ABSTRACT:Objective: To describe the neonatal mortality coefficient attributed to sepsis and other causes, and to report the maternal, neonatal and death characteristics of newborn infants that died in the city of Londrina, Paraná, in Southern Brazil.Methods: This is a cross-sectional study with a time series analysis. Neonatal deaths that contained neonatal sepsis records in any field of the death certificate between the years 2000 and 2013 were studied. The years were grouped into biennia, and cause specific neonatal mortality coefficient was calculated, according to the International Classification of Diseases, 10th revision. Results are expressed as prevalence ratio and 95% confidence interval (95CI%). For bivariate analysis, p<0.05 was considered significant. Results: Among the 745 deaths, 229 (30.7%) had sepsis, with a neonatal mortality coefficient of 7.5 per one thousand livebirths. Sepsis was involved in 2.3 deaths per 1,000 live births. The main underlying causes were conditions originated in the perinatal period and congenital malformations. Sepsis was associated with pre-eclampsia, urinary tract infection, Apgar in the 1st and 5th minutes, and occurrence of late death. In the descriptive trend analysis, there was an increased proportion of mothers aged 35 years or older and with eight or more schooling years. Prenatal coverage was high, but a little more than half of the mothers attended seven or more medical appointments. Conclusions: In the 14 years analyzed, the prenatal care was identified as a preventive measure against maternal and fetal disorders and the advanced maternal age was associated with neonatal mortality.

Objective: To determine the frequency of adrenal insufficiency in children diagnosed with sepsis that were staying in pediatric intensive care units and to establish the association between adrenal function and the use of vasoactive drugs, mechanical ventilation time and mortality.Methods: A cohort-designed study was conducted to assess the incidence of adrenal insufficiency in children aged 29 days to 12 years who were diagnosed with sepsis using the adrenocorticotropic hormone (ACTH) stimulation test.Results: Thirty-nine children were included in the study. The frequency of adrenal insufficiency was 30.7% (12 patients). Children with adrenal insufficiency had an increased need for vasoactive drugs as well as longer mechanical ventilation times; however, the differences were not statistically significant. A KaplanMeier curve indicated lower survival rates among the adrenal insufficiency children, but the differences were not statistically significant (p = 0.1263). No differences were identified between the adrenal sufficiency and adrenal insufficiency groups in regards to mechanical ventilation time, use of vasoactive drugs, infection type and chronic disease.Conclusion: This study determined the frequency of adrenal insufficiency in children with sepsis and its relationship to increased mortality within the first 28 postadmission days. No statistically significant association was found between adrenal insufficiency and mechanical ventilation time or the use of vasoactive drugs.Keywords: Sepsis; Adrenal insufficiency; Corticotropin-releasing hormone; Vasoactive drugs; Children This study was conducted at the Hospital Universitário Regional do Norte do Paraná, Universidade Estadual de Londrina -UEL -Londrina (PR), Brazil. Conflicts of interest:None.

BACKGROUND AND OBJECTIVES:The objective of this study was to describe the process of implementing a protocol for treating pain in hospitalized children, seeking to contribute to the standardization of strategies for the assessment and relief of child pain. METHODS: Convergent Care Research guided by Knowledge Translation in a pediatric unit of a university hospital in southern Brazil. In interaction with convergence groups with 66 professionals members of the medical, nursing and physiotherapy teams, elaborated motivational strategies for the participation in the collective construction process and maintenance of knowledge about pain. RESULTS:The following strategies were developed: creation of the #criançasemdor (#childrenwithoutpain) logo, distribution of a personalized kit with scales for pain assessment, illustrative folder, pain scales for the wards' clipboards, discussions of clinical cases and creation of an informative page on social network. As technical-scientific products, a pharmacological framework and a Standard Operating Procedure were prepared. CONCLUSION: The collective construction process favored the involvement of professionals in the adopted strategies, which is fundamental for the changes to be incorporated into practice. In addition, Knowledge Translation has proven to be a useful tool for improving care for hospitalized children.

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Objetivo: Analisar associação das condições crônicas complexas (CCC) com óbito numa unidade de terapia intensiva pediátrica (UTIP). Secundariamente, verificar associação com suporte ventilatório invasivo e hemodinâmico, infecções hospitalares e tempo de internação. Métodos: Coorte retrospectiva, entre 2012 e 2017, com internações de crianças com CCC, considerada variável de exposição. Utilizou-se regressão de Poisson, com significância de 5% e cálculo do risco relativo (RR). Resultados: Das 585 crianças, 51,3% tinham CCC. Foram mais frequentes encefalopatias, neoplasias e pneumopatias. Essas crianças também apresentaram menor risco para uso de drogas vasoativas (DVA) nas primeiras 24 horas de terapia intensiva (RR=0,72; IC95%=0,54-0,98), porém foi maior a incidência de infecções hospitalares (RR=1,49; IC95%=1,10-2,03) e óbito (RR=2,14; IC95%=1,13), mesmo após controle por variáveis de confusão. Conclusão: Verificou-se elevada frequência de CCC, com diferença significativa para menor risco de uso de DVA nas primeiras 24 horas da internação, e maior incidência de infecções hospitalares e óbito.