The Brazilian Neonatal Resuscitation Program releases guidelines based on local interpretation of international consensus on science and treatment recommendations. We aimed to analyze whether ...guidelines for preterm newborns were applied to practice in the 20 Brazilian Network on Neonatal Research centers of this middle-income country.
Prospectively collected data from 2014 to 2020 were analyzed for 8514 infants born at 230/7 to 316/7 weeks' gestation. The frequency of procedures was evaluated by gestational age (GA) category, including use of a thermal care bundle, positive pressure ventilation (PPV), PPV with a T-piece resuscitator, maximum fraction of inspired oxygen (Fio2) concentration during PPV, tracheal intubation, chest compressions and medications, and use of continuous positive airway pressure in the delivery room. Logistic regression, adjusted by center and year, was used to estimate the probability of receiving recommended treatment.
For 3644 infants 23 to 27 weeks' GA and 4870 infants 28 to 31 weeks' GA, respectively, the probability of receiving care consistent with guidelines per year increased, including thermal care (odds ratio OR, 1.52 95% confidence interval (CI) 1.44-1.61 and 1.45 1.38-1.52) and PPV with a T-piece (OR, 1.45 95% CI 1.37-1.55 and 1.41 1.32-1.51). The probability of receiving PPV with Fio2 1.00 decreased equally in both GA groups (OR, 0.89; 95% CI, 0.86-0.93).
Between 2014 and 2020, the resuscitation guidelines for newborns <32 weeks' GA on thermal care, PPV with a T-piece resuscitator, and decreased use of Fio2 1.00 were translated into clinical practice.
To evaluate the prevalence of congenital heart disease and their outcomes in a Brazilian cohort of very low birth weight preterm infants.
Post hoc analysis of data from the Brazilian Neonatal Network ...database, complemented by retrospective data from medical charts and a cross-sectional survey.
Twenty public tertiary-care university hospitals.
A total of 13,955 newborns weighing from 401 to 1,499 g and between 22 and 36 weeks of gestational age, born from 2010 to 2017.
None.
The prevalence of congenital heart disease was 2.45% (95% CI, 2.20-2.72%). In a multivariate regression analysis, risk factors associated with congenital heart disease were maternal diabetes (relative risk, 1.55; 95% CI, 1.11-2.20) and maternal age above 35 years (relative risk, 2.09; 95% CI, 1.73-2.51), whereas the protection factors were maternal hypertension (relative risk, 0.54; 95% CI, 0.43-0.69), congenital infection (relative risk, 0.45; 95% CI, 0.21-0.94), and multiple gestation (relative risk, 0.73; 95% CI, 0.55-0.97). The pooled standardized mortality ratio in patients with congenital heart disease was 2.48 (95% CI, 2.22-2.80), which was significantly higher than in patients without congenital heart disease (2.08; 95% CI, 2.03-2.13). However, in multiple log-binomial regression analyses, only the presence of major congenital anomaly, gestational age (< 29 wk; relative risk, 2.32; 95% CI, 2.13-2.52), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20; relative risk, 3.76; 95% CI, 3.41-4.14) were independently associated with death, whereas the effect of congenital heart disease was spotted only when a conditional inference tree approach was used.
The overall prevalence of congenital heart disease in this cohort of very low birth weight infants was higher and with higher mortality than in the general population of live births. The occurrence of a major congenital anomaly, gestational age (< 29 wk), and Score for Neonatal Acute Physiology and Perinatal Extension II (> 20) were significantly and independently associated with death, whereas the association of congenital heart disease and death was only evident when a major congenital anomaly was present.
Egg incubation waste in association with sheep manure might be an interesting alternative for improving energy efficiency in anaerobic co-digestion systems. The goal of this study was to determine ...whether the inclusion of liquid hatchery waste (LHW) can improve the energy efficiency of anaerobic digestion from sheep manure and whether this inclusion is economically viable. The study was carried out in a completely randomized 4 × 3 factorial design that corresponded to four LHW levels (0, 10, 20, and 30% total solids in the affluent) and three hydraulic retention times (HRTs; 12, 17, and 22 d). Greater reductions in chemical oxygen demand (COD, 58.00 and 60.59%) and volatile solids (VS, 75.91 and 79.44%) were attained with the inclusion of 12.65 to 14.43% at 17 and 22 d of HRT, respectively. The HTRs of 17 and 22 d presented similar biogas production; however, the HTR of 17 d led to higher concentrations of methane in the biogas composition (64.0%) compared to that at 22 d (62.2%). Using the ideal level of LHW and 17 d of HRT attained an increase in methane production by 25.36% compared with that of the isolated digestion of sheep manure. An economic viability analysis showed that the investment risk was low with zero probability of negative net present value (NPV). We concluded that co-digestion between LHW and sheep manure might improve energy generation and promote the economic sustainability of such energy production.
Display omitted
•Liquid hatchery residue generates clear energy.•Semi-continuous co-digestion is efficient in treating hatchery residues.•Adding lipid-rich residues enhances biogas and methane productions.•The inclusion of 13% liquid residue resulted in maximum methane production.•17 days are enough to break down the liquid hatchery residues.
