A double-blind, randomised controlled study was conducted to evaluate the intubation conditions in 20 preterm neonates following the use of either morphine or remifentanil as premedication. The findings suggest that the overall intubation conditions were significantly better (p = 0.0034) in the remifentanil group than in the morphine group. No severe complications were observed in either group. E ndotracheal intubation of preterm neonates forms a major part of routine practice in the neonatal intensive care unit (NICU). This procedure is associated with physiological and biochemical responses, and premedication (sedation and analgesia) seems to improve physiological stability and decrease the time taken for and the level of difficulty of the procedure.1 Morphine has been used for several years in most NICUs with apparent safety and efficacy, and midazolam is given for sedation. However, morphine has several limitations, the main one being its delayed onset of action, which makes the drug unsuitable for premedication.1 2 In this setting, remifentanil has theoretical and practical advantages over other sedative drugs, making it appropriate for noxious procedures such as intubation and ventilation. 4 The aim of our randomised double-blind study was to compare the intubation conditions achieved following sedation with remifentanil and morphine in preterm neonates with respiratory distress syndrome (RDS). PATIENTS AND METHODSOur study population included 20 preterm neonates (28-34 weeks' gestation) admitted to a single tertiary NICU, who required elective tracheal intubation to treat respiratory failure due to RDS. The ethics committee of our institution approved the study, and informed consent was obtained from parents of all selected neonates. Neonates were excluded from the study if they had major congenital malformations, birth weight less than 1000 g, previous or concurrent use of opioids or haemodynamic instability before intubation.Following enrolment the neonates were randomised sequentially, using a random numbers table, to receive an intravenous bolus injection over 1 min of either morphine 150 mg/kg and midazolam 200 mg/kg or remifentanil 1 mg/kg and midazolam 200 mg/kg. A single pharmacist was responsible for allocating each neonate in the randomised treatment group, and she also ensured that the two preparations could not be differentiated.The neonates were preoxygenated with 100% oxygen and a monitor (Dixtal 2010; Dixtal Collaborative Evolution, São Paulo, Brazil) recorded the heart rate, blood pressure and oxygen saturation (SaO 2 ). A single paediatric anaesthetist, who was blinded to the study protocol, carried out all intubations and classified the intubation conditions as poor, good or excellent. 5 The intubation conditions were scored using a four-point scale and the variables assessed were: ease of laryngoscopy, position of the vocal cords, coughing, jaw relaxation and movement of the limbs. 5The blood pressure, heart rate and SpO 2 were recorded before and during the first 10 min after the intub...

Objective:To describe the observed behavior of professionals in two neonatal and pediatric intensive care units regarding the use of central venous catheter insertion bundle, and the clinical and birth profile of neonates and children who received the devices. Method: A quantitative descriptive exploratory study was conducted in two intensive care units of a public hospital in Belo Horizonte with neonates and children, between February and September 2016. Results: The sample consisted of 59 observed implants of central venous catheter. Most patients were male preterm infants, of cesarean delivery and proper weight according to the gestational age. Among all procedures observed, only three followed all recommendations for the central venous catheter insertion bundle. Incorrect techniques were observed while performing surgical antisepsis and inadequate use of chlorhexidine, an antiseptic. Conclusion: The findings highlight the importance of more investment in continuous training of the team on the prevention of bloodstream infection caused by central venous catheter to reduce the number of adverse events related to intravenous therapy. DESCRIPTORS INTRODUCTIONThe technical and scientific advances related to invasive procedures have led to reduced infant mortality and increased survival rate of preterm newborns, which has changed the profile of care, raising the demand for increasingly complex care required for the survival of this population (1)(2)(3) . The adoption of central venous catheters (CVC) in clinical practice was an important advance in the care to preterm newborns, ensuring safe venous access with less invasive, simple and low-cost techniques.The types of CVC commonly used in pediatrics and neonatology are peripherally inserted central catheters (PICC), central insertion catheters, and umbilical venous catheters (UVC). These devices allow continuous administration of intravenous fluids and medications, parenteral nutrition, hemodynamic monitoring, and in some cases transfusion of blood products, depending on the catheter caliber and the patient's age (2,4) . Despite the advantages of CVC, there are risks of complications associated with their use, such as venous thromboembolism, hemorrhage, infiltration, rupture, phlebitis and infection, with primary bloodstream infections (PBSI) being the most frequently related to health care (5)(6)(7) . PBSI can lead to clinical complications for patients, longer hospital stay, increased morbidity and mortality, and a significant increase in health care costs (8) . Planning and adopting PBSI prevention measures is essential for reducing morbidity and mortality rates, improving the quality and safety of health care, and reducing hospitalization costs (7,(9)(10) . Strategies have been developed to reduce the incidence of PBSI associated with central venous catheters, for instance, the guidelines proposed by the Centers for Disease Control and Prevention (CDC), called Guidelines for the Prevention of Intravascular Catheter-Related Infections (10) . This is a...

Objective This study sought to describe and quantify the pharmacological and nonpharmacological strategies used to relieve the pain/stress of neonates during hospitalization in neonatal intensive care units. Methods This quantitative, longitudinal, and descriptive study examined 50 neonates from neonatal intensive care unit admission to discharge. Results A total of 9,948 painful/stressful procedures were recorded (mean = 11.25 ± 6.3) per day per neonate. A total of 11,722 pain-management and relief interventions were performed, of which 11,495 (98.1%) were nonpharmacological strategies, and 227 (1.9%) were pharmacological interventions. On average, each neonate received 235 pain-management and treatment interventions during hospitalization, 13 nonpharmacological interventions per day, and one pharmacological intervention every 2 days. Conclusion Neonates receive few specific measures for pain relief given the high number of painful and stressful procedures performed during hospitalization. Thus, it is essential to implement effective pain-relief protocols.

Our results show an interesting potential for the use of remifentanil in premature neonates. Remifentanil allowed an adequate level of sedation and analgesia as well as rapid recovery after discontinuation. However, further properly designed clinical trials are needed before it can be generally recommended.

RESUMO: Objetivos: Definir o perfil das vítimas de queimadura atendidas nos serviços de emergência e identificar possíveis associações entre as variáveis investigadas. Métodos: Estudo transversal com base nos dados do inquérito “Vigilância de Violências e Acidentes em Unidades Sentinelas de Urgência e Emergência”, de 2017. Procedeu-se à análise descritiva segundo características demográficas e aspectos relativos ao acidente por queimadura, bem como à técnica de análise de correspondência, que permitiu verificar possíveis associações entre as variáveis investigadas. Resultados: Os casos de queimadura foram mais frequentes: em adultos com idade entre 20 e 39 anos (40,7%); em homens (57%); no domicílio (67,7%); em decorrência do manuseio de substâncias quentes (52%). Acidentes no domicílio foram mais frequentes nas faixas etárias de 0 a 15 anos (92%) e idosos (84,4%) e em mulheres (81,6%). Acidentes no comércio, serviços e indústria acometeram indivíduos com idades entre 16 e 59 anos (73,6%). O encaminhamento para outros hospitais esteve associado aos casos ocorridos em idosos e a internação aos eventos que acometeram indivíduos na faixa de 0 a 15 anos de idade. Eventos na população em idade produtiva apresentaram associação com o uso de álcool e o local de trabalho. Entre as mulheres, sugere-se associação dos acidentes com o domicílio e substâncias quentes. Conclusão: Os resultados apontam para a necessidade de ações orientadas no campo da educação em saúde, bem como da regulamentação e da fiscalização trabalhistas.