To analyze the incidence of early-onset nasal injury in infants with very low birth weight and indication for noninvasive ventilation via nasal prongs. A prospective case series of infants with gestational age <37 weeks, weight <1.500 g and postnatal age <29 days. The patients were evaluated three times daily from the installation of nasal prongs to the 3rd day of use. The patients' clinical conditions and the device's characteristics and its application were analyzed. The initial analysis was descriptive, indicating the prevalence of nasal injury and factors associated with it. Categorical data were analyzed using the chi-squared test or Fisher's exact test, and numerical data were analyzed using the t-test or the Mann-Whitney test. Eighteen infants were included; 12 (with a gestational age of 29.8 ± 3.1 weeks, birth weight of 1.070 ± 194 g and a Score for Neonatal Acute Physiology - Perinatal Extension (SNAPPE) of 15.4 ± 17.5) developed nasal injuries (injury group), and 6 (with a gestational age of 28.0 ± 1.9 weeks, weight of 1.003 ± 317 g and SNAPPE of 26.2 ± 7.5) showed no nasal injury (uninjured group). The injury group subjects were more often male (75% versus 17%), and their injuries appeared after an average of 18 hours, predominantly during the night (75%). The incidence of nasal injury in preterm infants who experienced noninvasive ventilation via nasal prongs was high, and a study of associated factors may be planned based on this pilot.

Oxygen therapy is an important therapeutic resource for patients with hypoxemia. When changing oxygen flow meters, we have observed that sometimes, even with the same oxygen flow setting as before, a different S(pO(2)) is obtained. To analyze the precision and accuracy of flow meters used in hospital settings. An experimental study was performed to test oxygen flow meters from a tertiary hospital, by using a calibrated flow analyzer. Used and new flow meter accuracy was tested by reading in the gas analyzer a single measurement at flow rates of 1, 3, 5, and 10 L/min in 91 flow meters, and they were compared using the Student t test or Mann-Whitney U test. Flow meter precision was tested by reading in the flow analyzer 3 repetitive measurements set at flow rates of 1, 3, 5, and 10 L/min in 11 flow meters, and the reproducibility of these measurements was conducted by using the intraclass correlation coefficient and the Friedman test. The mean measured flow rates were slightly lower than the stipulated flow rate at 1 L/min, very close for 3 L/min, and higher for the 5 and 10 L/min flow rates. There was a large variability among the measurements from different flow meters, mainly at low flow rates (1 and 3 L/min). There was no difference between new and used flow meters at the flow rates measured, except at 10 L/min. Flow meters precision analysis showed a good reproducibility in 3 repetitive measurements for each flow rate (minimum 0.95, maximum 0.99 intraclass correlations). The flow meters tested showed good precision and poor accuracy.

Objective: This study was carried out to understand the disparities in mortality and survival without major morbidities among very premature and very low birth weight infants between participating Neonatal Intensive Care Units (NICUs) from the Brazilian Network on Neonatal Research (RBPN) and the Neonatal Research Network of Japan (NRNJ). Methods: Secondary data analysis of surveys by the RBPN and NRNJ was performed. The surveys were conducted in 2014 and 2015 and included 187 NICUs. Primary outcome was mortality or survival without any major morbidity. Logistic regression analysis adjustment for confounding factors was used. Results: The study population consisted of 6,406 infants from the NRNJ and 2,319 from the RBPN. Controlling for various confounders, infants from RBPN had 9.06 times higher adjusted odds of mortality (95%CI 7.30–11.29), and lower odds of survival without major morbidities (AOR 0.36; 95%CI 0.32–0.41) compared with those from the NRNJ. Factors associated with higher odds of mortality among Brazilian NICUs included: Air Leak Syndrome (AOR 4.73; 95%CI 1.26–15.27), Necrotizing Enterocolitis (AOR 3.25; 95%CI 1.38–7.26), and Late Onset Sepsis (LOS) (AOR 4.86; 95%CI 2.25–10.97). Conclusions: Very premature and very low birth weight infants from Brazil had significantly higher odds for mortality and lower odds for survival without major morbidities in comparison to those from Japan. Additionally, we identified the factors that increased the odds of in-hospital neonatal death in Brazil, most of which was related to LOS.

To describe the characteristics of physical therapy assistance to newborns and to provide a profile of physical therapists working in intensive care units in the city of São Paulo, Brazil. This cross-sectional study was conducted in every hospital in São Paulo city that had at least one intensive care unit bed for newborns registered at the National Registry of Health Establishments in 2010. In each unit, three types of physical therapists were included: an executive who was responsible for the physical therapy service in that hospital (chief-physical therapists), a physical therapist who was responsible for the physical therapy assistance in the neonatal unit (reference-physical therapists), and a randomly selected physical therapist who was directly involved in the neonatal care (care-physical therapists). Among the 67 hospitals eligible for the study, 63 (94.0%) had a physical therapy service. Of those hospitals, three (4.8%) refused to participate. Thus, 60 chief-PTs, 52 reference-physical therapists, and 44 care-physical therapists were interviewed. During day shifts, night shifts, and weekends/holidays, there were no physical therapists in 1.7%, 45.0%, and 13.3% of the intensive care units, respectively. Physical therapy assistance was available for 17.8±7.2 hours/day, and each physical therapist cared for 9.4±2.6 newborns during six working hours. Most professionals had completed at least one specialization course. Most neonatal intensive care units in the city of São Paulo had physical therapists working on the day shift. However, other shifts had incomplete staff with less than 18 hours of available physical therapy assistance per day.