Browsing by Author "Carvalho, Carmen"
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- Minimally invasive surfactant therapy in preterm infants: towards less invasive managementPublication . Meireles, Daniel; Neiva-Araújo, Luísa; Nascimento, Marta; Pinho, Liliana; Freitas, Ana Cristina; Almeida, Alexandra; Carvalho, Carmen; Proença, ElisaIntroduction: Minimally invasive surfactant therapy (MIST) is a surfactant administration procedure that intends to reduce intubations and associated risks. The aim of this study was to compare MIST with INtubation-SURfactant-Extubation (INSURE) technique. Material and methods: Retrospective analysis (from January 2015 to June 2019) of preterm infants on nasal continuous positive airway pressure (nCPAP) treated with surfactant. Results: Fifty-four preterm infants were included and divided in two groups: MIST (n=34) and INSURE (n=20). No significant differences were found between groups regarding gestational age (p=0.480), birth weight (p=0.299), fraction of inspired oxygen (FiO2) prior to surfactant (p=0.220), oxygen therapy duration (p=0.306), progression to intubation (p=0.712), or length of Neonatal Intensive Care Unit stay (p=0.778). FiO2 variation before and after surfactant administration was higher in MIST group (14% vs 9%, p=0.078). No significant complications were reported with either technique. Conclusions: MIST is a safe technique in preterm infants on nCPAP. This study shows similar outcomes with MIST and INSURE procedures, with a greater reduction in FiO2 requirements with MIST. Overall, MIST is less invasive and as effective as INSURE in preterm infants.
- Shared decisions in neonatal intensive care − bioethical approachPublication . Carvalho, Carmen; Freitas, Ana Cristina; Pinho, Liliana; Novo, AnaTechnological and therapeutic advances in neonatal intensive care have led to a decrease in neonatal morbidity and mortality in recent decades. Along with technical and scientific expertise, it is important to provide a holistic and comprehensive approach to the care of the newborn and family. The purpose of this review is to describe and analyze strategies to improve decision-making within a shared process between health professionals and caregivers at neonatal intensive care setting. The decision-making process is not linear or immutable over time and there is no consensus on the definition of ‘shared decision’. More unanimous is the role of communication as a atherapeutic relationship pillar. Professional ethics, bioethics, and narrative medicine should be used as tools to address the vulnerabilities of families and professionals and as a way to consolidate and structure the human relational dimension intrinsic to medical practice.
- Transfusão feto-fetal – sobrevivente policitémicoPublication . Dias, Joana; Fraga, José; Branco, Susana; Monteiro, Tânia; Carvalho, Carmen; Alexandrino, Ana MargaridaIntroduction: Twin-twin transfusion syndrome (TTTS) is associated with the death of one or both foetuses, particularly if diagnosed before 28 weeks’ gestation. Sudden deteriorations can occur, leading to death of the cotwin and neurological handicap in the survivor. Case Report: We report a case of polycythemia in the recipient twin of a pregnancy with TTTS. Laser photocoagulation of placental anastomoses was performed successfully at 18 weeks. Follow-up showed resolution of signs of TTTS on ultrasound examination. Caesarean section at 33 weeks due to foetal death of donor twin, the recipient twin demonstrated symptomatic polycythemia (hematocrit 70%). Partial exchange transfusion (PET) was performed twice in the first 12 hours. Normal hematocrit levels were achieved without complication. Perinatal outcome was good. Conclusion: Despite the prognosis improvement after laser photocoagulation of placental anastomoses, perinatal mortality and morbidity remains height.