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
9 resultados
Resultados de Busca
Agora exibindo 1 - 9 de 9
- 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.
- 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.
- 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.
- Orofacial characteristics of the very low-birth-weight preterm infants(2021) RUIZ, Doris Rocha; DINIZ, Edna Maria de Albuquerque; KREBS, Vera Lucia Jornada; CARVALHO, Werther Brunow deObjective: To evaluate the orofacial characteristics of very low-birth-weight preterm infants through anthropometric facial measures, orofacial anteroposterior analysis and the relationship between the gum pads. Method: Orofacial examinations was performed in 154 infants, classified into two groups: Group A comprised 54 very low-birth-weight infants who were examined after clinical stabilization and before hospital discharge, and Group B comprised 100 full-term infants. Results: The average anthropometricmeasurements in millimetres for Group A and Group B were as follows: upper third:30.2 and 31.1; middle third: 24.2 and 25.9; lower third: 27.6 and 29.9; facial width: 64.8 and 81.4. Regarding the orofacial anteroposterior analysis, the results showed that in 99% of these infants, the mandible was in a retrognathic position relative to the maxilla.Group A and Group B had the following distributions of the relationship between the gum pads: overbite-overjet: 43% and 77%; overjet: 39% and 17%; open bite: 15% and 3%; end-to-end: 2% and 1%; overbite: both 2%. Conclusion: The very low-birth-weight preterm infants showed the upper third with the highest values in the facialharmony analysis, followed by the lower third and the middle third; and exhibited themandible in a retrognathic position relative to the maxilla, and with overbite-overjet themost prevalent type of gum pad relationship. The study emphasizes the importance of orofacial examination during neonatal hospitalization and the investigation of birth weight and gestational age in a multidisciplinary therapeutic approach that includes orofacial neonatal evaluation and actions that promote oral health, besides foster follow-up studies. (C) 2020 Published by Elsevier Editora Ltda. on behalf of Sociedade Brasileira de Pediatria.
- Use of budesonide associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia in premature newborns- A systematic review(2023) MORAES, Lucas Hirano Arruda; COELHO, Rachel Mocelin Dias; BEOZZO, Glenda Priscila Neves dos Santos; YOSHIDA, Renata de Araujo Monteiro; DINIZ, Edna Maria de Albuquerque; CARVALHO, Werther Brunow deObjective: Among the mechanisms proposed for the development of bronchopulmonary dysplasia is the increase in the pulmonary inflammatory process and oxidative stress. Thus, the control of this process may result in improvements in bronchopulmonary dysplasia-related outcomes. This study aims to analyze the current scientific evidence regarding the use of budesonide, a potent anti-inflammatory drug, associated with a pulmonary surfactant to prevent bronchopulmonary dysplasia.Methods: A systematic review of the literature was performed on the Embase and MEDLINE plat-forms, and studies that compared budesonide with pulmonary surfactant versus pulmonary sur-factant for treating respiratory distress syndrome were included. The primary outcome was a reduction in bronchopulmonary dysplasia or death. Results: Four randomized clinical trials and two observational studies were included in this systematic review. Three of the randomized clinical trials found a reduction in bronchopulmonary dysplasia or death in the use of budesonide with the surfactant, all the other studies (1 clinical trial and 2 observa-tional studies) found no statistical differences between the groups for the primary outcomes. The three main studies showed a reduction in the primary outcome; however, all studies showed great heteroge-neity regarding the type of surfactant (poractant or beractant) and the method of administration. Conclusion: Robust clinical studies, in a heterogeneous population, using porcine surfactant associated with budesonide, with administration by a minimally invasive technique are necessary for there to be a recommendation based on scientific evidence for its widespread use.(c) 2022 Sociedade Brasileira de Pediatria.
conferenceObject METABOLIC ALTERATIONS AND GROWTH DISORDERS IN CHILDREN BORN WITH VERY LOW BIRTH WEIGHT AND PRETERM INFANTS SMALL FOR GESTATIONAL AGE AT 36 MONTHS OF CORRECTED GESTATIONAL AGE(2023) ATHAYDE, D.; COMINATO, L.; ATHAYDE, G.; FIRMINO, S.; SADECK, L.; DINIZ, E.; DAMIANI, D.- Early Empiric Antibiotic Use Is Associated With Delayed Feeding Tolerance in Preterm Infants: A Retrospective Analysis(2017) MARTINEZ, Francisco E.; FERRI, Walusa A. G.; LEONE, Clea R.; ALMEIDA, Maria Fernanda Branco de; GUINSBURG, Ruth; MENESES, Jucille do Amaral; VALE, Marynea Silva do; MARBA, Sergio Tadeu Martins; CARVALHO, Werther Brunow de; RUGOLO, Ligia Maria Suppo de Souza; LOPES, Jose Maria de Andrade; RIBEIRO, Manoel A.; PROCIANOY, Renato S.; DUARTE, Jose Luiz Muniz Bandeira; BOUZADA, Maria Candida Ferrarez; FERREIRA, Daniela Marques de Lima Mota; ALVES FILHO, Navantino; DINIZ, Edna Maria de Albuquerque; ZANARDI, Dulce Maria Toledo; TESTONI, Daniela; SANTOS, Cristina Nunes dos; GOMZALEZ, Maria Rafaela Conde; VENZON, Paulyne Stadler; BELIK, JaquesThe causative factors of neonatal feeding intolerance are poorly understood, but potentially related to clinical practices such as empiric antibiotic usage. The objective of this study was to evaluate whether early empiric antibiotic exposure negatively affects preterm infants' enteral feeding tolerance. Data from infants without risk factors for sepsis, 500 to 1499 g birth weight and 24 to 34 weeks gestational age were analyzed. The primary outcomes were the empiric antibiotic exposure effects on the infants' total parenteral nutrition usage duration and prevalence of necrotizing enterocolitis (NEC). Among the 901 infants included, 67 were exposed to early empiric antibiotic. A 50% increase in parenteral nutrition usage duration and a 4-fold greater prevalence of NEC was seen in the early empiric antibiotic-exposed neonates, when compared with control infants (P<0.01). Early empiric antibiotic exposure appears to negatively influence preterm infant feeding tolerance and possibly contributes to NEC.