EDNA MARIA DE ALBUQUERQUE DINIZ
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Pediatria, Faculdade de Medicina - Docente
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/36 - Laboratório de Pediatria Clínica, Hospital das Clínicas, Faculdade de Medicina
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- Translating Neonatal Resuscitation Guidelines Into Practice in Brazil(2022) ALMEIDA, Maria Fernanda B. de; GUINSBURG, Ruth; WEINER, Gary M.; PENIDO, Marcia G.; FERREIRA, Daniela M. L. M.; ALVES, Jose Mariano S.; EMBRIZI, Lais F.; GIMENES, Carolina B.; SILVA, Nathalia M. Mello E.; FERRARI, Ligia L.; VENZON, Paulyne S.; GOMEZ, Dafne B.; VALE, Marynea S. do; BENTLIN, Maria Regina; SADECK, Lilian R.; DINIZ, Edna M. A.; FIORI, Humberto H.; CALDAS, Jamil P. S.; ALMEIDA, Joao Henrique C. L. de; DUARTE, Jose Luis M. B.; GONCALVES-FERRI, Walusa A.; PROCIANOY, Renato S.; LOPES, Jose Maria A.BACKGROUND AND OBJECTIVES: The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country. METHODS: Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 23(0/7) to 31(6/7) weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio(2)) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment. RESULTS: For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio [OR], 1.52 [95% confidence interval (CI) 1.44-1.61] and 1.45 [1.38-1.52]) and PPV with a T-piece (OR, 1.45 [95% CI 1.37-1.55] and 1.41 [1.32-1.51]). The probability of receiving PPV with Fio(2) 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93). CONCLUSIONS: Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio(2) 1.00 were translated into clinical practice.
- Auditory pathway maturational study in small for gestational age preterm infants(2014) ANGRISANI, Rosanna Giaffredo; DINIZ, Edna Maria Albuquerque; GUINSBURG, Ruth; FERRARO, Alexandre Archanjo; AZEVEDO, Marisa Frasson de; MATAS, Carla GentilePURPOSE: To follow up the maturation of the auditory pathway in preterm infants small for gestational age (SGA), through the study of absolute and interpeak latencies of auditory brainstem response (ABR) in the first six months of age. METHODS: This multicentric prospective cross-sectional and longitudinal study assessed 76 newborn infants, 35 SGA and 41 appropriate for gestational age (AGA), born between 33 and 36 weeks in the first evaluation. The ABR was carried out in three moments (neonatal period, three months and six months). Twenty-nine SGA and 33 AGA (62 infants), between 51 and 54 weeks (corrected age), returned for the second evaluation. In the third evaluation, 49 infants (23 SGA and 26 AGA), with age range from 63 to 65 weeks (corrected age), were assessed. The bilateral presence of Transient Evoked Otoacoustic Emissions and normal tympanogram were inclusion criteria. RESULTS: It was found interaural symmetry in both groups. The comparison between the two groups throughout the three periods studied showed no significant differences in the ABR parameters, except for the latencies of wave III in the period between three and six months. As for the maturation with tone burst 0.5 and 1 kHz, it was found that the groups did not differ. CONCLUSION: The findings suggest that, in the premature infants, the maturational process of the auditory pathway occurs in a similar rate for SGA and AGA. These results also suggest that prematurity is a more relevant factor for the maturation of the auditory pathway than birth weight.
- Risk Perception and Decision Making about Early-Onset Sepsis among Neonatologists: A National Survey(2022) RUGOLO, Ligia Maria Suppo de Souza; BENTLIN, Maria Regina; ALMEIDA, Maria Fernanda Branco de; GUINSBURG, Ruth; CARVALHO, Werther Brunow de; MARBA, Sergio Tadeu Martins; ALMEIDA, Joao Henrique Carvalho Leme de; LUZ, Jorge Hecker; PROCIANOY, Renato Soibelmann; DUARTE, Jose Luiz Muniz Bandeira; ANCHIETA, Leni Marcia; FERREIRA, Daniela Marques de Lima Mota; ALVES JUNIOR, Jose Mariano Sales; DINIZ, Edna Maria de Albuquerque; SANTOS, Juliana Paula Ferraz dos; GIMENES, Carolina Boschi; SILVA, Nathalia Moura de Mello e; FERRARI, Ligia Lopes; SILVA, Regina Paula Guimaraes Vieira Cavalcante da; MENESES, Jucille; GONCALVES-FERRI, Walusa Assad; VALE, Marynea Silva do; BRINE, Holly; WEINER, Gary M.Objective Many newborns are investigated and empirically treated for suspected early-onset sepsis (EOS). This study aimed to describe neonatologists' self-identified risk thresholds for investigating and treating EOS and assess the consistency of these thresholds with clinical decisions. Study Design Voluntary online survey, available in two randomized versions, sent to neonatologists from 20 centers of the Brazilian Network on Neonatal Research. The surveys included questions about thresholds for investigating and treating EOS and presented four clinical scenarios with varying calculated risks. In survey version A, only the scenarios were presented, and participants were asked if they would order a blood test or start antibiotics. Survey version B presented the same scenarios and the risk of sepsis. Clinical decisions were compared between survey versions using chi-square tests and agreement between thresholds and clinical decisions were investigated using Kappa coefficients. Results In total, 293 surveys were completed (145 survey version A and 148 survey version B). The median risk thresholds for blood test and antibiotic treatment were 1:100 and 1:25, respectively. In the high-risk scenario, there was no difference in the proportion choosing antibiotic therapy between the groups. In the moderate-risk scenarios, both tests and antibiotics were chosen more frequently when the calculated risks were included (survey version B). In the low-risk scenario, there was no difference between survey versions. There was poor agreement between the self-described thresholds and clinical decisions. Conclusion Neonatologists overestimate the risk of EOS and underestimate their risk thresholds. Knowledge of calculated risk may increase laboratory investigation and antibiotic use in infants at moderate risk for EOS.
- EVALUATION OF USABILITY OF A NEONATAL HEALTH INFORMATION SYSTEM ACCORDING TO THE USER’S PERCEPTION(2018) PADRINI-ANDRADE, Lucio; BALDA, Rita de Cássia Xavier; ARECO, Kelsy Catherina Nema; BANDIERA-PAIVA, Paulo; NUNES, Marynéa do Vale; MARBA, Sérgio Tadeu Martins; CARVALHO, Werther Brunow de; RUGOLO, Ligia Maria Suppo de Souza; ALMEIDA, João Henrique Carvalho de; PROCIANOY, Renato Soibelmann; DUARTE, José Luiz Muniz Bandeira; REGO, Maria Albertina Santiago; FERREIRA, Daniela Marques de Lima Mota; ALVES FILHO, Navantino; GUINSBURG, Ruth; DINIZ, Edna Maria de Albuquerque; SANTOS, Juliana Paula Ferraz dos; TESTONI, Daniela; SILVA, Nathalia Moura de Mello e; GONZALES, Maria Rafaela Conde; SILVA, Regina Vieira Cavalcante da; MENESES, Jucille; GONÇALVES-FERRI, Walusa Assad; PERUSSI-E-SILVA, Ricardo; BOMFIM, OlgaABSTRACT Objective: To measure the level of satisfaction regarding the usability of a neonatal health information system and identify if demographic factors can influence the usability of a health information system. Methods: A cross-sectional, exploratory study was carried out with a convenience sample of 50 users of the Brazilian Neonatal Research Network. The instrument chosen for the usability evaluation was the System Usability Scale between February and March 2017. The statistical analysis of the collected variables was carried out in order to describe the sample, to quantify the level of satisfaction of the users and to identify the variables associated with the level of satisfaction. Results: The female gender represented 75% of the sample. The mean age was 52.8 years; 58% had a doctoral degree, average time of graduation was 17 years, with area of practice in medicine (neonatology), with intermediate knowledge in computer science (74%) and mean system use time of 52 months. Regarding usability, 94% rated the system as “good”, “excellent” or “better than imaginable”. The usability of the system was not associated with age, gender, education, profession, area of practice, knowledge in computer science and time of system use. Conclusion: The level of satisfaction of the computerized health system user was considered good. No demographic factors were associated with the satisfaction of the users.
- Monitoramento eletrofisiológico do sistema auditivo central em crianças nascidas pequenas para a idade gestacional(2020) ANGRISANI, Rosanna Giaffredo; MATAS, Carla Gentile; DINIZ, Edna Maria Albuquerque; GUINSBURG, Ruth; AZEVEDO, Marisa Frasson deABSTRACT Purpose To follow up the central auditory system of children born small for gestational age, through electrophysiological evaluation of hearing, in order to verify the occurrence of possible neural dysfunctions in this system. Methods A longitudinal study was carried out with 23 children divided into four groups: Term-born group, subdivided into small for gestational age (four children) and four children born with appropriate weight for gestational age, whose age at the end of the research was three years old. Preterm group subdivided into small for gestational age (seven children), and appropriate for gestational age (eight children), whose corrected age, at the end of the research was three years old. All children were subjected to assessment of auditory brainstem auditory evoked potentials at birth, at six months and at three years of age, and Long-Latency Auditory Evoked Potential at three years. Results children born at term and small for gestational age had a higher occurrence of hearing alterations in relation to the other groups, with increased latency of waves III and V and interpeaks I-III and I-V. All children presented normal evaluation in the Long-Latency Auditory Evoked Potential. Conclusion Children born term and small for gestational age present dysfunctions in neural conduction in the brainstem and should be considered at risk for alterations in the development of the auditory skills that are necessary to guarantee quality of acoustic information processing.
- Caracterização eletrofisiológica da audição em prematuros nascidos pequenos para a idade gestacional(2013) ANGRISANI, Rosanna Mariangela Giaffredo; AZEVEDO, Marisa Frasson de; CARVALLO, Renata Mota Mamede; DINIZ, Edna Maria de Albuquerque; FERRARO, Alexandre Archanjo; GUINSBURG, Ruth; MATAS, Carla GentilePURPOSE: To characterize the Auditory Brainstem Response (ABR) of small for gestational age preterm newborns and to compare the findings to those of appropriate for gestational age premature newborns in order to verify whether the small for gestational age condition is a risk factor for hearing loss. METHODS: This prospective cross-sectional multicenter study evaluated 72 preterm newborns of both genders (35 small and 37 appropriate for gestational age), who were born at 30 to 36 weeks of gestational age and were evaluated before hospital discharge. Only newborns with present transient evoked otoacoustic emissions and tympanometry type A were included. The ABR was performed with click stimuli. The quantitative data analysis was performed using mean and standard deviation measures for each group. For qualitative analysis, the ABR results were classified as normal or altered according to the absolute latencies of waves I, III, V and interpeaks I-III, III-V, I-V. The analysis was carried out considering the age of the newborn at the time of examination. RESULTS: Alterations were evident in 32 newborns (44.44%), being 15 small (43%) and 17 appropriate for gestational age (46%), with no between-groups difference. Of the 15 small for gestational age newborns with altered ABR, six presented as auditory risk only the small for gestational age condition. In the group of adequate for gestational age newborns, there was a higher occurrence of alteration in males. CONCLUSION: There was no difference in responses of auditory evoked potential between small and appropriate for gestational age preterm newborns. Therefore, the condition does not behave as a risk factor for retrocochlear impairment.
- T-piece versus self-inflating bag ventilation in preterm neonates at birth(2018) GUINSBURG, Ruth; ALMEIDA, Maria Fernanda Branco de; CASTRO, Junia Sampel de; GONCALVES-FERRI, Walusa Assad; MARQUES, Patricia Franco; CALDAS, Jamil Pedro Siqueira; KREBS, Vera Lucia Jornada; RUGOLO, Ligia Maria Suppo de Souza; ALMEIDA, Joao Henrique Carvalho Leme de; LUZ, Jorge Hecker; PROCIANOY, Renato S.; DUARTE, Jose Luiz Muniz Bandeira; PENIDO, Marcia Gomes; FERREIRA, Daniela Marques de Lima Mota; FILHO, Navantino Alves; DINIZ, Edna Maria de Albuquerque; SANTOS, Juliana Paula; ACQUESTA, Ana Lucia; SANTOS, Cristina Nunes dos; GONZALEZ, Maria Rafaela Conde; SILVA, Regina P. G. Vieira Cavalcanti da; MENESES, Jucile; LOPES, Jose Maria de Andrade; MARTINEZ, Francisco EulogioObjective To verify whether the use of the T-piece resuscitator compared with the self-inflating bag in preterm infants ventilated at birth modifies survival to hospital discharge without major morbidities. Design Pragmatic prospective cohort study. Setting 20 Brazilian university hospitals of Brazilian Network on Neonatal Research. Patients were 1962 inborn infants in 2014-2015 ventilated at birth with 23-33' weeks gestation and birth weight 400-1499 g without malformations. Patients transferred until the 27th day after birth were excluded. Interventions Positive pressure ventilation at birth with T-piece resuscitator or self-inflating bag without positive end expiratory pressure valve. Intervention with ventilation followed the Brazilian Society of Pediatrics guidelines. The choice of the equipment was at the neonatologist's discretion in each delivery. The main outcome measures were survival to hospital discharge without bronchopulmonary dysplasia, severe peri-intraventricular haemorrhage and periventricular leucomalada. Logistic regression adjusted for confounding variables was applied for main outcome. Results 1456 (74%) were only ventilated with T-piece resuscitator and 506 (26%) with the self-inflating bag. The characteristics of those ventilated with T-Piece resuscitator versus self-inflating bag were birth weight 969 +/- 277 vs 941 +/- 279 g, gestational age 28.2 +/- 2.5 vs 27.8 +/- 2.7 weeks and survival to hospital discharge without major morbidities 47% vs 35%, Logistic regression adjusted for maternal characteristics, obstetric and neonatal morbidities showed that the T-piece resuscitator increased the chance of survival to hospital discharge without major morbidities (OR=1.38; 95% Cl 1.06 to 1.80; Hosmer-Lemeshow goodness of fit: 0.695). Conclusion This study is the first that highlights the effectiveness of T-piece resuscitator ventilation in improving relevant outcomes in preterm neonates.
- Admission hypothermia, neonatal morbidity, and mortality: evaluation of a multicenter cohort of very low birth weight preterm infants according to relative performance of the center(2019) CALDAS, Jamil Pedro de Siqueira; FERRI, Walusa A. G.; MARBA, Sergio T. M.; ARAGON, Davi C.; GUINSBURG, Ruth; ALMEIDA, Maria F. B. de; DINIZ, Edna M. A.; SILVEIRA, Rita C. S.; ALVES JUNIOR, Jose M. S.; PAVANELLI, Marco B.; BENTLIN, Maria R.; FERREIRA, Daniela M. L. M.; VALE, Marynea S.; FIORI, Humberto H.; DUARTE, Jose L. M. B.; MENESES, Jucille A.; CWAJG, Silvia; CARVALHO, Werther B.; FERRARI, Ligia S. L.; SILVA, Nathalia M. M.; SILVA, Regina P. G. V. C. da; ANCHIETA, Leni M.; SANTOS, Juliana P. F.; KAWAKAMI, Mandira D.This prospective cohort study aimed to assess the association of admission hypothermia (AH) with death and/or major neonatal morbidities among very low birth weight (VLBW) preterm infants based on the relative performance of 20 centers of the Brazilian Network of Neonatal Research. This is a retrospective analysis of prospectively collected data using the database registry of the Brazilian Network on Neonatal Research. Center performance was defined by the relative mortality rate using conditional inference trees. A total of 4356 inborn singleton VLBW preterm infants born between January 2013 and December 2016 without malformations were included in this study. The centers were divided into two groups: G1 (with lower mortality rate) and G2 (with higher mortality rate). Crude and adjusted relative risks (RR) and 95% confidence intervals (95%CI) were estimated by simple and multiple log-binomial regression models. An AH rate of 53.7% (19.8-93.3%) was significantly associated with early neonatal death in G1 (adjusted RR 1.41, 95% CI 1.09-1.84) and G2 (adjusted RR 1.29, 95%CI 1.01-1.65) and with in-hospital death in G1 (adjusted RR 1.29, 95%CI 1.07-1.58). AH was significantly associated with a lower frequency of necrotizing enterocolitis (adjusted RR 0.58, 95%CI 38-0.88) in G2.Conclusion: AH significantly associated with early neonatal death regardless of the hospital performance. In G2, an unexpected protective association between AH and necrotizing enterocolitis was found, whereas the other morbidities assessed were not significantly associated with AH.
- Death or survival with major morbidity in VLBW infants born at Brazilian neonatal research network centers(2016) GUINSBURG, Ruth; ALMEIDA, Maria Fernanda Branco de; CASTRO, Junia Sampel de; SILVEIRA, Rita C.; CALDAS, Jamil Pedro de Siqueira; FIORI, Humberto Holmer; VALE, Marynea Silva do; ABDALLAH, Vania Olivetti Steffen; CARDOSO, Laura Emilia Monteiro Bigelli; ALVES FILHO, Navantino; MOREIRA, Maria Elisabeth; ACQUESTA, Ana Lucia; FERRARI, Ligia S. Lopes; BENTLIN, Maria Regina; VENZON, Paulyne Stadler; FERRI, Walusa Assad Goncalves; MENESES, Jucille do Amaral; DINIZ, Edna Maria De Albuquerque; ZANARDI, Dulce Maria Toledo; SANTOS, Cristina Nunes Dos; DUARTE, Jose Luiz Bandeira; REGO, Maria Albertina SantiagoObjective: To analyze unfavorable outcomes at hospital discharge of preterm infants born at Brazilian public university centers.Methods: Prospective cohort of 2646 inborn infants with gestational age 23-33 weeks and birth weight 400-1499g, without malformations, born at 20 centers in 2012-2013. Unfavorable outcome was defined as in-hospital death or survival at hospital discharge with 1 major morbidities: bronchopulmonary dysplasia (BPD) at 36 corrected weeks, intraventricular hemorrhage (IVH) grades 3-4, periventricular leukomalacia (PVL) or surgically treated retinopathy of prematurity (ROP).Results: Among 2646 infants, 1390 (53%) either died or survived with major morbidities: 793 (30%) died; 497 (19%) had BPD; 358 (13%) had IVH 3-4 or PVL; and 84 (3%) had ROP. Logistic regression adjusted by center showed association of unfavorable outcome with: antenatal steroids (OR 0.70; 95%CI 0.55-0.88), C-section (0.72; 0.58-0.90), gestational age <30 (4.00; 3.16-5.07), being male (1.44; 1.19-1.75), small for gestational age (2.19; 1.72-2.78), 5th-min Apgar <7 (3.89; 2.88-5.26), temperature at NICU admission <36.0 degrees C (1.42; 1.15-1.76), respiratory distress syndrome (3.87; 2.99-5.01), proven late sepsis (1.33; 1.05-1.69), necrotizing enterocolitis (3.10; 2.09-4.60) and patent ductus arteriosus (1.69; 1.37-2.09).Conclusions: More than half of the VLBW infants born at public university level 3 Brazilian hospitals either die or survive with major morbidities.
- Longitudinal electrophysiological study of auditory pathway in small for gestational age infants(2014) ANGRISANI, Rosanna Giaffredo; DINIZ, Edna Maria Albuquerque; GUINSBURG, Ruth; FERRARO, Alexandre Archanjo; AZEVEDO, Marisa Frasson de; MATAS, Carla GentilePURPOSE: To follow the maturation of the auditory pathway of infants born small for gestational age term, by studying absolute and interpeak latencies of Auditory Brainstem Response (ABR) in the first six months of life. METHODS: Multicentric prospective longitudinal study. The ABR was carried out in the neonatal period in 96 newborn infants, 49 small for gestational age (SGA) and 47 appropriate for gestational age (AGA). Of these, 77 infants (39 SGA and 38 AGA) returned for a second evaluation. In the third evaluation, 70 infants (35 SGA and 35 AGA) returned. RESULTS: SGA and AGA did not present significant differences in the neonatal period and at three months of life. However, at six months, there was statistical significant difference between SGA and AGA groups for the latencies of wave III and interpeak I-III. Latencies of ABR waves decreased more rapidly in the first three months than the third to the sixth month of life for the SGA. AGA group showed progressive decrease in latency of ABR waves during the six months. CONCLUSION: The findings suggest that, for SGA infants, the maturational process of the auditory pathway occurs in different rate when compared to AGA infants. The SGA infants have faster maturation especially at the first three months of life, while in infants AGA, this process occurred in a constant and gradual way throughout the six months studied.