Browsing by Author "Cunha, Manuel"
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- Factores preditivos da aderência dos pais a um programa de seguimento de crianças nascidas de muito baixo pesoPublication . Marecos, Clara; Oliveira, Alexandra; Figueiredo, Helena; Cadete, Ana; Cunha, ManuelIntroduction: Newborn infants of very low birth weight (VLBW) are at high risk of neurodevelopment disorder, justifying the implementation of early intervention programs for these children. Objectives: Evaluate the effects of long-term "Care Programme for Development” (CPD) applied to VLBW infants, analyze parents' compliance to follow-up and identify perinatal variables with influence on neurodevelopment. Methods: Cross sectional and retrospective study on the implementation and adherence to CPD in a level III hospital between 2001 and 2005. Morbidity defined as neurological or sensorial sequels. Out of 323 VLBW newborns, 265 were enrolled for the study (49 died; 9 transferred). Results: CPD was made on 89%. Comparing groups with follow-up (156/59%) and without follow-up (109/41%), there were significant differences in maternal age (28.7 / 26.1, p=0.001) and pregnancy surveillance (89% / 78%, p=0.008). There was significant association of adherence with maternal age (odds ratio 1.059, 95% CI 1.009-1.112, p=0.019); pregnancy surveillance (odds ratio 0.336, 95% CI 0.141-0.802, p=0.014) and early consultation (Odds ratio 6.390, 95% CI 2.685 -15.208, p<0.001). Group with follow-up evaluated at an average age of 3.6 years. Seventy-nine per cent had normal neurodevelopment, 10% development delay or cognitive impairment, 6.4% cerebral palsy and 4% had attention deficit hyperactivity. Visual deficit in 7.8% and hearing impairment in 10% of 156 evaluated children. Regression analysis showed a positive association between the existence of sequels and male gender (odds ratio 0.384, 95% CI 0.169 to 0.869, p=0.022) and peri-intraventricular hemorrhage (odds ratio 2.965, 95% CI 1.104 to 7.963, p=0.031). After discharge, 31% required specific intervention. Discussion and conclusion: Adherence to CPD was higher in older mothers, surveillance of pregnancy, intervention started in NICU and early consultation after discharge. Low birth weight, male gender, IPVH, ventilation time and BPD seem to be variables associated with poor prognosis of neurodevelopment.
- Medidas de pressão de sucção em recém-nascidos prematurosPublication . Cunha, Manuel; Diniz, Ana; Barreiros, João; Viegas, Vítor; Banha, Carlos; Pereira, José Miguel Costa Dias
- Moderation and moderated mediation in the analysis of non-nutritive sucking pattern of preterm newbornsPublication . Cunha, Manuel; Barreiros, João; Diniz, Ana; Pereira, José Miguel Costa Dias
- A promising and low-cost prototype to evaluate the motor pattern of nutritive and non-nutritive suction in newbornsPublication . Cunha, Manuel; Barreiros, João; Pereira, José Miguel Costa Dias; Viegas, Vítor; Banha, Carlos; Diniz, Ana; Pereira, Margarida; Barroso, Rosalina; Carreiro, HelenaIntroduction: Non-nutritive sucking (NNS) plays an important role in stabilizing the preterm, providing oral muscle training opportunity for nutritive sucking (NS). We aim to determine if the prototype tested allows a precise evaluation of suction pattern characteristics (rhythmic structure and pressure). We also aim to investigate the role of maturation in the variation of NNS an NS pattern in preterm infants. Methods: The patented prototype is non-invasive, low-cost and easily applicable to clinical ecological practice, measures the pressure exerted on a pacifier in newborn’s mouth. Samples were acquired continuously during a 10-minute period in 12 preterm (mean gestational age [GA] 29.9 ± 1.6 weeks) and 4 term neonates (GA 39.5 ± 1.4 weeks). Bursts, suctions per burst, pauses, suction frequency and pressure were analyzed to describe temporal structure and dynamic characteristics of NNS. Results: The NNS pattern was characterized by bursts duration 4.3 ± 2.2 s, number of sucks per burst 7.4 ± 3.2, sucking frequency 2.1 ± 0.4 Hz and sucking pressure 10.3 ± 4.5 mmHg. There were significant differences between the preterm and term groups in NNS sucking frequency (2.1 Hz vs 1.6 Hz; p = 0.008). Conclusion: The device is non-invasive and can easily be used in clinical practice in low GA newborns, in an ecological environment. It allows the evaluation of NNS patterns maturation and, at the same time, the use of the device pacifier promotes NNS, which is important in the process of acquiring feeding autonomy in preterm infants.