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The aim of this study was to verify if the adoption of a strict guideline would reduce the need for red blood cell transfusions in the first 28 days of life in very low birth weight preterm infants. Retrospective study of two cohorts of very low birth weight infants transfused according to neonatologist decision (Period 1) or according to a strict guideline for erythrocytes transfusion (Period 2). Clinical and hematological data of 80 premature infants transfused in both periods of the study were obtained by chart review. During the first 28 days of life, 45 (62.5%) of 72 premature infants born in the Period 1, and 44 (55.7%) of 79 newborns born in Period 2 received at least one erythrocyte transfusion; p = 0.40. Among patients transfused, the median number of transfusions was four per infant transfused (range: 1-13; mean: 4.6 +/- 3.2) in Period 1 and 3 (range: 1-18; mean: 4.0 +/- 3.5) in Period 2; p = 0.26. The median volume of erythrocytes administered per infant transfused in Period 1 was 40 ml kg(-1) (range: 10-170; mean: 48.8 +/- 38.3) and in Period 2 was 30 ml kg(-1) (range: 10-225; mean: 43.4 +/- 40.4), p = 0.41. Multiple linear regression analysis, after adjusting for birth weight, clinical risk index for babies, blood loss and days of ventilation, showed that the adoption of the strict guideline reduced the volume of erythrocytes transfused in 15.91 ml kg(-1) per infant transfused (95% CI: -24.69-7.14) p < 0.001. The adoption of a strict guideline reduced the need for red blood cells transfusions in very low birth weight infants.

ORIGINAL ARTICLE INTRODUCTIONThe practice of massage is a very ancient activity that spread out from the Orient.1 Over recent years, it has been presented in the West as an alternative therapeutic method that gives rise to certain proposed effects. Among the uses that have been put forward, there has been increasing development of techniques for its use on babies. One of the most widely-used of these massage techniques in the hospital environment in Brazil is Shantala, 2 which was brought from India by the French doctor Frédérick Leboyer. 1 Shantala massage is one of the oldest and most traditional therapies, especially in the Kerala region of southern India, where it first became widely used among the population. Initially, it was used by monks in monasteries, and subsequently it grew into a tradition that was transmitted naturally and progressively from mother to daughters, when they first became pregnant. In the 1960s, while visiting India, Leboyer observed a young woman serenely concentrating on massaging her baby while sitting on the floor with the child over her legs. 1 According to Mathai, the use of massage therapy on preterm and full-term babies was associated with weight gain and superior behavioral maturation using Brazelton's scale. 3,4 Although the effects of massage therapy on psychological maturation are not well known, the autonomous nervous system and the hypothalamic-pituitary-adrenocortical axis are the mediators of its effects. [4][5][6] Assessing stress hormone levels (salivary cortisol) and/or neuropeptide pain levels (substance P) during stressful medical procedures could provide additional measurement of the effects of massage therapy as an adjunct to the standard management of seriously ill patients. 7 OBJECTIVEWith the possibility in mind that tactilekinesthetic stimulation could be used to diminish distress among hospitalized infants (e.g. in pediatric intensive care units), we evaluated the levels of salivary cortisol before and after Shantala massage therapy on healthy infants. Through this, we aimed to obtain information that could contribute towards understanding the role of the hypothalamic-pituitary-adrenal axis in relation to traumatic stress. PATIENTS AND METHODSThe effects of Shantala massage therapy on salivary cortisol levels were ascertained for 11 infants (4 females and 7 males), aged 4 to 6 months (median age: 5 months) who were regularly enrolled in a public nursery, in São Paulo, Brazil. The Ethics Committee of the university approved the protocol and the parents gave written consent for their child's participation (Protocol no. 033-01; Research Ethics Committee of Universidade Federal de São Paulo -Escola Paulista de Medicina).Saliva samples were obtained at three times during a single day: between 8:00 and 9:00 a.m. and between 4:00 and 5:00 p.m. at the nursery, and between 9:00 and 10:00 p.m. at home. This was done on the day before the first massage session and after it. Saliva was collected (one hour prior to the massage), with due regard for the meal time...

OBJETIVO: Estudar os fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou suporte ventilatório durante o transporte intra-hospitalar de pacientes internados em Unidade de Terapia Intensiva neonatal. MÉTODOS: Estudo prospectivo de todos os pacientes internados na unidade neonatal que necessitaram de transporte intra-hospitalar de janeiro de 1997 a dezembro de 2000, entre segundas-feiras e sextas-feiras, das 8h às 17h. Fatores associados à hipotermia e ao aumento da necessidade de oxigênio e/ou de suporte ventilatório durante e até duas horas após o transporte foram estudados por meio de regressão logística. RESULTADOS: Foram realizados 502 transportes no período. Os pacientes tinham em média 2.000g, 35 semanas de idade gestacional ao nascer e 22 dias de vida. As principais indicações do transporte foram: cirurgia e realização de exames de imagem. A hipotermia ocorreu em 17% dos transportes e o aumento da necessidade de oxigênio e/ou de suporte ventilatório em 7%. Fatores associados à hipotermia foram: duração do transporte >3h (OR=2,1; IC95%=1,2-3,6), presença de malformações neurológicas (OR=1,7; IC95%=1,1-2,5), transporte realizado em 1997 (OR=1,7; IC95%=1,1-2,6) e peso no transporte >3.500g (OR=0,3; IC95%=0,16-0,68). Fatores de risco para o aumento da necessidade de oxigênio e/ou de suporte ventilatório foram: idade gestacional ao nascimento em semanas (OR=0,9; IC95%=0,8-0,9), idade em dias no transporte (OR=1,0; IC95%=1,0-1,1) e presença de malformações gastrintestinais e geniturinárias (OR=3,1; IC95%=1,6-6,2). CONCLUSÕES: As intercorrências relativas ao transporte intra-hospitalar são freqüentes nos neonatos em UTI e estão associadas às condições dos pacientes e dos transportes.

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