Estado de organização comportamental e desempenho da mamada de recém-nascidos pré-termo tardios com hiperbilirrubinemia submetidos a fototerapia

Abstract

Introduction: Prematurity is a risk factor for eating disorders. However, late preterm newborns are generally monitored in the rooming-in unit without different management. Hyperbilirubinemia is a common finding in the neonatal period and is generally considered physiological, but high bilirubin levels are potentially neurotoxic. Phototherapy is the treatment commonly used to treat hyperbilirubinemia, but it can lead to adverse events such as water loss and circadian rhythm changes. Prematurity and feeding difficulties are major risk factors for significant hyperbilirubinemia. It is therefore necessary to assess the performance of late preterm infants in breastfeeding, their state of behavioral organization and their relationship with sucking responses, in order to provide data that will enable appropriate management in the face of possible difficulties and ensure that preterm infants undergoing phototherapy have an effective feed and adequate intake. Such measures could reduce the risk of an increase in bilirubin and, as a consequence, the possibility of reducing the length of phototherapy treatment. Objective: 1) To evaluate the feeding performance of late preterm newborns with hyperbilirubinemia undergoing phototherapy. 2) To evaluate the state of behavioral organization of late preterm newborns undergoing phototherapy and its association with non-nutritive sucking responses. Methods: This was a controlled cross-sectional study carried out in a public teaching and research maternity hospital. The sample was based on convenience and consisted of 60 mother/late preterm newborn dyads, divided into two groups. One group consisted of 30 dyads whose newborns had hyperbilirubinemia that required phototherapy (case group) and another group with 30 dyads in which the newborns did not require phototherapy (control group). Data characterizing the sample was obtained through anamnesis and medical/hospital records. Breastfeeding performance was assessed using the Breastfeeding Observation Form (UNICEF), and behavioral organization and nonnutritive sucking were assessed using the Preterm Oral Feeding Readiness Scale. For statistical analysis, the Mann-Whitney U test was used to analyze the differences between the groups in characterizing the sample. Kendall's Tau test was used to verify the association between the variables state of behavioral organization and nonnutritive sucking. A 5% significance level was adopted for all analyses. The study was approved by the Research Ethics Committee. All guardians/participants signed an informed consent form. Results: The newborns in the case group had a predominance of "fair" and "poor" scores in all sections of the Breastfeeding Observation Form. There was a significant difference between the groups in the state of behavioral organization and non-nutritive sucking. There was also an association between behavioral status and non-nutritive sucking responses. Conclusion: Late preterm newborns under phototherapy have more breastfeeding difficulties, lower scores in the state of behavioral organization and in non-nutritive sucking.