Lêni Márcia Anchieta

Federal University of Minas Gerais, Cidade de Minas, Minas Gerais, Brazil

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Publications (18)17.94 Total impact

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    ABSTRACT: Objetivo analisar os efeitos da terapêutica adotada para o canal arterial (CA) em recém-nascidos (RN) < 1.000gadmitidos em unidades neonatais (UN) da Rede Brasileira de Pesquisas Neonatais (RBPN), sobre os desfechos: óbito, displasia broncopulmonar (DBP), hemorragia intraventricular grave (HIVIII/IV), retinopatia da prematuridade cirúrgica (ROPcir), enterocolite necrosante cirúrgica (ECNcir) e o desfecho combinado óbito e DBP. Métodos estudo multicêntrico, de coorte, coleta de dados retrospectiva, incluindo RN de 16 UN da RBPN de 01/01/2010 a 31/12/2011, PN < 1.000 g, idade gestacional (IG) < 33 semanas e diagnóstico ecocardiográfico de PCA. Excluídos: óbitos ou transferências até o terceiro dia de vida, infecções congênitas ou malformações. Grupos: G1 – conservadora (sem intervenção medicamentosa ou cirúrgica), G2 – farmacológica (indometacina ou ibuprofeno) e G3 – cirúrgico (com ou sem tratamento farmacológico anterior). Analisou-se: uso de esteroide antenatal, parto cesárea, PN, IG, Apgar5′ < 4, sexo masculino, SNAPPE II, síndrome do dDesconforto respiratório (SDR), sepse tardia, ventilação mecânica (VM), surfactante < 2 horas de vida, tempo de VM e os desfechos: óbito, dependência de oxigênio com 36 semanas (DBP36s), HIV III/IV, ROPcir, ECNcir e óbito/DBP36s. Estatística: Teste t-Student, Qui-Quadrado ou teste Exato de Fisher. Testes de Regressão Binária Logística e Regressão Múltipla Stepwise Backward. MedCalc (Medical Calculator) software, versão 12.1.4.0.p < 0,05. Resultados foram selecionados 1.097 RN e 494 foram incluídos: G1-187 (37,8%), G2-205 (41,5%) e G3-102 (20,6%). Verificou-se: maior mortalidade (51,3%) no G1 e menor no G3(14,7%); maior frequência DBP36s (70,6%) e ROPcir (23,5%) no G3; maior frequência de óbito/DBP36s no G2 (58,0%). As abordagens farmacológica (OR-0,29; 95%, IC-0,14-0,62) e conservadora (OR-0,34; 95%, IC- 0,14-0,79) foram protetoras somente para o desfecho óbito/DBP36sem. Conclusão em RN com PCA, a abordagem conservadora relacionou-se à maior mortalidade, a cirúrgica à ocorrência de DBP36s e ROPcir., enquanto o tratamento farmacológico mostrou-se protetor para o desfecho óbito/DBP36sem.
    12/2014; 90(6). DOI:10.1016/j.jped.2014.04.010
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    ABSTRACT: Objetivo avaliar a aplicação dos critérios nacionais para notificação de infecções relacionadas à assistência à saúde (IRAS) em Unidade Neonatal e comparar com os critérios propostos pelo National Healthcare Safety Network (NHSN). Métodos estudo transversal realizado de 2009 a 2011. Forma incluídos os neonatos que apresentaram notificação de IRAS por pelo menos um dos critérios. Análise estatística incluiu cálculo de densidade de incidência de IRAS e distribuição por peso e por critério de notificação. Foi realizada análise da sensibilidade, especificidade, valor preditivo positivo (VPP) e valor preditivo negativo (VPN) para os critérios nacionais, considerando o NHSN como padrão-ouro e a concordância avaliada pelo Kappa. Resultados foram acompanhados 882 neonatos, e 330 apresentaram pelo menos uma infecção notificada por, no mínimo, um dos critérios. Foram notificadas 522 IRAS, independentemente do critério. Observou-se densidade de incidência de 27,28 infecções por 1.000 pacientes-dia, e as principais topografias foram sepse (58,3%), monilíase (15,1%) e conjuntivite (6,5%). Um total de 489 (93,7%) notificações foram por ambos os critérios; oito infecções foram notificadas apenas pelo critério nacional (duas conjuntivites e seis enterocolites necrosantes); e 25 casos de sepse clínica foram notificadas apenas pelo NHSN. A sensibilidade, especificidade, VPP e VPN foram de 95,1%, 98,6%, 98,4%, 95,7%, respectivamente, para todas as topografias, e para análise de sepse foram 91,8%, 100%, 100% e 96,3%. O Kappa revelou concordância de 96,9%. Conclusão verificou-se uma elevada concordância entre os critérios. A utilização dos critérios nacionais facilita a notificação da sepse em neonatologia e podem contribuir para melhorar a especificidade e VPP.
    Jornal de pediatria 07/2014; 90(4). DOI:10.1016/j.jped.2013.11.002 · 0.94 Impact Factor
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    ABSTRACT: Healthcare Associated Infections constitute an important problem in Neonatal Units and invasive devices are frequently involved. However, studies on risk factors of newborns who undergo surgical procedures are scarce. To identify risk factors for laboratory-confirmed bloodstream infection in neonates undergoing surgical procedures. This case-control study was conducted from January 2008 to May 2011, in a referral center. Cases were of 21 newborns who underwent surgery and presented the first episode of laboratory-confirmed bloodstream infection. Control was 42 newborns who underwent surgical procedures without notification of laboratory-confirmed bloodstream infection in the study period. Information was obtained from the database of the Hospital Infection Control Committee Notification of infections and related clinical data of patients that routinely collected by trained professionals and follow the recommendations of Agência Nacional de Vigilância Sanitária and analyzed with Statistical Package for Social Sciences. During the study period, 1141 patients were admitted to Neonatal Unit and 582 Healthcare Associated Infections were reported (incidence-density of 25.75 Healthcare Associated Infections/patient-days). In the comparative analysis, a higher proportion of laboratory-confirmed bloodstream infection was observed in preterm infants undergoing surgery (p=0.03) and use of non-invasive ventilation was a protective factor (p=0.048). Statistically significant difference was also observed for mechanical ventilation duration (p=0.004), duration of non-invasive ventilation (p=0.04), and parenteral nutrition duration (p=0.003). In multivariate analysis duration of parenteral nutrition remained significantly associated with laboratory-confirmed bloodstream infection (p=0.041). Shortening time on parenteral nutrition whenever possible and preference for non-invasive ventilation in neonates undergoing surgery should be considered in the assistance of these patients, with the goal of reducing Healthcare Associated Infections, especially laboratory-confirmed bloodstream infection.
    The Brazilian journal of infectious diseases: an official publication of the Brazilian Society of Infectious Diseases 03/2014; 18(4). DOI:10.1016/j.bjid.2013.12.003 · 1.10 Impact Factor
  • 01/2014; 24(2). DOI:10.5935/2238-3182.20140053
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    ABSTRACT: To evaluate risk factors and lethality of late onset laboratory-confirmed bloodstream infection (LCBI) in a Brazilian neonatal unit for progressive care (NUPC). This was a case-control study, performed from 2008 to 2012. Cases were defined as all newborns with late onset LCBI, excluding patients with isolated common skin contaminants. Controls were newborns who showed no evidence of late onset LCBI, matched by weight and time of permanence in the NUPC. Variables were obtained in the Hospital Infection Control Committee (HICC) database. Analysis was performed using the Statistical Package for the Social Sciences (SPSS). The chi-squared test was used, and statistical significance was defined as p < 0.05, followed by multivariate analysis. 50 patients with late onset LCBI were matched with 100 patients without late onset LCBI. In the group of patients with late onset LCBI, a significant higher proportion of patients who underwent surgical procedures (p = 0.001) and who used central venous catheter (CVC) (p = 0.012) and mechanical ventilation (p = 0.001) was identified. In multivariate analysis, previous surgery and the use of CVC remained significantly associated with infection (p = 0.006 and p = 0.047; OR: 4.47 and 8.99, respectively). Enterobacteriacea was identified in 14 cases, with three (21.4%) deaths, and Staphylococcus aureus was identified in 20 cases, with three (15%) deaths. Surgical procedures and CVC usage were significant risk factors for LCBI. Therefore, prevention practices for safe surgery and CVC insertion and manipulation are essential to reduce these infections, in addition to training and continuing education to surgical and assistance teams.
    Jornal de pediatria 03/2013; 89(2):189-96. DOI:10.1016/j.jped.2013.03.002 · 0.94 Impact Factor
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    ABSTRACT: To describe occurence of Healthcare Related Infections in a neonatal unit of public reference service in Belo Horizonte-MG, based on international criteria. This is a descriptive study, performed by active searching, in the Progressive Care Unit Neonatal Hospital das Clinicas, Federal University of Minas Gerais (HC / UFMG), from 2008 to 2009. Notification of infections was based on National Healthcare Safety Network (NHSN) criteria. The database and analysis were performed in a internal program. A total of 325 episodes of infection in newborns were notified and overall incidence density of infections was 22.8/1,000 patient-days, with a rate of 36.7% of newborns. Sepsis was the main infection (62.5%) reported. The incidence density of infections was higher in neonates weighing lower than 750g (42.4/1,000 patient-days). There were 18.15 episodes of central venous catheter related sepsis/1,000 central venous catheter-day and 19.29 umbilical catheter related sepsis /1,000 umbilical catheter-days. Microorganisms were isolated in 122 (37.5%) cases of reported infections, mainly defined as Staphylococcus coagulase negative and Staphylococcus aureus (51 cases). Mortality and lethality rates were 4.3% and 17,12%, respectively. The use of standardized criteria for reporting infections is necessary for the construction of indicators in neonatology, which are scarce in the country and highlight the need for evaluation of national criteria proposed by National Agency of Sanitary Surveillance (ANVISA).
    Revista Brasileira de Epidemiologia 03/2013; 16(1):77-86. DOI:10.1590/S1415-790X2013000100008
  • Revista Brasileira de Epidemiologia 01/2013; 16(1):77-86. DOI:10.1590/S1415-790X2013000100077
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    ABSTRACT: To analyze the prevalence and types of prescribing and dispensing errors occurring with high-alert medications and to propose preventive measures to avoid errors with these medications. The prevalence of adverse events in health care has increased, and medication errors are probably the most common cause of these events. Pediatric patients are known to be a high-risk group and are an important target in medication error prevention. Observers collected data on prescribing and dispensing errors occurring with high-alert medications for pediatric inpatients in a university hospital. In addition to classifying the types of error that occurred, we identified cases of concomitant prescribing and dispensing errors. One or more prescribing errors, totaling 1,632 errors, were found in 632 (89.6%) of the 705 high-alert medications that were prescribed and dispensed. We also identified at least one dispensing error in each high-alert medication dispensed, totaling 1,707 errors. Among these dispensing errors, 723 (42.4%) content errors occurred concomitantly with the prescribing errors. A subset of dispensing errors may have occurred because of poor prescription quality. The observed concomitancy should be examined carefully because improvements in the prescribing process could potentially prevent these problems. The system of drug prescribing and dispensing at the hospital investigated in this study should be improved by incorporating the best practices of medication safety and preventing medication errors. High-alert medications may be used as triggers for improving the safety of the drug-utilization system.
    Clinics (São Paulo, Brazil) 10/2011; 66(10):1691-7. DOI:10.1590/S1807-59322011001000005 · 1.42 Impact Factor
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    ABSTRACT: To compare the need for positive pressure ventilation (PPV) by bag and mask and by bag and endotracheal tube in newly born term infants with vertex presentation delivered by non-urgent caesarean section under regional anaesthesia or non-instrumental vaginal delivery. Cross-sectional study. 35 public hospitals in 20 Brazilian state capitals. 6929 inborn infants without congenital anomalies, with gestational ages from 37(0/7) to 41(6/7) weeks with vertex presentation, born between 1 and 30 September 2003. Non-urgent caesarean versus non-instrumental vaginal delivery. Non-urgent caesarean was defined as delivery occurring in the absence of prolapsed cord, third trimester haemorrhage, failure of labour induction, fetal distress or non-clear amniotic fluid. PPV with bag and mask and with bag and endotracheal tube. Both outcomes were adjusted for potential confounding variables by logistic regression analysis. 2087 infants were born by non-urgent caesarean and 4842 by non-instrumental vaginal delivery. Non-urgent caesarean delivery under regional anaesthesia compared to vaginal delivery under local or no anaesthesia increased the risk of bag and mask ventilation (OR 1.42, 95% CI 1.07 to 1.89) adjusted for number of gestations, maternal hypertension and birth weight. Ventilation with bag and endotracheal tube was associated only with low birth weight, adjusted for delivery mode and twin gestation. Term neonates with vertex presentation and clear amniotic fluid born by non-urgent caesarean section under regional anaesthesia need to be assisted at birth by health professionals skilled in PPV.
    Archives of Disease in Childhood - Fetal and Neonatal Edition 09/2010; 95(5):F326-30. DOI:10.1136/adc.2009.174532 · 3.86 Impact Factor
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    ABSTRACT: In 2002, the early neonatal mortality rate in Brazil was 12.42 per thousand live births. Perinatal asphyxia was the greatest cause of neonatal death (about 23%). This study aimed to evaluate the availability of the resources required for neonatal resuscitation in delivery rooms of public hospitals in Brazilian state capitals. Multicenter cross-sectional study involving 36 hospitals in 20 Brazilian state capitals in June 2003. Each Brazilian region was represented by 1-4% of its live births. A local coordinator collected data regarding physical infrastructure, supplies and professionals available for neonatal resuscitation in the delivery room. The information was analyzed using the Statistical Package for the Social Sciences, version 10. Among the 36 hospitals, 89% were referral centers for high-risk pregnancies. Each institution had a monthly mean of 365 live births (3% < 1,500 g and 15% < 2,500 g). The 36 hospitals had 125 resuscitation tables (3-4 per hospital), all with overhead radiant heat, oxygen and vacuum sources. Appropriate equipment for pulmonary ventilation was available for more than 90% of the 125 resuscitation tables. On average, one pediatrician, three nurses and five nursing assistants per shift worked in the delivery rooms of each institution. Out of the 874 pediatricians and 1,037 nursing personnel that worked in the delivery rooms of the 36 hospitals, 94% and 22%, respectively, were trained in neonatal resuscitation. The main public maternity hospitals in Brazilian state capitals have the resources to resuscitate neonates at birth.
    Sao Paulo Medical Journal 05/2008; 126(3):156-60. DOI:10.1590/S1516-31802008000300004 · 0.70 Impact Factor
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    ABSTRACT: Evaluate the need for resuscitative procedures at birth, in late prematures. This prospective cohort study enrolled all liveborn infants from 1 to 30 September 2003, with 34 to 41 weeks of gestation without congenital anomalies, born in 35 public hospitals of 20 Brazilian state capitals. Logistic regression analyzed variables associated with the need for bag and mask ventilation. Of the 10 774 infants studied, 1054 were late preterms and 485 required resuscitative measures. Of the 1054, 338 (32%) received only free-flow oxygen, 143 (14%) were bag and mask ventilated, 27 (3%) were intubated and 10/27 received chest compressions and/or medications. Bag and mask ventilation in late preterms was associated with twin gestation, maternal hypertension, nonvertex presentation, cesarean delivery and lower gestational age. Improving control of maternal hypertension, prolonging gestation for 1 to 2 weeks and restricting operative deliveries could decrease the need of resuscitation of late preterms at birth.
    Journal of Perinatology 01/2008; 27(12):761-5. DOI:10.1038/sj.jp.7211850 · 2.35 Impact Factor
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    ABSTRACT: To analyze the teaching of neonatal resuscitation offered by Brazilian public hospitals to undergraduate doctors and nurses, pediatric residents and neonatal fellows. This cross-sectional multicenter study included 36 hospitals in 20 Brazilian State capitals during June/2003. Local coordinators collected data regarding what the institutions offer to undergraduate doctors and nurses, pediatric residents and neonatal fellows in terms of neonatal resuscitation training and practical activities in neonatal delivery room care. Descriptive analysis was performed. Twenty-three of the 36 institutions had undergraduate doctors: at 13 of them students had clinical activities in the delivery room, 12 offered neonatal resuscitation training, and at two of the 13 hospitals, interns cared for neonates in the delivery room without specific training. Twenty-three of the 36 hospitals had undergraduate nurses: at eight of them students had clinical activities in the delivery room and at seven of them nursing students cared for neonates in the delivery room without specific training. Twenty-seven of the 36 institutions had pediatric residence programs: at all of them, trained residents cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2-3 hours) at four institutions and theoretical and practical training (4-64 hours) at 23. Additionally, 15 had neonatal fellowship programs: at all of these, trained fellows cared for neonates in the delivery room, but the training was heterogeneous: theoretical training (2 hours) at one hospital and theoretical and practical training (3-68 hours) at 14. Formal neonatal resuscitation training is insufficient during medical and nursing graduation and heterogeneously offered to pediatric residents and neonatal fellows.
    Jornal de Pediatria 05/2005; 81(3):233-9. DOI:10.2223/JPED.1344 · 0.94 Impact Factor
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    Jornal de Pediatria 01/2005; 81(3). DOI:10.1590/S0021-75572005000400010 · 0.94 Impact Factor
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    Lêni M Anchieta, César C Xavier, Enrico A Colosimo
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    ABSTRACT: To assess the growth velocity of preterm appropriate for gestational age newborns through growth curves. A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte. Two hundred and sixty appropriate for gestational age preterm infants with birth weight < 2,500 g were evaluated weekly for body weight, head circumference and length. Growth velocity curves were constructed based on the derivative of the mathematical equation of the Count's model applied to somatic growth. Two analyses were made in the present study: absolute velocity, i.e., weight gain (g/day), and head circumference and length gains (cm/week); and relative velocity, i.e., weight gain(g/kg/day), and head circumference and length gains (cm/m/week). The curves of weight gain (g/day) were proportional to birth weight (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). The curves of weight gain (g/kg/day) were inversely proportional to birth weight with increasingly higher rates of weight gain between the first and fourth weeks (during the third week, the lowest and the highest weight newborns gained 18 and 11.5 g/kg/day, respectively). Later there was a drop, and by the 12th week the rates were similar for all groups (7.5 to 10.2 g/kg/day). The curves of relative velocity (cm/m/week) for head circumference and length were inversely proportional to birth weight; the lower weight preterm newborns had, the higher head circumference and length growing rates were, compared with those with more weight. The relative velocity is the best parameter to describe the growth dynamics of preterm infants, especially of those with lower birth weight. Lower birth weight infants gained more weight, head circumference and length.
    Jornal de Pediatria 09/2004; 80(5):417-24. DOI:10.2223/JPED.1228 · 0.94 Impact Factor
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    Lêni M Anchieta, César C Xavier, Enrico A Colosimo
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    ABSTRACT: To assess the somatic growth of preterm newborns through growth curves during the first 12 weeks of life. A longitudinal and prospective study was carried out at two state operated maternity hospitals in the city of Belo Horizonte. Three hundred and forty preterm infants with birth weight less than 2,500 g were weekly evaluated in terms of body weight, head circumference, and height. Growth curves were constructed and adjusted to Count's model. Count's model clearly showed that the dynamics of loss, stabilization and gain of weight of all curves are graphically similar. The growth curve was characterized by weight loss during the 1st week (4-6 days) ranging from 5.9 to 9.7% (the greater the percentage, the lower the birth weight). For all curves, recovery of birth weight ranged from 16 to 19 days, showing that these newborns took longer to recover their birth weight. After the 3rd week, the newborns maintained increasingly rates of weight gain. Head circumference and height curves are little affected by weight loss. However, newborns with low birth weight presented loss of head circumference and height, probably due to their lower gestational ages. The dynamics of the preterm infants evaluated was similar to that of previous studies. The infants also presented growth deficit. However, it was also noted that the infants present a high potential to recover their growth.
    Jornal de Pediatria 07/2004; 80(4):267-76. DOI:10.2223/1199 · 0.94 Impact Factor
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    Lêni M. Anchieta, César C. Xavier, Enrico A. Colosimo
    Jornal de Pediatria 01/2004; 80(4). DOI:10.1590/S0021-75572004000500005 · 0.94 Impact Factor
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    Lêni M. Anchieta, César C. Xavier, Enrico A. Colosimo
    Jornal de Pediatria 01/2004; 80(5). DOI:10.1590/S0021-75572004000600014 · 0.94 Impact Factor
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    L M Anchieta, C C Xavier, EA Colosimo, M F Souza
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    ABSTRACT: A longitudinal and prospective study was carried out at two state-operated maternity hospitals in Belo Horizonte during 1996 in order to assess the weight of preterm appropriate-for-gestational-age newborns during the first twelve weeks of life. Two hundred and sixty appropriate-for-gestational-age preterm infants with birth weight <2500 g were evaluated weekly. The infants were divided into groups based on birth weight at 250-g intervals. Using weight means, somatic growth curves were constructed and adjusted to Count's model. Absolute (g/day) and relative (g kg-1 day-1) velocity curves were obtained from a derivative of this model. The growth curve was characterized by weight loss during the 1st week (4-6 days) ranging from 5.9 to 13.3% (the greater the percentage, the lower the birth weight), recovery of birth weight within 17 and 21 days, and increasingly higher rates of weight gain after the 3rd week. These rates were proportional to birth weight when expressed as g/day (the lowest and the highest birth weight neonates gained 15.9 and 30.1 g/day, respectively). However, if expressed as g kg-1 day-1, the rates were inversely proportional to birth weight (during the 3rd week, the lowest and the highest weight newborns gained 18.0 and 11.5 g kg-1 day-1, respectively). During the 12th week the rates were similar for all groups (7.5 to 10.2 g kg-1 day-1). The relative velocity accurately reflects weight gain of preterm infants who are appropriate for gestational age and, in the present study, it was inversely proportional to birth weight, with a peak during the 3rd week of life, and a homogeneous behavior during the 12th week for all weight groups.
    Brazilian Journal of Medical and Biological Research 06/2003; 36(6):761-70. DOI:10.1590/S0100-879X2003000600012 · 1.03 Impact Factor

Publication Stats

55 Citations
17.94 Total Impact Points

Institutions

  • 2003–2014
    • Federal University of Minas Gerais
      • • Hospital das Clínicas
      • • Faculty of Medicine
      Cidade de Minas, Minas Gerais, Brazil
  • 2013
    • Hospital de Clínicas Niterói
      Vila Real da Praia Grande, Rio de Janeiro, Brazil
  • 2004
    • Fundação Hospitalar do Estado de Minas Gerais
      Cidade de Minas, Minas Gerais, Brazil