Gustavo rocha - Academia.edu (original) (raw)

Papers by Gustavo rocha

Introdução: A pneumonia congénita é uma infeção do trato respiratório inferior com origem intraut... more Introdução: A pneumonia congénita é uma infeção do trato respiratório inferior com origem intrauterina, que se estabelece nas primeiras horas ou dias de vida e contribui para a morbilidade e mortalidade do recém-nascido. Objetivo: Avaliar os fatores de risco e agentes patogénicos mais preponderantes na pneumonia congénita, bem como a sua importância e associação com a taxa de morbilidade e mortalidade dos recém-nascidos em dois períodos, 2002 a 2006 e 2007 a 2012. Métodos: Foram revistos todos os registos clínicos maternos e dos recém-nascidos internados no Serviço de Neonatologia do Hospital de São João, Porto, entre 2002 e 2012,. Foram avaliados todos os dados dos recém-nascidos e verificada a relevância estatística dos mesmos. Resultados: Nos 61 processos clínicos acedidos, foram encontrados 14 (23%) recém-nascidos que faleceram. Os fatores de risco com maior incidência foram a rotura prolongada de membranas e a corioamnionite. As infeções de placenta são mais graves (grau II e I...

Introdução-A admissão e permanência numa Unidade de Cuidados Intensivos Neonatais constituem uma ... more Introdução-A admissão e permanência numa Unidade de Cuidados Intensivos Neonatais constituem uma experiência ansiógena para os pais, dada a frustração das suas expectativas e o confronto com a possibilidade de morte do bebé.Os objectivos deste estudo foramverificar como as mães lidam com as características físicas do contexto, com os tratamentos e com a perda do papel parental idealizado; investigar o modo como estas avaliam o atendimento da equipa médica e da equipa de enfermagem; e aferir o grau de satisfação com o Serviço. Material e métodos-Constituiu-se uma amostra de 100 mães cujos recém-nascidos estavam internados na Unidade de Cuidados Intensivos Neonatais, a quem foi solicitado o preenchimento de um questionário elaborado para o efeito. Resultados-De uma forma geral, de acordo com a média de todas as subescalas de stress, verificou-se que o stress total sentido pelas mães foi moderado. Não foram encontradas relações nem diferenças significativas entre a escolaridade e o stress, bem como entre este e a idade das mães. Quanto à satisfação com o atendimento dos médicos, verificou-se que, quando esta aumenta, o stress total diminui e vice-versa. As mães mostram-se satisfeitas com o atendimento da equipa de enfermagem. Conclusão-A perda do papel parental é o factor mais ansiógeno para as mães. Os resultados obtidos reforçam a necessidade de continuar o trabalho de transformação da unidade num espaço o mais acolhedor possível para as mães e para os recém-nascidos.

Revista Portuguesa de Pneumologia, 2008

Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pe... more Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém-nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém-nascido é frequentemente fatal.

Revista Portuguesa de Pneumologia (English Edition), 2008

Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pe... more Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém-nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém-nascido é frequentemente fatal.

Revista Portuguesa de Pneumologia (English Edition), 2010

Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a ... more Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a apresentação neonatal ocorre em cerca de 50% dos casos. Os autores apresentam quatro casos clínicos de ELC no recém-nascido. Casos clínicos: Quatro recém-nascidos de termo, 3M/1F, admitidos por dificuldade respiratória com início variável entre as 20 horas e os 18 dias de vida, apresentaram radiografia de tórax na admissão sugestiva de ELC, diagnóstico confirmado por tomografia axial computorizada. O ELC afectou o lobo superior direito em três casos e o lobo Abstract Introduction: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that presents in the neonatal period in about 50% of the cases. The authors report four clinical cases of congenital lobar emphysema in the newborn. Clinical cases: Four term newborns, 3M/ 1F, were admitted for respiratory distress starting between 20 hours of life and 18 days. The chest x-ray at admission was suggestive of CLE and the diagnosis was confirmed by computorized tomography. The CLE affected the right upper lobe in three cases and the Enfisema lobar congénito com apresentação neonatal. Revisão de quatro casos clínicos Congenital lobar emphysema of the newborn. Report of four clinical cases Recebido para publicação/received for publication: 30.11.09 Aceite para publicação/accepted for publication: 07.06.10

The Journal of Maternal-Fetal & Neonatal Medicine, 2014

Objective: Bronchopulmonary dysplasia (BPD) or chronic lung disease is one of the principal cause... more Objective: Bronchopulmonary dysplasia (BPD) or chronic lung disease is one of the principal causes of mortality and morbidity in preterm infants. Early identification of infants at the greater risk of developing BPD may allow a targeted approach for reducing disease severity and complications. The trigger cause of the disease comprehends the impairment of the alveolar development and the increased angiogenesis. Nevertheless, the molecular pathways characterizing the disease are still unclear. Therefore, the use of the metabolomics technique, due to the capability of identifying instantaneous metabolic perturbation, might help to recognize metabolic patterns associated with the condition. Methods: The purpose of this study is to compare urinary metabolomics at birth in 36 newborns with a gestational age below 29 weeks and birth weight51500 g (very low birth weight-VLBW), admitted in Neonatal Intensive Care Unit (NICU) divided into two groups: the first group (18 cases) consisting of newborns who have not yet developed the disease, but who will subsequently develop it and the second group (18 controls) consisting of newborns not affected by BPD. Urine samples were collected within 24-36 h of life and immediately frozen at À80 C. Results: The 1 H-NMR spectra were analyzed using a partial least squares discriminant analysis (PLS-DA) model coupled with orthogonal Signal Correction. Using this approach it was possible with urine at birth to discriminate newborns that will be later have a diagnosis of BPD with a high statistics power. In particular, we found five important discriminant metabolites in urine in BPD newborns: lactate, taurine, TMAO, myoinositol (which increased) and gluconate (which decreased). Conclusion: These preliminary results seem to be promising for the identification of predictor's biomarkers characterizing the BPD condition. These data may suggest that BPD is probably the result of an abnormal development (respiratory bud, vascular tree, hypodysplasia of pneumocytes) and could be considered a congenital disease (genetics plus intrauterine epigenetics). Early identification of infants at the greater risk of developing BPD may allow a targeted approach for reducing disease severity and complications.

Revista Portuguesa de Pneumologia (English Edition), 2007

Quilotórax no feto e no recém-nascido-Orientação do tratamento Chylothorax in the fetus and the n... more Quilotórax no feto e no recém-nascido-Orientação do tratamento Chylothorax in the fetus and the neonate-Guidelines for treatment Recebido para publicação/received for publication: 06.05.24 Aceite para publicação/accepted for publication: 07.01.19

Revista Portuguesa de Pneumologia (English Edition), 2010

Resumo A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hiali... more Resumo A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese Objectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes. Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) <30 semanas e/ou peso <1250 g internados em cinco unidades portuguesas, entre 2004 e 2006, foram estudados. Foi recolhida a informação clínica dos processos. A DBP foi definida como a necessidade de oxigénio às 36 semanas de idade pós-conceptional.

Clinics, 2010

AIM: The main objective of this study was to evaluate the association between prematurity and the... more AIM: The main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure. METHODS: The medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups. RESULTS: Forty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680-3000) and a mean gestational age (GA) of 36 weeks (range=34-36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500-3550) and a mean GA of 38 weeks (range=37-39). The mean time to achieve full enteral feeding was 30.1±6.7 days in group A and 17.0±2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20-3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (<2500 g), mode of delivery and number of days to achieve full enteral feeding (p=0.34 and p=0.13, respectively). Patients with BW over 2500 g had fewer days in the hospital (22.9±3.1 vs. 35.7±5.7 days; p=0.06). CONCLUSION: The results of this study do not support the idea of anticipating the delivery of fetuses with gastroschisis in order to achieve full enteral feeding earlier.

The Journal of Maternal-Fetal & Neonatal Medicine, 2012

Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision... more Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge and the ethical issues are controversial. The newborn is a person with specific rights which he cannot claim, due to his physical and mental immaturity. These rights impose to the society obligations and responsibilities, which health professionals and institutions of all countries must enforce. Every newborn has the right to life with dignity. Providing compassionate family-centered end-of-life care to infants and their families in the NICU should be a mandatory component of an optimally neonatal palliative care.

The Journal of Maternal-Fetal & Neonatal Medicine, 2009

Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among very low birth ... more Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among very low birth weight infants and must be treated on an individual basis. Non-steroid anti-inflammatory drugs (NSAIDs) have been used in the treatment of PDA. However, no general guidelines have been followed. To know the European reality on NSAIDs in the treatment of PDA in preterm newborns. A questionnaire was sent to 24 European Societies of Neonatology and Perinatology to be filled, at least, by two neonatal intensive care units (NICUs) in each country, and to three representatives NICUs in Europe. We received 45 filled forms from 19 countries: 1 (2%) from North, 12 (27%) from East, 6 (13%) from West, and 26 (58%) from South Europe. Intravenous (iv) indomethacin is used in 32 (71%) NICUs (88% use a 30-60 min perfusion), iv ibuprofen in 16 (36%), and oral ibuprofen in 13 (29%). In 45% of NICUs a second course is used; 27% prescribed a third one. Prolonged treatment, 4-6 days, is mentioned by 45% of NICUs, in extremely low birth eight infants and after the failure of 3 courses of treatment. Prophylactic treatment is used in two NICUs, 24% treat no hemodynamically significant PDA, 96% treat with NSAIDs hemodynamically significant PDA and one NICU uses surgical closure as first line treatment. The ibuprofen/indomethacin contra-indications and preferences are similar to the literature. Pedea is the iv ibuprofen solution used and oral ibuprofen is a solution with 20 mg/ml. The choices are influenced by economical reasons in 22% of NICUs. Our data show a wide variation among NICUs and countries, regarding the use of NSAIDs to treat PDA, and that no general guidelines are followed. Guidelines or recommendations are necessary to standardize treatment of PDA in Europe, in order to give to all newborns identical health care opportunities.

The Journal of Maternal-Fetal & Neonatal Medicine, 2007

To evaluate the association between histological chorioamnionitis and brain damage (intraventricu... more To evaluate the association between histological chorioamnionitis and brain damage (intraventricular hemorrhage and cystic periventricular leukomalacia) in the preterm newborn. This was a retrospective study on neonates born at less than 34 weeks gestational age, and their respective mothers, at three tertiary medical centers in the north of Portugal, from January 2001 to December 2002. The study included 452 newborns (235 male/217 female; birth weight 1440 (515-2620) grams; gestational age 31 (23-33) weeks), 125 from mothers whose placenta showed signs of chorioamnionitis and 327 from mothers without the condition. The association between histological chorioamnionitis and: (1) intraventricular hemorrhage grades I-IV was OR 1.43 (95% CI 0.49-3.94); (2) intraventricular hemorrhage grades III and IV was OR 2.49 (95% CI 1.20-5.11); (3) cystic periventricular leukomalacia was OR 3.02 (95% CI 1.50-6.07). The association, adjusted for birth weight and gestational age, between chorioamnionitis and: (1) intraventricular hemorrhage grades III and IV was OR 0.94 (95% CI 0.39-2.28); (2) cystic periventricular leukomalacia was OR 1.94 (95% CI 1.03-4.61). The association between histological chorioamnionitis with funisitis and/or vasculitis and: (1) intraventricular hemorrhage grades I to IV was OR 1.27 (95% CI 0.52-3.10); (2) cystic periventricular leukomalacia was OR 2.08 (95% CI 0.72-5.98). This study confirms the association between histological chorioamnionitis and cystic periventricular leukomalacia, but was unable to confirm the association between histological chorioamnionitis and intraventricular hemorrhage.

Neonatology, 2013

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal, neo... more Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal, neonatal developmental lung disorder, which usually presents as persistent pulmonary hypertension unresponsive to treatment. The authors report the case of a neonate with persistent pulmonary hypertension, associated with duodenal stenosis secondary to annular pancreas and intestinal malrotation. Support treatment, inhaled nitric oxide, oral sildenafil and nebulized iloprost were used with no clinical improvement. The neonate presented an overwhelming course, with hypoxemia refractory to treatment. At autopsy lung histology showed the characteristic features of ACD/MPV. DNA sequence analysis revealed a heterozygous nonsense mutation c.539C>A;p.S180X, in the first exon of FOXF1. FOXF1 has been identified as one of the genes responsible for ACD/MPV associated with multiple congenital malformations. This clinical case is the first report of a heterozygous nonsense mutation c.539C>A;p.S18...

Journal of Pediatric Hematology/Oncology, 2012

To describe a case of neonatal alloimmune neutropenia (NAN), a very rare disease of the newborn a... more To describe a case of neonatal alloimmune neutropenia (NAN), a very rare disease of the newborn and the first ever reported in our neonatal intensive care unit, with emphasis in its management and outcome. We report a case of NAN due to anti-human neutrophil antigen-1b alloimmunization in a 29-week preterm admitted to our neonatal intensive care unit. In this case, the neutropenia was severe and persisted for almost 2 months. There was a good response to the administration of intravenous immunoglobulin. NAN is caused by maternal production of neutrophil-specific alloantibodies in response to antigens from paternal heritage present on the newborn neutrophiles. The course of the disease is usually mild and self-limiting. The optimal therapy is yet a debate, with some authors finding the use of intravenous immunoglobulin effective, prophylactic antibiotic therapy or recombinant human granulocyte colony-stimulating factor.

Early Human Development, 2008

Background and aim Sildenafil is phosphodiesterase-5 inhibitor. Inhibition of phosphodiesterase-5... more Background and aim Sildenafil is phosphodiesterase-5 inhibitor. Inhibition of phosphodiesterase-5 leads to increased concentration of cyclic guanosine monophosphate locally thereby enhancing the cyclic guanosine monophosphate mediated relaxation of smooth muscles in pulmonary arterial wall. Sildenafil can reduce hyperoxia-induced lung injury in newborn.

Early Human Development, 2008

Background and aim Prematurity < 33 weeks gestation carries a high mortality and morbidity in the... more Background and aim Prematurity < 33 weeks gestation carries a high mortality and morbidity in the neonatal period. The outcome varies according to whether the data comes from regional or individual centres. To assess neurodevelopmental, cognitive and behavioural performance in a cohort of surviving children born at a gestational age >23 and < 33 weeks from a level III NICU. Materials and methods Data was retrospectively collected from files of all inborn children admitted between January1999 to December2003; those transferred elsewhere were excluded. Follow-up was prospectively done according to standard clinical procedures and statistic analysis by SPSS 15.0 and Fisher's exact test. Results Out of 149 < 33 weeks gestation live born admitted to the NICU, 22 (15%) died before discharge and 19 were transferred elsewhere for various reasons, often due to place of residence; of the remaining 108 survivors, 98 were available for follow-up (91%) and assessed at 60 +/− 20 months. Of those, mean GA at birth was 30 +/− 2 weeks, BW 1390 +/− 403 g (with 16% SGA) and neonatal complications included BPD 26%, ROP 7%, IVH 4%, PVL 13% and clinical diagnosis of infection in 62%. Five children (5%) presented with moderate to severe CP, whilst minor neurologic abnormalities queried in 43%, in the first two years of age, completely subsided by the time of the present assessment. Visual impairments (squint/refraction errors) were present in 19%, 3 of them (15%) with CP. No blindness or deafness was registered. Mean Psychomotor Developmental Index (PDI) was 90 +/− 21; moderate to severe mental developmental delay was found in only 8% of children. Of those already at school (30), 50% have learning disabilities, 23% behavioural problems and 20% have ADHD. Of the neonatal morbidities, postnatal steroids, lower GA, BW < 1000 g and the need for supplementary O 2 at 36 weeks GA appeared to negatively influence developmental outcome (p < 0.05). Conclusions Neonatal mortality and morbidity was similar to other series. At follow-up only five children presented with major disabilities. None of the children are blind or deaf and those with minor handicaps all live independent lives. However, learning disabilities and social behavioural problems demand that provision must be made for their educational needs and social support, starting as early as possible preferably before school entry.

Early Human Development, 2008

correlated to clinical and microbiological data. To evaluate temporal association between the pro... more correlated to clinical and microbiological data. To evaluate temporal association between the procedure and infection, we analyzed a 5 days window after the catheter removal. Data about catheters removed because of infection were excluded from the analysis. Results During the study period, 164 neonates were admitted in our NICU (GA 31 ±3.8 weeks; BW 1498 ± 736 g) and a total of 248 catheters were considered for the analysis. The prevalence of sepsis associated to PICC was 10.9% (27/248). In the 5-days window after the catheter removal, the rate of bacterial sepsis was 1.6% (4/248). Sepses were due to Staphylococcus mitis (1), Staphylococcus hominis (1), Staphylococcus epidermidis (1) and Proteus mirabilis (1). All CoNS were susceptible to both teicoplanin and vancomicin, and the Proteus was susceptible to aminoglicosides. The neonates with post removal sepsis showed a longer duration in situ of catheter than those without sepsis (31.8 ± 10.3 vs 18.2 ± 13.7 days; p = 0.0145). Conclusions Our data show a very low rate of sepsis after the PICC removal and do not justify antibiotic prophylaxis.

Early Human Development, 2008

chest radiograph or the ultrasound findings. On a chest X-ray, the diagnosis is made if the right... more chest radiograph or the ultrasound findings. On a chest X-ray, the diagnosis is made if the right hemidiaphragm is two intercostal spaces (ICS) higher than the left or the left hemidiaphragm is one ICS higher than the right. By ultrasound, limited or paradoxical movement would be seen in the involved diaphragm. Results A total of five preterm infants were enrolled with a median gestational age of 28 weeks (range: 26-29) and a median birthweight of 1040 gm (range: 760-1480). One patient underwent diaphragmatic plication because of weaning failure, and the others were managed conservatively. Those who underwent medical treatment were extubated at the median age of 12 days (range: 0-24) after diagnosis. In contrast, the one who received operation was extubated 68 days after diagnosis and 4 days after surgery. The median days for intubation and hospital stay were 55 and 88 in medical group, compared to 71 and 104 days in surgical group. All patients had respiratory distress syndrome and received survanta treatment and developed mild BPD later. Two of the medical group had retinopathy of prematurity (ROP) stage II and III respectively, and the surgical one had ROP stage III. No one developed significant intraventricular hemorrhage. Conclusions Most VLBW infants with diaphragmatic paralysis following PDA ligation can recover spontaneously without having additional complications in this study. Diaphragmatic plication may be considered if there is difficulty in extubation after 2 weeks for observation. However, long term follow-up is needed for VLBW infants with diaphragmatic plication.

Early Human Development, 2010

From a total of 94 children (52-GA; 42-GB), 26/52(50%) and 30/42 (71%) infants of group A and B, ... more From a total of 94 children (52-GA; 42-GB), 26/52(50%) and 30/42 (71%) infants of group A and B, respectively, had indication for PVZ prophylaxis. In GB, 14/30(47%) were immunized. The estimated cost of prophylaxis (5 doses) was 26,000 €-GA and 30,000 €-GB. Ten infants (17.8%) were admitted with RSV bronchiolitis: 8(31%)-GA and 2(6.6%)-GB, median age 4 months (range 1-22) and 80% male. In GA, 4(50%) children were admitted to paediatric intensive care unit (PICU), 3 needing mechanical ventilation. One infant was readmitted. In GB, one infant, admitted for 11 days in the PICU without mechanical ventilation, was infected 13 days after 2 doses of PVZ. The other, was admitted in the nursery 40 days after the fifth dose of PVZ. The total cost of admission was 36,129 €-GA and 27,318 €-GB. Comparing both groups, mechanical ventilation was only needed for GA (1.62 vs. 0; p = 0.003). No differences occurred between total and PICU length of stay (8.

Early Human Development, 2010

Introdução: A pneumonia congénita é uma infeção do trato respiratório inferior com origem intraut... more Introdução: A pneumonia congénita é uma infeção do trato respiratório inferior com origem intrauterina, que se estabelece nas primeiras horas ou dias de vida e contribui para a morbilidade e mortalidade do recém-nascido. Objetivo: Avaliar os fatores de risco e agentes patogénicos mais preponderantes na pneumonia congénita, bem como a sua importância e associação com a taxa de morbilidade e mortalidade dos recém-nascidos em dois períodos, 2002 a 2006 e 2007 a 2012. Métodos: Foram revistos todos os registos clínicos maternos e dos recém-nascidos internados no Serviço de Neonatologia do Hospital de São João, Porto, entre 2002 e 2012,. Foram avaliados todos os dados dos recém-nascidos e verificada a relevância estatística dos mesmos. Resultados: Nos 61 processos clínicos acedidos, foram encontrados 14 (23%) recém-nascidos que faleceram. Os fatores de risco com maior incidência foram a rotura prolongada de membranas e a corioamnionite. As infeções de placenta são mais graves (grau II e I...

Introdução-A admissão e permanência numa Unidade de Cuidados Intensivos Neonatais constituem uma ... more Introdução-A admissão e permanência numa Unidade de Cuidados Intensivos Neonatais constituem uma experiência ansiógena para os pais, dada a frustração das suas expectativas e o confronto com a possibilidade de morte do bebé.Os objectivos deste estudo foramverificar como as mães lidam com as características físicas do contexto, com os tratamentos e com a perda do papel parental idealizado; investigar o modo como estas avaliam o atendimento da equipa médica e da equipa de enfermagem; e aferir o grau de satisfação com o Serviço. Material e métodos-Constituiu-se uma amostra de 100 mães cujos recém-nascidos estavam internados na Unidade de Cuidados Intensivos Neonatais, a quem foi solicitado o preenchimento de um questionário elaborado para o efeito. Resultados-De uma forma geral, de acordo com a média de todas as subescalas de stress, verificou-se que o stress total sentido pelas mães foi moderado. Não foram encontradas relações nem diferenças significativas entre a escolaridade e o stress, bem como entre este e a idade das mães. Quanto à satisfação com o atendimento dos médicos, verificou-se que, quando esta aumenta, o stress total diminui e vice-versa. As mães mostram-se satisfeitas com o atendimento da equipa de enfermagem. Conclusão-A perda do papel parental é o factor mais ansiógeno para as mães. Os resultados obtidos reforçam a necessidade de continuar o trabalho de transformação da unidade num espaço o mais acolhedor possível para as mães e para os recém-nascidos.

Revista Portuguesa de Pneumologia, 2008

Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pe... more Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém-nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém-nascido é frequentemente fatal.

Revista Portuguesa de Pneumologia (English Edition), 2008

Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pe... more Caso Clínico Clinical Case Resumo Apesar da ampla cobertura vacinal, a infecção por Bordetella pertussis está longe de estar controlada. Os recém-nascidos e lactentes ainda sem imunização completa e filhos de mães com baixos títulos de anticorpos para a Bordetella pertussis são altamente susceptíveis à infecção e têm maior risco de doença grave e morte. A infecção por Bordetella pertussis associada a hipertensão pulmonar no recém-nascido é frequentemente fatal.

Revista Portuguesa de Pneumologia (English Edition), 2010

Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a ... more Introdução: O enfisema lobar congénito (ELC) é uma anomalia rara do desenvolvimento pulmonar e a apresentação neonatal ocorre em cerca de 50% dos casos. Os autores apresentam quatro casos clínicos de ELC no recém-nascido. Casos clínicos: Quatro recém-nascidos de termo, 3M/1F, admitidos por dificuldade respiratória com início variável entre as 20 horas e os 18 dias de vida, apresentaram radiografia de tórax na admissão sugestiva de ELC, diagnóstico confirmado por tomografia axial computorizada. O ELC afectou o lobo superior direito em três casos e o lobo Abstract Introduction: Congenital lobar emphysema (CLE) is a rare anomaly of lung development that presents in the neonatal period in about 50% of the cases. The authors report four clinical cases of congenital lobar emphysema in the newborn. Clinical cases: Four term newborns, 3M/ 1F, were admitted for respiratory distress starting between 20 hours of life and 18 days. The chest x-ray at admission was suggestive of CLE and the diagnosis was confirmed by computorized tomography. The CLE affected the right upper lobe in three cases and the Enfisema lobar congénito com apresentação neonatal. Revisão de quatro casos clínicos Congenital lobar emphysema of the newborn. Report of four clinical cases Recebido para publicação/received for publication: 30.11.09 Aceite para publicação/accepted for publication: 07.06.10

The Journal of Maternal-Fetal & Neonatal Medicine, 2014

Objective: Bronchopulmonary dysplasia (BPD) or chronic lung disease is one of the principal cause... more Objective: Bronchopulmonary dysplasia (BPD) or chronic lung disease is one of the principal causes of mortality and morbidity in preterm infants. Early identification of infants at the greater risk of developing BPD may allow a targeted approach for reducing disease severity and complications. The trigger cause of the disease comprehends the impairment of the alveolar development and the increased angiogenesis. Nevertheless, the molecular pathways characterizing the disease are still unclear. Therefore, the use of the metabolomics technique, due to the capability of identifying instantaneous metabolic perturbation, might help to recognize metabolic patterns associated with the condition. Methods: The purpose of this study is to compare urinary metabolomics at birth in 36 newborns with a gestational age below 29 weeks and birth weight51500 g (very low birth weight-VLBW), admitted in Neonatal Intensive Care Unit (NICU) divided into two groups: the first group (18 cases) consisting of newborns who have not yet developed the disease, but who will subsequently develop it and the second group (18 controls) consisting of newborns not affected by BPD. Urine samples were collected within 24-36 h of life and immediately frozen at À80 C. Results: The 1 H-NMR spectra were analyzed using a partial least squares discriminant analysis (PLS-DA) model coupled with orthogonal Signal Correction. Using this approach it was possible with urine at birth to discriminate newborns that will be later have a diagnosis of BPD with a high statistics power. In particular, we found five important discriminant metabolites in urine in BPD newborns: lactate, taurine, TMAO, myoinositol (which increased) and gluconate (which decreased). Conclusion: These preliminary results seem to be promising for the identification of predictor's biomarkers characterizing the BPD condition. These data may suggest that BPD is probably the result of an abnormal development (respiratory bud, vascular tree, hypodysplasia of pneumocytes) and could be considered a congenital disease (genetics plus intrauterine epigenetics). Early identification of infants at the greater risk of developing BPD may allow a targeted approach for reducing disease severity and complications.

Revista Portuguesa de Pneumologia (English Edition), 2007

Quilotórax no feto e no recém-nascido-Orientação do tratamento Chylothorax in the fetus and the n... more Quilotórax no feto e no recém-nascido-Orientação do tratamento Chylothorax in the fetus and the neonate-Guidelines for treatment Recebido para publicação/received for publication: 06.05.24 Aceite para publicação/accepted for publication: 07.01.19

Revista Portuguesa de Pneumologia (English Edition), 2010

Resumo A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hiali... more Resumo A displasia broncopulmonar (DBP) é multifactorial. Prematuridade, doença da membrana hialina, oxigénio, ventilação mecânica, inflamação e canal arterial são alguns dos factores na sua patogénese Objectivo: Avaliar a prevalência da DBP e seus factores de risco em cinco unidades portuguesas, para implementar boas práticas no tratamento deste doentes. Material e métodos: 256 recém-nascidos (RN) com idade gestacional (IG) <30 semanas e/ou peso <1250 g internados em cinco unidades portuguesas, entre 2004 e 2006, foram estudados. Foi recolhida a informação clínica dos processos. A DBP foi definida como a necessidade de oxigénio às 36 semanas de idade pós-conceptional.

Clinics, 2010

AIM: The main objective of this study was to evaluate the association between prematurity and the... more AIM: The main objective of this study was to evaluate the association between prematurity and the time to achieve full enteral feeding in newborns with gastroschisis. The second objective was to analyze the associations between length of hospital stay and time to achieve full enteral feeding with mode of delivery, birth weight and surgical procedure. METHODS: The medical records of newborns with gastroschisis treated between 1997 and 2007 were reviewed. Two groups were considered: those delivered before 37 weeks (group A) and those delivered after 37 weeks (group B). The variables of gestational age, mode of delivery, birth weight, time to achieve full enteral feeding, length of hospital stay and surgical approach were analyzed and compared between groups. RESULTS: Forty-one patients were studied. In Group A, there were 14 patients with a mean birth weight (BW) of 2300 g (range=1680-3000) and a mean gestational age (GA) of 36 weeks (range=34-36). In group B, there were 24 patients with a mean BW of 2700 g (range=1500-3550) and a mean GA of 38 weeks (range=37-39). The mean time to achieve full enteral feeding was 30.1±6.7 days in group A and 17.0±2.5 days in group B (p=0.09) with an OR of 0.82 and a 95% CI of 0.20-3.23 after adjustment for sepsis and BW. No statistical difference was found between low BW (<2500 g), mode of delivery and number of days to achieve full enteral feeding (p=0.34 and p=0.13, respectively). Patients with BW over 2500 g had fewer days in the hospital (22.9±3.1 vs. 35.7±5.7 days; p=0.06). CONCLUSION: The results of this study do not support the idea of anticipating the delivery of fetuses with gastroschisis in order to achieve full enteral feeding earlier.

The Journal of Maternal-Fetal & Neonatal Medicine, 2012

Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision... more Advances in perinatal medicine have dramatically improved neonatal survival. End-of-life decision making for newborns with adverse prognosis is an ethical challenge and the ethical issues are controversial. The newborn is a person with specific rights which he cannot claim, due to his physical and mental immaturity. These rights impose to the society obligations and responsibilities, which health professionals and institutions of all countries must enforce. Every newborn has the right to life with dignity. Providing compassionate family-centered end-of-life care to infants and their families in the NICU should be a mandatory component of an optimally neonatal palliative care.

The Journal of Maternal-Fetal & Neonatal Medicine, 2009

Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among very low birth ... more Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among very low birth weight infants and must be treated on an individual basis. Non-steroid anti-inflammatory drugs (NSAIDs) have been used in the treatment of PDA. However, no general guidelines have been followed. To know the European reality on NSAIDs in the treatment of PDA in preterm newborns. A questionnaire was sent to 24 European Societies of Neonatology and Perinatology to be filled, at least, by two neonatal intensive care units (NICUs) in each country, and to three representatives NICUs in Europe. We received 45 filled forms from 19 countries: 1 (2%) from North, 12 (27%) from East, 6 (13%) from West, and 26 (58%) from South Europe. Intravenous (iv) indomethacin is used in 32 (71%) NICUs (88% use a 30-60 min perfusion), iv ibuprofen in 16 (36%), and oral ibuprofen in 13 (29%). In 45% of NICUs a second course is used; 27% prescribed a third one. Prolonged treatment, 4-6 days, is mentioned by 45% of NICUs, in extremely low birth eight infants and after the failure of 3 courses of treatment. Prophylactic treatment is used in two NICUs, 24% treat no hemodynamically significant PDA, 96% treat with NSAIDs hemodynamically significant PDA and one NICU uses surgical closure as first line treatment. The ibuprofen/indomethacin contra-indications and preferences are similar to the literature. Pedea is the iv ibuprofen solution used and oral ibuprofen is a solution with 20 mg/ml. The choices are influenced by economical reasons in 22% of NICUs. Our data show a wide variation among NICUs and countries, regarding the use of NSAIDs to treat PDA, and that no general guidelines are followed. Guidelines or recommendations are necessary to standardize treatment of PDA in Europe, in order to give to all newborns identical health care opportunities.

The Journal of Maternal-Fetal & Neonatal Medicine, 2007

To evaluate the association between histological chorioamnionitis and brain damage (intraventricu... more To evaluate the association between histological chorioamnionitis and brain damage (intraventricular hemorrhage and cystic periventricular leukomalacia) in the preterm newborn. This was a retrospective study on neonates born at less than 34 weeks gestational age, and their respective mothers, at three tertiary medical centers in the north of Portugal, from January 2001 to December 2002. The study included 452 newborns (235 male/217 female; birth weight 1440 (515-2620) grams; gestational age 31 (23-33) weeks), 125 from mothers whose placenta showed signs of chorioamnionitis and 327 from mothers without the condition. The association between histological chorioamnionitis and: (1) intraventricular hemorrhage grades I-IV was OR 1.43 (95% CI 0.49-3.94); (2) intraventricular hemorrhage grades III and IV was OR 2.49 (95% CI 1.20-5.11); (3) cystic periventricular leukomalacia was OR 3.02 (95% CI 1.50-6.07). The association, adjusted for birth weight and gestational age, between chorioamnionitis and: (1) intraventricular hemorrhage grades III and IV was OR 0.94 (95% CI 0.39-2.28); (2) cystic periventricular leukomalacia was OR 1.94 (95% CI 1.03-4.61). The association between histological chorioamnionitis with funisitis and/or vasculitis and: (1) intraventricular hemorrhage grades I to IV was OR 1.27 (95% CI 0.52-3.10); (2) cystic periventricular leukomalacia was OR 2.08 (95% CI 0.72-5.98). This study confirms the association between histological chorioamnionitis and cystic periventricular leukomalacia, but was unable to confirm the association between histological chorioamnionitis and intraventricular hemorrhage.

Neonatology, 2013

Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal, neo... more Alveolar capillary dysplasia with misalignment of pulmonary veins (ACD/MPV) is a rare, fatal, neonatal developmental lung disorder, which usually presents as persistent pulmonary hypertension unresponsive to treatment. The authors report the case of a neonate with persistent pulmonary hypertension, associated with duodenal stenosis secondary to annular pancreas and intestinal malrotation. Support treatment, inhaled nitric oxide, oral sildenafil and nebulized iloprost were used with no clinical improvement. The neonate presented an overwhelming course, with hypoxemia refractory to treatment. At autopsy lung histology showed the characteristic features of ACD/MPV. DNA sequence analysis revealed a heterozygous nonsense mutation c.539C>A;p.S180X, in the first exon of FOXF1. FOXF1 has been identified as one of the genes responsible for ACD/MPV associated with multiple congenital malformations. This clinical case is the first report of a heterozygous nonsense mutation c.539C>A;p.S18...

Journal of Pediatric Hematology/Oncology, 2012

To describe a case of neonatal alloimmune neutropenia (NAN), a very rare disease of the newborn a... more To describe a case of neonatal alloimmune neutropenia (NAN), a very rare disease of the newborn and the first ever reported in our neonatal intensive care unit, with emphasis in its management and outcome. We report a case of NAN due to anti-human neutrophil antigen-1b alloimmunization in a 29-week preterm admitted to our neonatal intensive care unit. In this case, the neutropenia was severe and persisted for almost 2 months. There was a good response to the administration of intravenous immunoglobulin. NAN is caused by maternal production of neutrophil-specific alloantibodies in response to antigens from paternal heritage present on the newborn neutrophiles. The course of the disease is usually mild and self-limiting. The optimal therapy is yet a debate, with some authors finding the use of intravenous immunoglobulin effective, prophylactic antibiotic therapy or recombinant human granulocyte colony-stimulating factor.

Early Human Development, 2008

Background and aim Sildenafil is phosphodiesterase-5 inhibitor. Inhibition of phosphodiesterase-5... more Background and aim Sildenafil is phosphodiesterase-5 inhibitor. Inhibition of phosphodiesterase-5 leads to increased concentration of cyclic guanosine monophosphate locally thereby enhancing the cyclic guanosine monophosphate mediated relaxation of smooth muscles in pulmonary arterial wall. Sildenafil can reduce hyperoxia-induced lung injury in newborn.

Early Human Development, 2008

Background and aim Prematurity < 33 weeks gestation carries a high mortality and morbidity in the... more Background and aim Prematurity < 33 weeks gestation carries a high mortality and morbidity in the neonatal period. The outcome varies according to whether the data comes from regional or individual centres. To assess neurodevelopmental, cognitive and behavioural performance in a cohort of surviving children born at a gestational age >23 and < 33 weeks from a level III NICU. Materials and methods Data was retrospectively collected from files of all inborn children admitted between January1999 to December2003; those transferred elsewhere were excluded. Follow-up was prospectively done according to standard clinical procedures and statistic analysis by SPSS 15.0 and Fisher's exact test. Results Out of 149 < 33 weeks gestation live born admitted to the NICU, 22 (15%) died before discharge and 19 were transferred elsewhere for various reasons, often due to place of residence; of the remaining 108 survivors, 98 were available for follow-up (91%) and assessed at 60 +/− 20 months. Of those, mean GA at birth was 30 +/− 2 weeks, BW 1390 +/− 403 g (with 16% SGA) and neonatal complications included BPD 26%, ROP 7%, IVH 4%, PVL 13% and clinical diagnosis of infection in 62%. Five children (5%) presented with moderate to severe CP, whilst minor neurologic abnormalities queried in 43%, in the first two years of age, completely subsided by the time of the present assessment. Visual impairments (squint/refraction errors) were present in 19%, 3 of them (15%) with CP. No blindness or deafness was registered. Mean Psychomotor Developmental Index (PDI) was 90 +/− 21; moderate to severe mental developmental delay was found in only 8% of children. Of those already at school (30), 50% have learning disabilities, 23% behavioural problems and 20% have ADHD. Of the neonatal morbidities, postnatal steroids, lower GA, BW < 1000 g and the need for supplementary O 2 at 36 weeks GA appeared to negatively influence developmental outcome (p < 0.05). Conclusions Neonatal mortality and morbidity was similar to other series. At follow-up only five children presented with major disabilities. None of the children are blind or deaf and those with minor handicaps all live independent lives. However, learning disabilities and social behavioural problems demand that provision must be made for their educational needs and social support, starting as early as possible preferably before school entry.

Early Human Development, 2008

correlated to clinical and microbiological data. To evaluate temporal association between the pro... more correlated to clinical and microbiological data. To evaluate temporal association between the procedure and infection, we analyzed a 5 days window after the catheter removal. Data about catheters removed because of infection were excluded from the analysis. Results During the study period, 164 neonates were admitted in our NICU (GA 31 ±3.8 weeks; BW 1498 ± 736 g) and a total of 248 catheters were considered for the analysis. The prevalence of sepsis associated to PICC was 10.9% (27/248). In the 5-days window after the catheter removal, the rate of bacterial sepsis was 1.6% (4/248). Sepses were due to Staphylococcus mitis (1), Staphylococcus hominis (1), Staphylococcus epidermidis (1) and Proteus mirabilis (1). All CoNS were susceptible to both teicoplanin and vancomicin, and the Proteus was susceptible to aminoglicosides. The neonates with post removal sepsis showed a longer duration in situ of catheter than those without sepsis (31.8 ± 10.3 vs 18.2 ± 13.7 days; p = 0.0145). Conclusions Our data show a very low rate of sepsis after the PICC removal and do not justify antibiotic prophylaxis.

Early Human Development, 2008

chest radiograph or the ultrasound findings. On a chest X-ray, the diagnosis is made if the right... more chest radiograph or the ultrasound findings. On a chest X-ray, the diagnosis is made if the right hemidiaphragm is two intercostal spaces (ICS) higher than the left or the left hemidiaphragm is one ICS higher than the right. By ultrasound, limited or paradoxical movement would be seen in the involved diaphragm. Results A total of five preterm infants were enrolled with a median gestational age of 28 weeks (range: 26-29) and a median birthweight of 1040 gm (range: 760-1480). One patient underwent diaphragmatic plication because of weaning failure, and the others were managed conservatively. Those who underwent medical treatment were extubated at the median age of 12 days (range: 0-24) after diagnosis. In contrast, the one who received operation was extubated 68 days after diagnosis and 4 days after surgery. The median days for intubation and hospital stay were 55 and 88 in medical group, compared to 71 and 104 days in surgical group. All patients had respiratory distress syndrome and received survanta treatment and developed mild BPD later. Two of the medical group had retinopathy of prematurity (ROP) stage II and III respectively, and the surgical one had ROP stage III. No one developed significant intraventricular hemorrhage. Conclusions Most VLBW infants with diaphragmatic paralysis following PDA ligation can recover spontaneously without having additional complications in this study. Diaphragmatic plication may be considered if there is difficulty in extubation after 2 weeks for observation. However, long term follow-up is needed for VLBW infants with diaphragmatic plication.

Early Human Development, 2010

From a total of 94 children (52-GA; 42-GB), 26/52(50%) and 30/42 (71%) infants of group A and B, ... more From a total of 94 children (52-GA; 42-GB), 26/52(50%) and 30/42 (71%) infants of group A and B, respectively, had indication for PVZ prophylaxis. In GB, 14/30(47%) were immunized. The estimated cost of prophylaxis (5 doses) was 26,000 €-GA and 30,000 €-GB. Ten infants (17.8%) were admitted with RSV bronchiolitis: 8(31%)-GA and 2(6.6%)-GB, median age 4 months (range 1-22) and 80% male. In GA, 4(50%) children were admitted to paediatric intensive care unit (PICU), 3 needing mechanical ventilation. One infant was readmitted. In GB, one infant, admitted for 11 days in the PICU without mechanical ventilation, was infected 13 days after 2 doses of PVZ. The other, was admitted in the nursery 40 days after the fifth dose of PVZ. The total cost of admission was 36,129 €-GA and 27,318 €-GB. Comparing both groups, mechanical ventilation was only needed for GA (1.62 vs. 0; p = 0.003). No differences occurred between total and PICU length of stay (8.

Early Human Development, 2010