID-19 and pregnancy: A scoping review on pregnancy characteristics and outcomes

Aim

The study aim was to map clinical characteristics and the evolution of pregnancies in pregnant women with confirmed diagnosis of SARS‐CoV‐2 infection.

Methods

Searching four databases, studies were investigated that described the evolution of pregnancies in women diagnosed with SARS‐CoV‐2 infection through laboratory tests. A scoping review was undertaken, including 35 articles published in English. Two pairs of independent researchers synthesized the data.

Results

Most studies were case studies or case series and had a low risk of bias. A predominance of cases was found in women over the age of 30 years who got infected in the third term of pregnancy and who had comorbidities. The prematurity index varied with the heterogeneity of the samples, and the cases of abortion occurred in combination with severe forms of infection. Caesarean section deliveries predominated, indicated mainly by respiratory decompensation caused by infection. Most women were discharged.

Conclusion

Based on the reviewed studies, the profile and evolution of pregnant women infected with COVID‐19 could be evaluated.

What is already known about this topic?

In 2020, the COVID‐19 pandemic was decreed, currently accounting for more than 105 million cases and more than two million deaths.

Physiological changes of pregnancy predispose pregnant women to COVID‐19 infection.

The characteristics of pregnancy associated with COVID‐19 infection turn obstetric care into a constant challenge.

What this paper adds?

The review presents the profile of pregnant women infected by SARS‐CoV‐2, with laboratory confirmation using the diagnostic reference standard (PCR).

This review presents the profile of pregnant women infected with SARS‐CoV‐2 and the outcomes of the infection and pregnancy.

The implications of this paper:

Based on the knowledge of the profile, public policies can be planned to prevent and manage infection among pregnant and postpartum women.

Further studies are suggested, mainly follow‐up studies of cohorts with pregnant women infected with SARS‐CoV‐2 to expand knowledge about the profile and obstetric outcomes.

Adesão à consulta puerperal: facilitadores e barreiras

Resumo Objetivos identificar a prevalência de adesão e não adesão à consulta puerperal, assim como facilitadores e barreiras, entre puérperas assistidas em um hospital de ensino. Método estudo de coorte prospectivo, realizado com 121 puérperas, no período de agosto a dezembro de 2019, nas dependências de um hospital de ensino do interior de Minas Gerais. Resultados a prevalência de adesão à consulta puerperal foi de 34,7%. Observou-se, como facilitador, o acolhimento da equipe durante o pré-natal e/ou parto. Citaram-se como barreiras: esquecimento; intercorrências com o RN e/ou puerperais; dificuldade de transporte e distância entre o serviço e a residência. Foram associados à adesão: puérperas com maior escolaridade, que realizaram todo ou parte do pré-natal na instituição, que tiveram a gestação classificada como alto risco, que apresentaram doenças prévias durante a gestação, primigestas e as que tiveram parto cesáreo. Conclusões e implicações para a prática os dados apresentados possibilitaram delinear um perfil das puérperas que aderiram ou não à consulta puerperal, desvelando fatores facilitadores e barreiras, assim como fatores associados à maior adesão. Faz-se necessário repensar a assistência ao puerpério, uma vez que a consulta é uma estratégia de prevenção de morte materna.

Bioimpedance as an indicator in the distribution of interface pressure in vulnerable regions for pressure ulcers: A preliminary study

AIM

To examine the influence of body mass index, bioimpedance, and skin folds on the distribution of body interface pressure in regions with the potential to develop pressure ulcers in contact with support surfaces.

DESIGN

This was a descriptive and analytical study.

METHODS

Twenty healthy volunteer adults were investigated in April 2017. Body mass index, skin folds, waist circumference, bioimpedance, and interface pressure on bony prominences were investigated. Descriptive statistics and correlations were analysed.

RESULTS

Peak pressures in the subscapular region presented moderate and significant correlations with body mass index, waist circumference, total and extracellular body water, fat-free mass, and lean mass per body segment. The peak pressure on the right heel showed a moderate correlation with total and extracellular body water, fat-free mass, and lean mass per segment.

CONCLUSION

The need for multicenter research was evident, focusing on bioimpedance assessment as a risk factor for the development of pressure ulcers.

Influence of support surfaces on the distribution of body interface pressure in surgical positioning

OBJECTIVE

to evaluate the interface pressure (IP) of support surfaces (SSs) on bony prominences.

METHOD

a quasi-experimental study with repeated measures on each SS. Twenty healthy adult volunteers participated in the study. The participants were placed in the supine position on a standard operating table for evaluation of IP on the bony prominences of the occipital, subscapular, sacral, and calcaneal regions using sensors. Seven evaluations were performed for each bony prominence: one on a standard operating table, and the others on tables containing SSs made of viscoelastic polymer, soft foam, or sealed foam. Descriptive statistics and analysis of variance were used to analyze the data.

RESULTS

the mean IP was higher on the viscoelastic polymer-based SS compared to the other SSs (p<0.001). The mean IP was relatively lower on the density-33 sealed foam and density-18 soft foam. In addition, this variable was comparatively higher in the sacral region (42.90 mmHg) and the calcaneal region (15.35 mmHg).

CONCLUSION

IP was relatively lower on foam-based SSs, especially on density-18 soft foam and density-33 sealed foam. Nonetheless, IP was not reduced on the viscoelastic polymer SS compared to the control SS.

Support surfaces in the prevention of pressure ulcers in surgical patients: An integrative review

AIM

To assess the scientific evidence about the types of support surfaces used in intraoperative surgical practice in the prevention of pressure ulcers due to surgical positioning.

METHOD

This is an integrative literature review. The electronic databases Cochrane, PubMed, Web of Science, Scopus, Lilacs, and CINAHL were used. The descriptors surgical patients, support surfaces, perioperative care, patient positioning, and pressure ulcer were used in the search strategy. Articles that addressed the use of support surfaces intraoperatively, published between 1990 and 2016, were selected. The PRISMA guidelines were used to structure the review.

RESULTS

Of 18 evaluated studies, most were in English, followed by Portuguese and Spanish; most were performed by nurses. The most commonly cited support surfaces were viscoelastic polymer, micropulse mattresses, gel based mattresses, and foam devices.

CONCLUSION

There are gaps in knowledge regarding the most efficient support surfaces and the specifications of the products used to prevent pressure ulcers due to surgical positioning.

Lesão de mucosa laringotraqueal e fatores associados após extubação endotraqueal: estudo piloto

Resumo Objetivo Descrever os sinais clínicos de lesão de mucosa laringotraqueal e seus fatores associados. Métodos Estudo observacional, longitudinal, em pacientes intubados por ocasião da anestesia geral. Foram realizadas avaliações no pré-operatório, transoperatório, e nas 24, 48 e 72 horas após extubação. Para análise, utilizaram-se estatísticas descritiva e exploratória, e também foi verificada a razão de chances. Resultados Dentre os pacientes, 53,3% apresentaram pelo menos um sinal clínico de lesão de mucosa laringotraqueal, sendo predominantes: rouquidão (43,3%), disfagia (40%) e odinofagia (33,3%). Estiveram associados aos seguintes fatores: pressão intra-cuff acima de 25cmH2O, intubação por mais de 120 minutos e uso de tubos maiores que 7,5mm. Conclusão Os sinais clínicos de lesão de mucosa laringotraqueal mais frequentes na população deste estudo foram rouquidão, disfagia e odinofagia, associados à pressão do cuff acima de 25 cmH2O, seguido do tempo de intubação e tamanho inadequado de tubos endotraqueais.

Clima de segurança do paciente em unidades de clínica médica e cirúrgica

Estudo transversal, analítico e quantitativo, que objetivou avaliar o clima de segurança do paciente na perspectiva dos profissionais da equipe de Enfermagem dos setores de Clínica Médica e Cirúrgica. Participaram 52 profissionais. Os dados foram coletados utilizando-se o Safety Attitudes Questionnaire. Para análises foram utilizados os testes t de Student, análise de variância e correlação de Sperman (α= 0,05). O escore geral médio do instrumento foi 66,94 pontos. O domínio com melhor escore foi “percepção da gerência” (84,60) e os domínios com menor escore foram “condições de trabalho” (60,15) e “percepção do estresse” (55,59). Houve diferenças estatisticamente significantes entre os sexos, nível de escolaridade com o domínio Clima de Segurança. Não houve relação entre a atuação profissional, vínculo empregatício e categoria profissional. Observaram-se fragilidades na percepção da equipe em relação ao clima de segurança, o que remete à necessidade de instituição de estratégias para promoção de um ambiente seguro.

PATIENT SAFETY CLIMATE AT A PRIVATE HOSPITAL

ABSTRACT Evaluate the patient safety climate from the perspective of the health team members at a medium-sized private hospital in a city in the state of Minas Gerais, Brazil and check for relations between the sociodemographic variables and the safety climate scores. This is a descriptive, exploratory and correlational study, conducted with 123 health professionals, with approval from the Research Ethics Committee. Data were collected using the Safety Attitudes Questionnaire. For analysis, we used Student's t-test, analysis of variance and Spearman's correlation (α = 0.05). The general score on the instrument was 67.50. The best domain score was found for job satisfaction (82.79) and the lowest for perceived management (58.90) and working conditions (59.58). No differences were found between the sexes, education level, presence of other employment or professional activities. The safety climate scores observed were lower than the scores recommended in the literature.

Sociodemographic and health factors associated with chronic pain in institutionalized elderly

OBJECTIVES

to characterize chronic pain in institutionalized elderly and verify the associated factors.

METHOD

observational, cross-sectional and non-experimental study with a quantitative approach. The study participants were 124 elderly living in Long-Term Care Institutions for the Elderly (LTCIs) in a city in Minas Gerais (Brazil). Approval for the project was obtained from the Research Ethics Committee. The elderly's clinical and sociodemographic variables and pain-related aspects were assessed. The data were analyzed through descriptive statistics and bivariate analysis (chi-squared).

RESULTS

the prevalence of chronic pain corresponded to 58.1%; for more than 10 years (26.4%); in lower limbs (31.9%); characterized as "twinges" (33.3%); 33.3% adopted medication treatment; the pain did not improve (41.7 %); or worsen (34.7 %). It was evidenced that elderly aged 60├ 70 old had 70% less chances of chronic pain than those aged 80 years and older (p=0.018).

CONCLUSION

institutionalized elderly have a high prevalence of chronic pain, mainly in the lower limbs. No factors of pain improvement or worsening were identified and medication was evidenced as the preferred treatment. Age showed to be associated with the presence of pain. It is considered important to accomplish multiprofessional actions at the LTCIs to guide prevention and rehabilitation actions of the pain episodes in these elderly.