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Resumo As tecnologias eHealth contribuem na promoção das práticas parentais de cuidado para bebês pré-termo. Não obstante, é notável a abundância de informações e aplicativos disponíveis, a disparidade na qualidade, facilidade de uso e confiabilidade desses recursos. Este artigo objetiva examinar as tecnologias eHealth direcionadas aos pais para o cuidado de bebês pré-termo. Realizou-se uma revisão integrativa nas principais bases de dados da área da saúde (Capes, EBSCO, BVS, PubMed, Scholar e SciELO), com a seleção de publicações de 2011 a 2022, em português e inglês, sobre a utilização de tecnologias eHealth voltadas aos cuidados de bebês pré-termo. Identificaram-se 13 artigos com temáticas sobre: as tecnologias da informação e comunicação nas estratégias de educação e a promoção da saúde de bebês pré-termo e seus pais; e importância da avaliação e validação das tecnologias eHealth na promoção da saúde materno-infantil. Tecnologias eHealth validadas adequadamente podem desempenhar um papel fundamental em apoiar os pais na promoção da saúde e na prestação de cuidados ao bebê pré-termo após a alta hospitalar. Isso, por sua vez, tem o potencial de impulsionar a evolução dos sistemas de saúde e a melhoria das práticas clínicas.

Abstract The eHealth technologies promote parental care practices for preterm infants. Nonetheless, we should underscore the abundant information and available apps and disparities in these resources' quality, usability, and reliability. This article examines eHealth technologies directed at parents to care for preterm infants. An integrative review was conducted across the principal health databases (Capes, EBSCO, BVS, PubMed, Scholar, and SciELO), selecting works published from 2011 to 2022 in Portuguese and English, focusing on the use of eHealth technologies for the care of preterm infants. We identified 13 articles related to information and communication technologies in strategies for educating and promoting the health of preterm infants and their parents and the importance of evaluating and validating eHealth technologies in maternal and child health promotion. Properly validated eHealth technologies can be crucial in supporting parents in promoting health and providing care for preterm infants after hospital discharge, which, in turn, can drive the evolution of healthcare systems and improve clinical practices.

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The aim of the current study was to assess the influence of maternal weight gain in different clinical gestational conditions on the child's weight at pre-school age. This was a longitudinal observational study of a prospective and controlled multiple cohort of 372 mother-child pairs with four causal groups of different adverse intrauterine environments (smoking, diabetic, hypertensive and intrauterine growth-restricted pregnant women) and a control group, in the period of, from 2011 to 2016 in three hospitals in Porto Alegre (Brazil). Sociodemographic, prenatal and perinatal data were analysed. Gestational weight gain (GWG) was categorised as 'insufficient', 'adequate' and 'excessive'. The generalised estimation equations (GEE) model was used to assess changes in the z-score of the child's body mass index from birth to pre-school age according to the GWG and gestational group. The child's GWG and weight gain were adjusted for maternal age and education, marital status, family income, pregnancy planning, number of children, prepregnancy BMI, prenatal consultations and type of delivery. A triple interaction effect was observed involving the gestational group, weight gain and study time (p = 0.020) through an adjusted model. Maternal weight gain above the recommended is associated with a significant increase in the child's z - BMI score over time, except for children from pregnant smokers. Children from diabetic mothers , hypertensive mothers and the control group who had a weight gain above that recommended during pregnancy changed their nutritional status from eutrophic to overweight, becoming obese in the DM and hypertension groups and overweight in control. Monitoring of the GWG, especially in the presence of hypertensive diseases and DM, should be effective to prevent children from developing overweight or obesity in pre-school age with an important impact on health conditions in the future.

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Objective. Understand the motivations and expectations of pregnant women using psychoactive substances during prenatal care. Methods. A qualitative study developed in the light of Alfred Schütz's Theoretical Framework of Phenomenological Sociology, in which 25 pregnant women using psychoactive substances, belonging to a Family Health Strategy, participated. Data production took place between August and November 2022.Results. Two units of meanings emerged: (i) social influences for the performance of prenatal care and (ii) expectation regarding the care to be received by the health professional. Pregnant women do pre-natal due to family influences, for fear of losing their children due to loss of guardianship and concern about the well-being and development of the baby. And, the expectations are that they receive good attention, feel safe when they are attended to by health professionals and also that they are understood and have a relationship of trust. Conclusion. Pregnant women who use psychoactive substances bring motivations for prenatal care linked to the past, such as influences from family members and previous experiences. As for expectations, they are related to the child's health and the care expected by professionals. Finally, strategies to reduce harm during pregnancy of users of psychoactive substances are fundamental for the effectiveness of care.

Objetivo. Conocer las motivaciones y expectativas de las gestantes consumidoras de sustancias psicoactivas durante la atención prenatal. Método. Se trata de un estudio cualitativo basado en el marco teórico de la sociología fenomenológica de Alfred Schütz, en el que participaron 25 gestantes consumidoras de sustancias psicoactivas pertenecientes a una Estrategia de Salud Familiar de una unidad de salud en Brasil. Los datos se recogieron entre agosto y noviembre de 2022. Resultados. Emergieron dos unidades de significado: (i) influencias sociales para la atención prenatal y (ii) expectativas sobre la atención recibida por el profesional de salud. Las gestantes acuden al control prenatal por influencias familiares, miedo a separarse de sus hijos por pérdida de la tutela y preocupación por el bienestar y desarrollo del bebé. Sus expectativas son recibir una buena atención, sentirse seguras con los profesionales sanitarios y ser comprendidas y escuchadas a través de una relación de confianza. Conclusión. Las embarazadas usuarias de sustancias psicoactivas tienen motivaciones para el cuidado prenatal relacionadas con su pasado, como influencias familiares y experiencias individuales previas. En cuanto a las expectativas, están relacionadas con la salud del niño y los cuidados esperados que les brindarán los profesionales de salud. Por último, el diseño de estrategias para reducir los daños durante el embarazo de las consumidoras de sustancias psicoactivas es fundamental para un cuidado eficaz.

Objetivo. Compreender as motivações e expectativas de gestantes usuárias de substâncias psicoativas durante a realização do pré-natal. Métodos. Estudo de abordagem qualitativa desenvolvida à luz do referencial Teórico da Sociologia fenomenológica de Alfred Schütz, em que participaram 25 gestantes usuárias de substâncias psicoativas, pertencentes a uma Estratégia Saúde da Família. A produção de dados ocorreu entre os meses de agosto a novembro de 2022.Resultados. Emergiram duas unidades de significados: (i) influências sociais para a realização do pré-natal e (ii) expectativa em relação ao cuidado a ser recebido pelo profissional de saúde. As gestantes realizam o pré-natal por influências de familiares, por receio de afastamento dos filhos decorrente de perda da tutela e pela preocupação com o bem-estar e desenvolvimento do bebê. E, as expectativas é de que recebam um bom atendimento, sintam segurança nos profissionais de saúde e que sejam compreendidas e ouvidas por meio de uma relação de confiança. Conclusão. As gestantes usuárias de substâncias psicoativas trazem motivações para a realização do pré-natal atreladas ao passado, como influências de familiares e experiências prévias. Quanto as expectativas, estão relacionadas à saúde da criança e o cuidado esperado pelos profissionais. Por fim, as estratégias para reduzir danos durante a gestação de usuárias de substâncias psicoativas é fundamental para a efetividade do cuidado.

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Objective: Understand the motivations and expectations of pregnant women using psychoactive substances during prenatal care. Methods: A qualitative study developed in the light of Alfred Schütz's Theoretical Framework of Phenomenological Sociology, in which 25 pregnant women using psychoactive substances, belonging to a Family Health Strategy, participated. Data production took place between August and November 2022. Results: Two units of meanings emerged: (i) social influences for the performance of prenatal care and (ii) expectation regarding the care to be received by the health professional. Pregnant women do pre-natal due to family influences, for fear of losing their children due to loss of guardianship and concern about the well-being and development of the baby. And, the expectations are that they receive good attention, feel safe when they are attended to by health professionals and also that they are understood and have a relationship of trust. Conclusion: Pregnant women who use psychoactive substances bring motivations for prenatal care linked to the past, such as influences from family members and previous experiences. As for expectations, they are related to the child's health and the care expected by professionals. Finally, strategies to reduce harm during pregnancy of users of psychoactive substances are fundamental for the effectiveness of care.

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Background and Objectives: The primary objective of this study was to assess the adherence of Ngäbe-Buglé women to WHO-recommended prenatal practices. The secondary objective was to compare adherence levels between women who received prenatal education from official medical providers and those educated through traditional or community-based sources within Ngäbe-Buglé communities. Materials and Methods: An eight-question survey was verbally administered to 137 Ngäbe-Buglé women at clinics set up by the non-profit NGO Floating Doctors in eight communities. A two-sided Fisher's Exact test with a p = 0.05 was used to compare the results of mothers who received prenatal education from evidence-based sources to other groups. Results: Out of the 137 surveyed women, 65 reported taking prenatal vitamins, 21 had prenatal check-ups, 136 avoided alcohol, 31 increased caloric intake, and 102 maintained their activity levels. Significant differences were observed in prenatal vitamin adherence between those educated by official sources versus unofficial sources (p = 0.0029) and official sources compared to those with no prenatal education (p < 0.0001). The difference was also significant for education from an unofficial source versus no education (p = 0.0056). However, no significant differences were found in other prenatal practices based on education sources. Conclusions: Our findings highlight deficiencies in both prenatal education and adherence to recommended practices among Ngäbe-Buglé women. Prenatal education significantly improved adherence to taking prenatal vitamins, suggesting its effectiveness as an intervention. Future interventions should prioritize culturally competent prenatal education and address barriers to accessing prenatal healthcare in Ngäbe-Buglé communities.

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OBJECTIVE: To quantify the extent to which pump use is associated with breastfeeding duration. STUDY DESIGN: We conducted a cross-sectional analysis of weighted data from the Centers for Disease Control and Prevention Pregnancy Risk Assessment Monitoring System from Maine, Michigan, New Mexico, and Utah between 2016 and 2021. Included respondents had a live-born infant at survey completion, initiated breastfeeding, and had nonmissing data for reported pump use and breastfeeding duration. Using Cox proportional hazard regression, we quantified the hazard of breastfeeding cessation and median duration (weeks) of breastfeeding by pump use. Pump use was suspected to be differentially impacted by race and ethnicity; an interaction was tested in our regression model. RESULTS: Our sample included 19 719 mothers (weighted n = 723 808) with mean age (SD) 29.5 years (5.6). Mothers with age <18 years, Medicaid enrollment, race, and ethnicity other than non-Hispanic White, lower income or education, and unmarried status demonstrated lower pump use (P < .001). Pump use was associated with 37% lower hazard of breastfeeding cessation (adjusted hazard ratio 0.63; 95% CI: 0.56-0.70) and 21 additional weeks of breastfeeding on average. The association varied by race and ethnicity (significant interaction observed between pump use and non-Hispanic Black mothers, P = .013); stratified analysis demonstrated the lowest hazard of breastfeeding cessation among non-Hispanic Black and Native American pump users (adjusted hazard ratio 0.47 [0.40-0.54] and 0.51 [0.37-0.70], respectively). CONCLUSIONS: Pump use was associated with longer breastfeeding duration; the greatest magnitudes of association were found among non-Hispanic Black and Native American participants, groups disproportionately affected by breastfeeding inequities. Future research examining the context around and causal impact of pump use on breastfeeding outcomes is needed.

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Background: Obesity disproportionately affects marginalized and low-income populations. Birth parent obesity from the prenatal period and childhood has been associated with child obesity. It is unknown whether prenatal or postnatal birth parent obesity has differential effects on subsequent changes in adiposity and metabolic health in children. Objectives: We evaluated how birth parent obesity 7 y after delivery was associated with child body composition changes and cardiometabolic health in midchildhood and further assessed the influence of the perinatal and postpartum period on associations. Methods: Black and Dominican pregnant individuals were enrolled, and dyads (n = 319) were followed up at child age 7 and 9 y. Measures included, height, weight, waist circumference (WC), and percent body fat (BF%). Multiple linear regression was used to relate postpartum weight status with child outcomes accounting for attrition, and a series of secondary analyses were conducted with additional adjustment for perinatal weight status, gestational weight gain (GWG), and/or long-term weight retention to evaluate how these factors influenced associations. Results: Almost one-quarter (23%) of birth parents and 24.1% children were classified with obesity at child age 7 y, while at 9 y, 30% of children had obesity. Birth parent obesity at child age 7 y was associated with greater changes, from ages 7 to 9 y, in child BMI z-score (ß: 0.13; 95% CI: 0.02, 0.24) and BF% (ß: 1.15; 95% CI: 0.22, 2.09) but not obesity at age 9 y. All observed associations crossed the null after additional adjustment for prenatal factors. Conclusions: Birth parent obesity at 7-y postpartum is associated with greater gains in child BMI z-score and BF% in midchildhood. These associations diminish after accounting for prenatal size, suggesting a lasting impact of the perinatal environment and that interventions supporting families from the prenatal period through childhood are needed.

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Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.

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Resumo O artigo analisa as práticas de cuidado e o processo de revelação do diagnóstico a crianças e adolescentes vivendo com HIV/Aids. Foi realizado um estudo de caso em um ambulatório localizado em um hospital público do Rio de Janeiro (RJ), através de observação participante, entrevistas semiestruturadas com profissionais de saúde e consulta a documentos produzidos pelos profissionais. A análise, baseada na sociologia de Simmel e Goffman, aponta a revelação do diagnóstico como uma marca que acompanha todo o cuidado estabelecido com os usuários e dá luz a questões como o segredo, o estigma e as possíveis compreensões acerca da condição de saúde estabelecidas. Com isso, as relações institucionalizadas contribuem para um progressivo contato com a condição de portador de um estigma e fazem existir fases de uma carreira de doente protegido pela informação.

Abstract This article analyzes practices of care and the HIV diagnosis disclosure process to children and adolescents living with HIV/AIDS. A case study was conducted in an outpatient clinic located in a public hospital in Rio de Janeiro through participant observation, semi-structured interviews with health professionals, and the consultation of documents produced by the professionals. The analysis, based on the sociology of Simmel and Goffman, points to the revelation of the diagnosis as a hallmark that accompanies all the care established with users and sheds light on issues such as secrecy, stigma and the possible understandings about the health condition established. As a result, institutionalized relationships contribute to a progressive contact with the condition of bearing a stigma and enable phases of a patient's life protected by information to exist.

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INTRODUCTION: Early initiation of breastfeeding (EIBF) is still little stimulated in several hospitals in Brazil. Objective: To estimate the prevalence and factors associated with Early initiation of breastfeeding (EIBF). METHODS: Cross-sectional, quantitative study with retrospective secondary data collection in hospital records of 250 full-term newborns, regardless of the type of delivery, with no history of maternal gestational risk, seen in the last six months. Data collection period in a public maternity hospital in Greater São Paulo. Data collection was performed between November 2018 and January 2019, with approval from the hospital and the FMABC Research Ethics Committee under register n. 2,924,393. RESULTS: The prevalence of EIBF was 66%. BFH is associated with anesthesia at childbirth (p<0,001), APGAR less than or equal to 8 in the 1st and 5th minutes (p<0,001), and with c-section (p<0,001), which represented 29.2% of deliveries in the sample. Respiratory distress (38.82%), hypotonia (24.70%), followed by unfavorable maternal conditions (18.82%), were shown to be impeding factors for EIBF, although 90% of newborns received Apgar 9 /10 in the 5th minute. CONCLUSION: The prevalence of early breastfeeding is lower than recommended, but compatible with the most recent national frequency proportions.

INTRODUÇÃO: O aleitamento materno na primeira hora de vida ainda é pouco estimulado em vários hospitais do Brasil. OBJETIVO: Analisar a prevalência e os fatores associados ao aleitamento materno na primeira hora de vida (AMP) entre recém-nascidos a termo. MÉTODOS: Estudo transversal, de natureza quantitativa, com coleta de dados secundários retrospectivos em prontuários hospitalares de 250 recém-nascidos a termo, independentemente do tipo de parto, com histórico de gestacional de risco habitual, atendidos nos últimos seis meses anteriores ao período de coleta de dados, em uma maternidade pública da Grande São Paulo. Os dados foram coletados entre novembro de 2018 e janeiro de 2019, por meio de roteiro estruturado, mediante aprovação do hospital e do Comitê de Ética em Pesquisa da FMABC (Parecer n.º 2.924.393). O banco de dados e o tratamento estatístico foram realizados através do programa STATA®. Para a análise, utilizou-se proporções e teste qui-quadrado, adotando-se um nível de significância de 5% e 95% o intervalo de confiança. RESULTADOS: A prevalência de AMP foi de 66%. O AMP está associado a anestesia no parto (p<0,001), APGAR menor ou igual a 8 no 1º e 5º minutos (p<0,001) e ao parto cesárea (p<0,001), cuja proporção na amostra foi de 29,2%. Desconforto respiratório (38,82%), hipotonia (24,70%), seguido de condições maternas desfavoráveis (18,82%), mostraram-se como fatores impeditivos para o AMP, embora 90% dos recém-nascidos tenham recebido Apgar 9/10 no 5º minuto. CONCLUSÃO: A prevalência do aleitamento materno precoce é inferior ao recomendado, porém compatível com as proporções de frequência nacional mais recentes.

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