LILIAN DOS SANTOS RODRIGUES SADECK
Projetos de Pesquisa
Unidades Organizacionais
Instituto da Criança, Hospital das Clínicas, Faculdade de Medicina - Médico
6 resultados
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- 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.
- Fatores de risco associados ao desmame em crianças até seis meses de idade no município de São Paulo(2012) LEONE, Cléa Rodrigues; SADECK, Lilian dos Santos R.OBJECTIVE: To evaluate risk factors associated to interruption of exclusive breastfeeding among children <6 months of age in São Paulo city in 2008. METHODS: A special questionnaire (Breastfeeding and Cities Project-1998) was applied to the parents/guardians of children <6 months of age during the National Poliomyelitis Campaign. Sample calculation used a two stage cluster sampling procedure. The following groups were compared: I (children exclusively breastfed); II (children without exclusive breastfeeding). Factors analyzed: mother's age and schooling, infant birth weight, gender, type of delivery, being born in a Baby-Friendly Hospital, presence of early breastfeeding, use of pacifier in the last 24 hours, and mother working outside home. Statistical analysis included binary logistic regression by SPSS 15.0, being significant p<0.05. RESULTS: 724 interviews were performed with 275 (39.1%) children in Group I and 429 (60.9%) in Group II. Differences between groups were found on: use of pacifier in the last 24 hours (GI 32.3 vs. GII59.8%; p<0.0001), mothers working outside home (GI 12.4 vs. GII 24.8%; p=0.0002) and child's age(GI 74.1±45.3 vs. GII105.8±49.5 days; p<0.0001). Multivariate analysis showed significant association of non-exclusive breastfeeding in this sample with use of pacifier in the last 24 hours (OR 3.02; 95%CI 2.10-4.36); mother working outside home (OR 2.11; 95%CI 1.24-3.57), and child's age (OR 1.01, 95%CI 1.01-1.02). CONCLUSIONS: In this population under six months of age, the use of pacifier in the last 24 hours was associated with not being exclusively breastfed, as well as mother work outside home and child's age. These are important factors to consider in breastfeeding promotion programs.
- Proactive management of extreme prematurity: disagreement between obstetricians and neonatologists(2012) GUINSBURG, R.; ALMEIDA, M. F. Branco de; SADECK, L. dos Santos Rodrigues; MARBA, S. T. M.; RUGOLO, L. M. Suppo de Souza; LUZ, J. H.; LOPES, J. M. de Andrade; MARTINEZ, F. E.; PROCIANOY, R. S.Objective: To verify, in extremely preterm infants, if disagreement between obstetricians and neonatologists regarding proactive management is associated with early death. Study Design: Prospective cohort of 484 infants with 23(0/7) to 26(6/7) weeks, without malformations, born from January 2006 to December 2009 in eight Brazilian hospitals. Pro-active management was defined as indication of >= 1 dose of antenatal steroid or cesarean section (obstetrician) and resuscitation at birth according to the international guidelines (neonatologist). Main outcome was neonatal death in the first 24 h of life. Result: Obstetricians and neonatologists disagreed in 115 (24%) patients: only neonatologists were proactive in 107 of them. Disagreement between professionals increased 2.39 times the chance of death in the first day (95% confidence interval 1.40 to 4.09), adjusted for center and maternal/neonatal clinical conditions. Conclusion: In infants with 23 to 26 weeks of gestation, disagreement between obstetricians and neonatologists, translated as lack of antenatal steroids and/or vaginal delivery, despite resuscitation procedures, increases the odds of death in the first day. Journal of Perinatology (2012) 32, 913-919; doi:10.1038/jp.2012.28; published online 29 March 2012
- Longitudinal study of Cystatin C in healthy term newborns(2011) NOVO, Ana Carolina de Albuquerque Cavalcanti Ferreira; SADECK, Lilian dos Santos Rodrigues; OKAY, Thelma Suely; LEONE, Clea RodriguesOBJECTIVE: The purpose of this study was to determine the levels of Cystatin C in healthy term newborns in the first month of life. INTRODUCTION: Cystatin C may be a suitable marker for determining the glomerular filtration rate because it is not affected by maternal renal function. METHODS: Cohort study. Inclusion: term newborns with appropriate weight; mother without renal failure or drugs that could affect fetal glomerular filtration rate. Exclusion: malformations; hypertension or any condition that could affect glomerular filtration rate. Cystatin C (mg/L) and creatinine (mg/dl) were determined in the mother (Mo) and in the newborn at birth (Day-0), 3(rd) (Day-3), 7(th) (Day-7) and 28(th) (Day-28) days. Statistics: one way ANOVA and Pearson's correlation tests. Sample size of 20 subjects for alpha = 5% and a power test = 80% (p < 0.05). RESULTS: Data from 21 newborns were obtained (mean +/- standard deviation): MoCystatin C = 1.00 +/- 0.20; Day-0 Cystatin C 1.70 +/- 0.26; Day-3 Cystatin C = 1.51 +/- 0.20; Day-7 Cystatin C = 1.54 +/- 0.10; Day-28 Cystatin C = 1.51 +/- 0.10. MoCystatin C was smaller than Day-0 Cystatin C (p < 0.001), while MoCreatinine was not different from Day-0 Creatinine. Cystatin C only decreased from Day-0 to Day-3 (p = 0.004) but newborns Creatinine decreased along the time. Correlations were obtained between MoCystatin C and MoCreatinine (p = 0.012), as well as Day-3 (p = 0.047) and Day-28 (p = 0.022) Cystatin C and Creatinine values. CONCLUSION: Neonatal Cystatin C values were not affected by MoCystatin C and became stable from the 3(rd) day of life.
- Avaliação da situação do aleitamento materno em menores de um ano de idade no Município de São Paulo, Brasil, em 2008(2013) SADECK, Lilian dos Santos Rodrigues; LEONE, Clea RodriguesThis cross-sectional epidemiological study based on AMAMUNIC aimed to evaluate infant breast-feeding (BF) prevalence and duration in Sao Paulo, Brazil. Sample size was based on a cluster calculation, selecting 35 primary care units and 35 infants (<1 year of age) per unit. A total of 1,424 interviews with mothers were performed (56 items on feeding in the previous 24 hours) in August 2008, subsequently analyzed according to residential areas: Central West, East, North, Southeast, and South. Prevalence of exclusive breastfeeding (EBF) was 52% up to three months and 39% up to six months, as follows: 44% (Central West), 57% (East), 62% (North), 43% (Southeast), and 48% (South) up to three months and 36% (Central West), 46% (East), 39% (North), 36% (Southeast), and 33% (South) up to six months. Prevalence of EBF according to infant age was 58% in the first month, 50% in the second and third, and 13% in the sixth. In conclusion, EBF prevalence up to six months is still heterogeneous in the city, suggesting the need for programs to encourage BF that are differentiated according to region.
- An update on vaccination in preterm infants(2023) SADECK, Lilian dos Santos Rodrigues; KFOURI, Renato de AvilaObjective: The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population.Data source: Most recent scientific publications addressing the immunization of preterm newborns. Data synthesis: Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that pre-term infants undergo unjustified delays in their vaccination schedule.Conclusions: Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants.(c) 2022 Sociedade Brasileira de Pediatria.