Academic literature on the topic 'Later preterm'

While premature birth is a risk factor, not a diagnosis, for difficulties later in life, it is becoming increasingly important that teachers are aware of it. A new, free e-learning resource is now addressing this need.

Being born very preterm is associated with later deficits in lung function and an increased rate of respiratory symptoms compared with term-born children. The rates of early respiratory infections are higher in very preterm-born subjects, which may independently lead to deficits in lung function in later life. As with very preterm-born children, deficits in lung function, increased respiratory symptoms and an increased risk of respiratory infections in early life are observed in late ­preterm-born children. However, the rates of respiratory symptoms are lower compared with very preterm-born children. There is some evidence to suggest that respiratory outcomes may be improving over time, although not all the evidence suggests improvements. Male sex appears to increase the risk for later adverse respiratory illness. Although not all studies report that males have worse long-term respiratory outcomes than females. It is essential that preterm-born infants are followed up into childhood and beyond, and that appropriate treatment for any lung function deficits and respiratory symptoms is prescribed if necessary. If these very preterm-born infants progress to develop chronic obstructive airway disease in later life then the impact, not only on the individuals, but also the economic impact on healthcare services, is immense.Educational aimsTo report the effect of the sex of the preterm baby on respiratory outcomes.To explore the short- and long-term respiratory outcomes of preterm birth.

This study attempted to determine how cognitive, motor, linguistic, and social competencies of preterm children develop from birth to five years in comparison with a group of fullterm children. The interaction between biological and social risks was considered in evaluating short- and long-term delays in development. The study was also designed to ascertain whether infant test scores of the first two years are predictive of later IQ scores. A total of 195 healthy Italian preterms (birthweight ≤ 2000 grams, without severe neonatal complications) were administered the Brunet-Lezine test at 6,12, and 24 months (corrected age), and 149 of them the Stanford-Binet test at 3,4, and 5 years (chronological age). The preterm group showed motor, cognitive, and social delays in the first year, linguistic delays until 24 months, and general cognitive delays until 5 years in comparison with the fullterm group. However, preterms' mean infant test scores and IQ scores fell within the normal range. The probability of delays in development was increased by the conditions of intra-uterine growth retardation and very-low-birthweight, and, after the first year of life, by a low level of paternal education. Brunet-Lezine test scores were predictive of later IQ scores, as were sex and parental education. In conclusion, preterm birth is correlated with delays in development, especially when it is associated with other biological and/or social risk factors.

Excessive weight gain in infancy may lead to obesity and its sequelae later in life. Children born preterm have higher associated risk of becoming obese than full term babies. The goal of the study was to examine early weight gain among preterm infants, who later in life became obese. In a retrospective chart review of 37 preterm infants, 27 grew to support a normal weight and 10 became obese. We demonstrated differences in early childhood weight gain dynamics with weight differences between groups noted at 6 months of age that persisted later in life. Increased risk of obesity could be identified very early in infancy among preterm children. Early nutritional consult and attention to weight gain in infancy and early childhood are important steps in obesity prevention.

Background: Placental blood vessels play important roles in maternal-fetal circulation. Although pathologic mechanisms of preeclampsia are unclear, it is known that placental vascular dysfunction could contribute to pregnant hypertension. However, placental micro-vessel function or dysfunction at preterm has not been investigated. Methods: Human placentas from normal and preeclamptic pregnancies at preterm and term were obtained. Placental micro-vessels were used for determining vascular tension and responses to various vasoconstrictors as well as intracellular calcium store capability. It was the first time to show vascular responses in placental arteries to angiotensin II, endothelin-1, and other vascular drugs at preterm. Results: Compared to the control, placental vascular contractile responses to angiotensin II and caffeine were significantly decreased, while placental vascular responses to KCl, endothelin-1, and bradykinin were not significantly altered in the later term group in preeclampsia. In comparison of placental micro-vessel tension between the preterm and later term, caffeine- and serotonin-induced vascular contractions were significantly weaker in the preterm than that in the later term. On the contrary, vascular response to angiotensin II was increased in the preterm preeclampsia, while KCl-, endothelin-1, and bradykinin-mediated placental vessel responses in the preterm preeclampsia were similar to that in later term preeclampsia. Conclusion: New data showed that micro-vessel responses to angiotensin II and serotonin, not endothelin- 1 or bradykinin, were significantly reduced in the human placentas at preterm, and intracellular Ca2+ store capacity was damaged too, providing important information on possible contributions of placental vascular dysfunction to pregnant hypertension.

Made available in DSpace on 2016-06-02T20:18:17Z (GMT). No. of bitstreams: 1 4460.pdf: 3155980 bytes, checksum: 07f27821d9b649411a8d031d8f90ba16 (MD5) Previous issue date: 2012-04-27<br>Financiadora de Estudos e Projetos<br>Head movements play an important role in typical motor development because they form the basis for the emergence of fundamental motor skills such as reaching and sitting. In addition, the head is the first part of the body to develop antigravity control, and serve as a frame for the organization of postural control. The aims of this longitudinal study were: 1) to provide information about the behavioral (frequency of head movement; proportion of head initial position to the right, left and midline; proportion of movement type sideto- midline, midline-to-side and side-to-side) and kinematics (amplitude of head movement: flexion, inclination and rotation; duration of the movement; mean angular velocity; peak velocity; deceleration index; number of movement unit; number of movement unit after peak velocity; mean duration of movement unit; mean duration of movement unit after peak velocity; duration of the longest movement unit) changes during the acquisition of head control in supine position; 2) to verify and to describe the age-related changes observed in the spatial-temporal organization of the head movement; 3) to verify e if different body orientations (unsupported supine; supported supine head supported and semi flexed approximately to 15° over an infant pillow; and supported reclined- head supported and semi flexed approximately and the body reclined to 20° with the horizontal plane) and if external head support can improve the alignment between head and trunk, thus turning the head movement more controlled and 4) to verify if the body orientation can facilitate the head movement in younger infants (from birth to two months), as they head movement are not as controlled as older infants. To this end, 17 infants were longitudinally assessed once a month. They were presented with a black and white card that was moved sideward in front of their face in all the conditions (unsupported supine, supported supine and supported reclined. Results of study 1, focused in the age-related effect of head movement showed that with age, particularly from two months onwards, the head was more often held at body midline. A larger amount of head movements and an increase in amplitude and speed of the head movement accompanied this change between two and three months. Kinematic analysis also showed that head movements were organized in movement units that increased in number until three months of age, but significantly decreased afterwards (especially the number of movement units after peak velocity). The results about body orientation manipulation, study 2, showed that the behavioral and kinematic analyses in the supported supine and supported reclined conditions, showed an increase in the proportions of head positions at the body midline and midline-to-side head movements in comparison to the unsupported supine condition. Further, a lower mean angular velocity and a prolonged duration of the head movement and its constituent movement units (including the longest movement unit) were observed in the supported supine and reclined conditions. The results suggest that the velocity profile became more symmetrical with age, especially after two months-old onwards, which is indicative for better and more efficient control of the head movements. Importantly, many of the differences only occurred when infants were younger than three months of age. In sum, vii the head movement became more fluent and well-organized through age, especially after three months. The external support of the head led to an improvement in the alignment of head and trunk, which promoted better-controlled head movements, especially in the younger infants. This suggests that neck muscle strength is an important limiting factor in the development of head movements.<br>Os movimentos de cabeça são importantes no desenvolvimento motor típico, uma vez que formam a base para a emergência das habilidades motoras fundamentais, como o alcance e o sentar independente. Além disso, a cabeça é a primeira parte do corpo a desenvolver controle antigravitacional, servindo como ponto de referência para a organização do controle postural. Os objetivos deste estudo longitudinal foram: 1) fornecer informações sobre as mudanças comportamentais (frequência de movimento; proporção de posição inicial da cabeça à direita, esquerda ou linha média; proporção de tipo de movimento de lado a linha média, linha média a lado ou lado a lado) e nos parâmetros cinemáticos (amplitude de movimento: flexão, inclinação e rotação; duração do movimento; velocidade angular média; pico de velocidade; índice de desaceleração; número de unidades de movimento; número de unidades de movimento após o pico de velocidade; duração média das unidades de movimento; duração média das unidades de movimento após o pico de velocidade e duração média da unidade de movimento mais longa) observadas durante o período de aquisição do controle de cabeça, ou seja, do nascimento aos quatro meses de idade, em lactentes típicos em decúbito supino; 2) identificar e descrever as mudanças observadas com a idade na organização espaçotemporal da estrutura básica do movimento de cabeça; 3) verificar se mudanças na orientação corporal do lactente (supino; supino com suporte de cabeça - cabeça apoiada e semi-flexionada a aproximadamente 15º por meio de um travesseiro infantil; e reclinado com suporte de cabeça - cabeça apoiada e semi-flexionada e o corpo reclinado a 20º com o plano horizontal) e o fornecimento de apoio externo de cabeça favorecem o alinhamento entre cabeça e tronco e o controle dos movimentos de cabeça em lactentes a termo e 4) verificar se a orientação corporal pode ser considerada um agente facilitador do movimento de cabeça em lactentes mais jovens (do nascimento aos dois meses), visto que estes apresentam o controle de cabeça menos desenvolvido que os lactentes mais velhos. Para isso, 17 lactentes foram avaliados longitudinalmente, do nascimento aos quatro meses de idade. Era apresentado aos lactentes um cartão de estimulação visual, nas cores branca e preta, o qual era movido diante dos olhos do lactente, de um lado para o outro em todas as condições experimentais (supino, supino com suporte de cabeça e reclinado com suporte de cabeça). Os resultados do estudo 1 mostraram que com a idade, particularmente a partir dos dois meses, a cabeça do lactente encontra-se mais frequentemente alinhada com a linha média do tronco. A frequência, a amplitude e a velocidade também aumentaram entre dois e três meses. A análise cinemática demonstrou que os movimentos de cabeça são organizados em unidades de movimento, as quais aumentaram em número até os três meses, mas diminuíram significativamente após essa idade (especialmente o número de unidades de movimentos após o pico de velocidade). Em relação à orientação corporal, os resultados do estudo 2 mostraram que nas condições supino com suporte e reclinado com suporte os lactentes apresentaram maior proporção de movimentos iniciados na linha média e de linha média a lado, quando comparados à condição supino sem suporte. Além disso, foi observado diminuição na x velocidade angular média e aumento na duração do movimento da cabeça e de seus componentes constituintes (incluindo a unidade de movimento mais longa) nas condições de suporte, o que sugere maior simetria do perfil da curva da velocidade com a idade, especialmente a partir dos dois meses, indicando melhor e mais eficiente controle dos movimentos de cabeça. Ressaltamos que várias diferenças foram observadas para os lactentes mais jovens que três meses. Em resumo, o movimento de cabeça torna-se mais fluente e harmônico com a idade, especialmente a partir dos três meses e o suporte externo de cabeça favorece o alinhamento da cabeça e do tronco, o qual promove movimentos mais controlados, especialmente em lactentes jovens. Isto sugere que a força muscular cervical é um importante fator limitante para o desenvolvimento dos movimentos de cabeça. Os movimentos de cabeça são importantes no desenvolvimento motor típico, uma vez que formam a base para a emergência das habilidades motoras fundamentais, como o alcance e o sentar independente. Além disso, a cabeça é a primeira parte do corpo a desenvolver controle antigravitacional, servindo como ponto de referência para a organização do controle postural. Os objetivos deste estudo longitudinal foram: 1) fornecer informações sobre as mudanças comportamentais (frequência de movimento; proporção de posição inicial da cabeça à direita, esquerda ou linha média; proporção de tipo de movimento de lado a linha média, linha média a lado ou lado a lado) e nos parâmetros cinemáticos (amplitude de movimento: flexão, inclinação e rotação; duração do movimento; velocidade angular média; pico de velocidade; índice de desaceleração; número de unidades de movimento; número de unidades de movimento após o pico de velocidade; duração média das unidades de movimento; duração média das unidades de movimento após o pico de velocidade e duração média da unidade de movimento mais longa) observadas durante o período de aquisição do controle de cabeça, ou seja, do nascimento aos quatro meses de idade, em lactentes típicos em decúbito supino; 2) identificar e descrever as mudanças observadas com a idade na organização espaço-temporal da estrutura básica do movimento de cabeça; 3) verificar se mudanças na orientação corporal do lactente (supino; supino com suporte de cabeça - cabeça apoiada e semi-flexionada a aproximadamente 15º por meio de um travesseiro infantil; e reclinado com suporte de cabeça - cabeça apoiada e semi-flexionada e o corpo reclinado a 20º com o plano horizontal) e o fornecimento de apoio externo de cabeça favorecem o alinhamento entre cabeça e tronco e o controle dos movimentos de cabeça em lactentes a termo e 4) verificar se a orientação corporal pode ser considerada um agente facilitador do movimento de cabeça em lactentes mais jovens (do nascimento aos dois meses), visto que estes apresentam o controle de cabeça menos desenvolvido que os lactentes mais velhos. Para isso, 17 lactentes foram avaliados longitudinalmente, do nascimento aos quatro meses de idade. Era apresentado aos lactentes um cartão de estimulação visual, nas cores branca e preta, o qual era movido diante dos olhos do lactente, de um lado para o outro em todas as condições experimentais (supino, supino com suporte de cabeça e reclinado com suporte de cabeça). Os resultados do estudo 1 mostraram que com a idade, particularmente a partir dos dois meses, a cabeça do lactente encontra-se mais frequentemente alinhada com a linha média do tronco. A frequência, a amplitude e a velocidade também aumentaram entre dois e três meses. A análise cinemática demonstrou que os movimentos de cabeça são organizados em unidades de movimento, as quais aumentaram em número até os três meses, mas diminuíram significativamente xi após essa idade (especialmente o número de unidades de movimentos após o pico de velocidade). Em relação à orientação corporal, os resultados do estudo 2 mostraram que nas condições supino com suporte e reclinado com suporte os lactentes apresentaram maior proporção de movimentos iniciados na linha média e de linha média a lado, quando comparados à condição supino sem suporte. Além disso, foi observado diminuição na velocidade angular média e aumento na duração do movimento da cabeça e de seus componentes constituintes (incluindo a unidade de movimento mais longa) nas condições de suporte, o que sugere maior simetria do perfil da curva da velocidade com a idade, especialmente a partir dos dois meses, indicando melhor e mais eficiente controle dos movimentos de cabeça. Ressaltamos que várias diferenças foram observadas para os lactentes mais jovens que três meses. Em resumo, o movimento de cabeça torna-se mais fluente e harmônico com a idade, especialmente a partir dos três meses e o suporte externo de cabeça favorece o alinhamento da cabeça e do tronco, o qual promove movimentos mais controlados, especialmente em lactentes jovens. Isto sugere que a força muscular cervical é um importante fator limitante para o desenvolvimento dos movimentos de cabeça.

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, well-being, stress and mood. In addition, infant temperament and perception of infant vulnerability influence development of maternal competence and responsiveness. A non-experimental repeated measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers. One group consisted of mothers of late preterm infants 34-36, 6/7 weeks gestation. The second group consisted of mothers of term infants, >/=37 weeks gestation. Both primiparas and multiparas were included in the study. Data was collected in the initial postpartum period prior to discharge from the hospital and again at six-weeks postpartum. No statistically significant differences in development of maternal competence or responsiveness between mothers of LPIs and term infants were identified. This study adds to our knowledge concerning outcomes of mothers of late preterm infants and development of competence and responsiveness.

Neonatal sepsis is an important cause of neonatal morbidity and mortality. There are two distinct types of sepsis- early and late onset. Group B streptococcus and Listeria are the most common causes of early onset neonatal sepsis historically. Physicians select antibiotics for neonates with fever based on historically common bacterial pathogens such as GBS, Ecoli, Listeria, and Staphylococcal aureus. However, the landscape of bacterial pathogens causing sepsis and fever in neonates seems to be changing. This could potentially change the first choice of antibiotics for this susceptible population. In this case study, we will present early-onset sepsis in a late preterm infant due to Streptococcus pneumoniae as confirmed by blood culture. The only maternal risk factors present in this case for septicemia were delivery less than 37 weeks. Patient initially had respiratory distress at delivery and required CPAP for 3 days. On day 2 of life, cultures were taken due to acute deterioration. Ampicillin and Gentamycin were given to the patient for empiric coverage initially. On day 2 of antibiotics, cultures were reported positive. Patient’s antibiotics had to be altered at that time to cover the isolated organism. The patient was inadequately treated up until cultures were positive. This case raises the question if Ampicillin and Gentamycin remain the best choice for broad antibiotic coverage in neonates with possible sepsis.

Introduction: Preterm births are common in all obstetric hospitals and present multiple challenges to both the obstetrician and the paediatrician. Preterm delivery is an important cause of perinatal morbidity and mortality, and places significant psychosocial stress on all involved. Late Preterm Birth (LPTB) is an important topic with many consequences for mother, child and society. It would be of interest to quantify the problem of late preterm birth at Mowbray Maternity Hospital (MMH); quantifying the deliveries into spontaneous versus medically indicated, and to explore the reasons and outcomes for each category. Aims and Objectives: To review the causes, indications for, and outcomes (maternal and neonatal) of all late preterm births delivered at Mowbray Maternity Hospital. Methods: This was a retrospective descriptive study, conducted at Mowbray Maternity Hospital, between January 1 st 2016 and March 31 st 2016. The study population, consisting of 231 patients, includes all deliveries at MMH during the above time period, which fit the inclusion criteria of a gestational age (GA) of between 34⁺⁰ and 36⁺⁶ weeks. All data pertaining to the patient’s previous history, risk factors and current pregnancy were captured and analyzed using Stata. This study was approved by the UCT Ethics Committee (HREC) and institutional approval was obtained from Mowbray Maternity Hospital. All information was treated with confidentially and in accordance with the Helsinki Declaration. Results: During the study period, 1st January 2016 and 31st March 2016, there were a total of 2342 deliveries. Of these deliveries 36 (1.5%) were found to have a GA < 28 weeks (these included those that were categorised as miscarriages); 24 (1%) were between 28 – 31⁺⁶ weeks; 56 (2.4%) were between 32 – 33⁺⁶ weeks and 1833 (78.2%) had a GA above 37 weeks. 162 (6.9%) folders were missing and therefore GA was not calculated, leaving 231 (9.9%) deliveries of late preterm infants. Of the 231 patients included, 64 (27.7%) were noted to have a poor obstetric history, 38 (16.5%) had a history of a previous preterm delivery. Gestational age was calculated by Early Ultrasound Scan (EUS) in 44.2% of cases; Late Ultrasound Scan (LUS) in 36.4 % of cases; Last Normal Menstrual Period (LNMP) in 14.3% of cases and booking palpation in 5.12% of cases. At least one maternal characteristic associated with preterm labour was seen in 131 (56.7%) of the included patients. There were 20 (8.7%) sets of twins. Of the 231 patients, 129 (55.8%) presented in spontaneous labour and 102 were delivered late preterm for medical reasons; this included 70 (30.3% of 231) who had labour induced and 32 (13.9% of 231) who were delivered via caesarean section despite not being in labour for reasons that prevented an Induction of Labour (IOL)/vaginal birth. There were 251 babies delivered in the late preterm category, and of these, 250 (99.6%) were born alive, with 1 Early Neonatal Death (ENND) and 1 macerated stillborn. Of the 251 newborns, 63 (25.1%) were admitted to at least one of the neonatal wards during their hospital stay. Of these, 64.1% spent time in the High Care Unit (HCU), 28.1% spent time in the Neonatal Intensive Care Unit (NICU) and 68.8% spent time in Kangaroo Mother Care (KMC) unit (majority of these newborns had been in either HCU or NICU prior to KMC). Of the 63 neonates admitted to a neonatal ward; there were 37 (36.3%) from the 102 mothers delivered for medical reasons and 26 (20.2%) from the 129 mothers who had presented in spontaneous labour. The overall correlation between gestational age calculated by EUS/LUS/LMNP and Ballard score was calculated as 37%. The average length of stay in the hospital for the newborns, whether admitted or with mom, was 4.96 days. Discussion and Conclusion: Late Preterm Birth accounts for 9.9% of all births and 66.6% of all preterm births at Mowbray Maternity Hospital. This is a substantial proportion of MMH deliveries, putting pressure on already strained resources. This pressure is confounded by the fact that 25.1% of these neonates are admitted to a neonatal ward. 44.2% of these births are medically initiated and this should give cause for thought as to whether our protocols that govern certain medical conditions in pregnancy could possibly be altered to prolong pregnancies and reduce the incidence of Late Preterm Birth.

Problem: Identifying the factors effecting birth transition success of late preterm infants may improve early recognition of newborn compromise. Multiple explanatory variables may be associated with birth transition success or failure. The purpose of the study was to determine the prevalence of, and clinical-epidemiological and demographic predictive factors for birth transition success of late preterm infants. Methods: A retrospective case-control chart review was used to compare the characteristics of successful and unsuccessful birth transition of 35 and 36 week gestational age late-preterm infants delivered in a large tertiary-care center during calendar year 2007. A mixture of categorical and numeric variables related to maternal, birth, and physiologic constructs were analyzed for their effects on birth transition as a binary outcome variable (success or failure). Results: Of 22 variables tested, four predictor variables were associated with birth transition failure: labor (OR = .42, p = .014), 5-minute Apgar score (OR = 1.79, p = .043), gender (OR = .47, p =.003), and respiratory rate (OR= 2.08, p = .001) as tested by logistic regression. The model was able to accurately assign transition failure and success at a rate of 66.7% and 74% respectively. The overall model was statistically significant (likelihood ratio chi square = 38.97(4), p less than].001). The Hosmer & Lemseshow test indicated that the model estimates fit the data at an acceptable level (chi]?? = 7.72, p = .358). Discussion/Implication: The absence of labor was identified as a risk factor for transition failure in this population. Male preterm infants were nearly twice as likely to fail transition as females in this population. The case group had a higher frequency of lower 5-minute Apgar scores, resulting in significantly lower mean scores. The failed transition group had more than twice the number of newborns with abnormally high respirations than the control group.; These findings indicate that identification infants at risk for birth transition failure begins with the recognition of the absence of labor as a significant risk factor for birth transition failure of late preterm infants.<br>ID: 029809145; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 109-115).<br>Ph.D.<br>Doctorate<br>Nursing

There are increasing concerns about the excessive use of cesarean delivery in the United States, as cesarean deliveries have been associated with adverse maternal and infant health outcomes. Currently, the cesarean section (C/S) rate for Florida is the second highest in the nation. Furthermore, preliminary reports from the Florida Department of Health (FDOH) have implicated the increasing rate of cesarean delivery to an increase in the rate of late preterm births (PTB) in Florida (births at 34 to 36 weeks gestational age). Information on the impact of late PTB associated with cesarean delivery on the rate of maternal and infant morbidity in Florida as well as corresponding utilization of health care services is scarce. Information on the validity of data sources used to investigate infant and maternal health outcomes in Florida is also scarce. Therefore, the objectives of this research project were: (1) to determine the validity of data sources used to investigate low documented risk C/S and late PTB, and (2) to assess the impact of low documented risk C/S on maternal and infant morbidity and subsequent healthcare utilization. To determine the accuracy of data elements reported on the Florida birth certificate and hospital discharge data, sensitivity, specificity, positive predictive value, negative predictive value, kappa statistics and likelihood ratios were calculated. To assess differences in morbidity by route of delivery, generalized estimating equations and survival analyses were employed. Markov Chain Monte Carlo methods were used to determine appropriate morbidities for inclusion in all analyses. Differences in accuracy of data by data source was observed, with linked birth certificate and hospital discharge data demonstrating improved accuracy compared to birth certificate and discharge data alone. Further, significant differences in the rate of maternal and infant morbidity by route of delivery were observed, with cesarean delivery increasing the risk of adverse health outcomes, and intensive use of healthcare services.

This study explores the experiences of women who are caring for late preterm baby/babies (LPBs). These women’s experiences are especially relevant to examine, as the number of babies born late preterm is rising. Traditionally mothers and their LPBs have been studied under the umbrella of the general preterm infant population, with all experiences extrapolated from within this group. Whilst there is a growing body of literature related to late preterm babies, the focus is on physiology and physical needs. There is minimal research exploring women's experiences of caring for a late preterm baby and their views largely unknown. My aim was to privilege women's experiences, therefore a feminist approach to research was utilised. A feminist lens offered me an opportunity of understanding the world of women who care for LPBs, and what I learned from their experiences. To obtain in depth perspectives, individual qualitative interviews in two phases were carried out, with a purposefully selected sample of fourteen women who were caring for a baby or babies within the late preterm gestation in South West England. Template Analysis linked to Birth Territory Theory (BTT) was carried out to identify key issues and experiences of women. The findings indicate women who become mothers’ of late preterm babies have a complex journey. It is one which begins with separation, with babies being cared for in unfamiliar and highly technical environments where the perceived experts are healthcare professionals. Women’s needs are side-lined in favour of their baby/babies, and they are required to mother with ‘powerless responsibility’. Institutional and professional barriers to mothering/caring are numerous. The study recommends organisations and healthcare professionals listen to women, hear their stories and use their experiences of mothering/caring to direct developments in practice. Professionals need to accept late preterm babies do not belong to an institution and to the professionals that work within it, but instead recognise a mother’s prime relationship is with her baby and thus work with women to facilitate autonomous mother-work.

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs.<br>Dissertation (MA)- University of Pretoria, 2017.<br>Speech-Language Pathology and Audiology<br>MA<br>Unrestricted

Background: The management of late preterm prelabour rupture of membranes (PPROM) is associated with an increased risk of neonatal prematurity related morbidity due to many obstetric care guidelines which favour delivery at 34 weeks or immediately upon diagnosis of ruptured membranes after 34 weeks gestation. However, expectant management of this group of patients (i.e delayed delivery) between 34+0 and 36+6 weeks of gestation is associated with an increased risk of neonatal and maternal infectious morbidities. Aim of Study: The aim of this study was to evaluate the impact of the latency period on maternal and neonatal outcomes in late preterm prelabour rupture of membranes in a regional perinatal service in Cape Town, South Africa. The latency period was defined as the time from rupture of membranes to the time of delivery. In addition, we sought to investigate whether immediate induction of labour in the absence of overt signs of infection or fetal compromise should be prioritised in women who present with late preterm prelabour rupture of membranes. Methods: This was a retrospective cohort study carried out over a period of two years in two secondary level hospitals of the Metro West area of Cape Town. The subjects were low risk HIV negative women with singleton pregnancies with ruptured membranes in the late preterm period. Maternal and neonatal outcomes were studied between two latency periods, namely short latency (< 48 hours) and long latency period (≥ 48 hours) after ruptured membranes. Results and Conclusion: There were no significant differences in maternal and neonatal outcomes between the two groups of latency periods when latency was defined as the time from ruptured membranes to delivery. The study favoured a delayed induction thereby improving neonatal outcomes by decreasing the complications of prematurity. There were more adverse maternal outcomes, including an increase likelihood of augmentation of labour and more operative delivery along with its major risk, that of obstetric haemorrhage, were noted in the short latency period group. Therefore, a delayed induction policy appeared to be more appropriate. Preterm delivery places the newborn at risk of prematurity. Therefore, the risk of prematurity must be balanced with the risks of intrauterine infection and antepartum haemorrhage, the two major complications of expectant management if delayed induction is to be adopted. Proper monitoring of both the pregnant woman and fetus is essential when expectant management is carried out to avoid these adverse maternal and neonatal outcomes.

Kinder, welche nach 34 (+0) bis 36 (+6) Gestationswochen geboren werden, bezeichnet man als späte Frühgeborene. Genau wie Kinder eines jüngeren Gestationsalters sind diese von einer höheren postnatalen Morbidität und Mortalität betroffen als reif geborene Kinder. Diese Studie betrachtet die pulmonale Funktionsleistung dieser Kinder weit über die Neonatalperiode hinaus. Ehemals späte Frühgeborene wurden im Alter von 6 Jahren untersucht. Eine gleichaltrige Kontrollgruppe, bestehend aus ehemals reifen Neugeborenen, diente dem Vergleich. Vor allem Parameter der Spirometrie sowie Peak-Flow- und Atemwegswiderstandsmessungen ermöglichten dabei die Objektivierung der pulmonalen Funktion. Statistisch signifikante Unterschiede ließen sich in der mittleren FVC (forcierte Vitalkapazität) sowie dem FEV1 (forciertes exspiratorisches Volumen in einer Sekunde) feststellen, wobei Kinder der Indexgruppe jeweils im Mittel nur geringere Werte erreichten als Kinder der Kontrollgruppe. Der mittlere Atemwegswiderstand unterschied sich in Index-und Kontrollgruppe ebenso signifikant, wobei bei ehemals späten Frühgeborenen der Atemwegswiderstand im Mittel höher war als bei ehemals reifen Neugeborenen.

Asthma’s progression during pregnancy is highly variable. Improvement in symptoms can be seen in 18%–34% of patients, while worsening of symptoms can be seen in 20%–42% of patients. Acute exacerbations of asthma are most frequently seen late in the second trimester and are associated with a viral upper-respiratory infection. An acute exacerbation of asthma in the parturient can result in increased risk of maternal mortality, preterm delivery, and low-birth-weight infants. In patients with moderate to severe asthma, good control with inhaled corticosteroids, such as budesonide, is a cornerstone of reducing morbidity and mortality. The four components of care for the asthmatic patient are education, control of environmental factors, medications, and monitoring of symptoms.

Group B Streptococcus (GBS) is a leading cause of early neonatal infection and neonatal mortality, with long-term adverse neurodevelopmental outcomes in up to 50% of survivors of GBS meningitis. GBS has a likely underappreciated role in causing preterm birth and stillbirth. GBS colonizes the vagina and gastrointestinal tract of the pregnant woman, and transmission to the infant occurs during or just before delivery. Although the majority of these infants do not develop invasive disease, maternal colonization is a prerequisite for early onset disease (0–6 days of life, most commonly associated with sepsis and respiratory distress) and a significant risk factor for late onset disease (7–89 days of life, most commonly associated with sepsis and meningitis). The introduction of intrapartum antibiotic prophylaxis has resulted in significant declines in the incidence of early onset disease but provides no protection against late onset disease.

Exercise has many beneficial effects for pregnant women and their offspring, reducing insulin resistance and blood pressure and supporting angiogenesis, while also helping to maintain a healthy weight and body composition. Exercise/physical activity also been reported to reduce the risks of large for gestational age/small for gestational age babies and of preterm birth. Moderate exercise of 30 minutes or more on most days is recommended. Reasonable goals of aerobic conditioning in pregnancy should be to maintain a good fitness level throughout pregnancy without trying to reach peak fitness level or train for athletic competition. However, extreme exercise in late gestation is cautioned against, as it is associated with lower birth weights and the possibility of long-term adverse consequences on the offspring.

Listeria monocytogenes is a intracellular bacterial pathogen that causes serious foodborne illness in humans. Among all infectious diseases caused by gastrointestinal pathogens, listeriosis has the highest mortality rate, likely because of its ability to cross the gastrointestinal barrier and cause sepsis and infection of other organs such as the brain and placenta. Infection of the placenta leads to fetal infection, and otherwise healthy pregnant women have a significantly increased incidence of listeriosis than the general population, likely due to changes in the maternal cell-mediated immune response during pregnancy. Clinical manifestations include miscarriage, stillbirth, preterm labor, and neonatal infection and death. Neonates develop early-onset sepsis or late-onset meningitis. Physicians must evaluate pregnant women and neonates with febrile illnesses for listeriosis, since prompt treatment with antibiotics can cure it. It is important to note that L. monocytogenes is resistant to cephalosporins. Ampicillin is the treatment of choice in patients without penicillin allergy.

In the 1990s Carter produced his two longest works: Symphonia: sum fluxae pretium spei; and the one-act opera What Next? to a libretto by Paul Griffiths. The action of the opera begins with a car crash from which its six characters slowly emerge. The Symphonia similarly grew from three independent commissions and its movements have been performed both independently and as a triptych. The “accidental” nature of both works announces Carter’s late life willingness to compose in a more casual, informal manner, even on a large scale.

Forumrepresents an idiosyncratic attempt to reconcile the principles of musical comedy with Sondheim’s avowed preference for writing integrated musical drama. The sources of its plot in Roman farce become a pretext for a camp pastiche of the vulgar clichés of American burlesque and vaudeville. By analyzing the dramaturgical function of the individual songs, the chapter illustrates the various ways in which their evocation of the thought processes of type characters motivates the causal logic of the plot. The ingenuity of their placement and form is shown to shape the mood and pace of the action, while their stylistic cleverness is revealed as an enhancement of the metatheatricality of Shevelove and Gelbart’s book, producing a play of self-reflexive ironies that foreshadows Sondheim’s later experiments with the nonlinear structure of the postmodern musical.

This chapter discusses racially motivated lynching and rioting in the Midwest, identifying the social coordinates of collective racial violence in Springfield, Ohio, in 1904 and 1906. Race riots represent only one form of antiblack violence. More common and widespread throughout the late nineteenth and early twentieth centuries was lynching, which is usually defined as an illegal group action causing the death of a person or persons under the pretext of service to justice or tradition. Lynching has been more intensively studied than race riots, strikes, political mobs, and other modes of violence and conflict across racial lines. Authors of lynching studies have portrayed this form of antiblack violence as arising from interaction between African American aspirations and behavior and white repression.

Focusing on a few key passages, derived principally from law codes and literary sources, this chapter sketches out the legal situation of collegia vis-à-vis “the state”. However, this material is weighed against the rich epigraphic evidence (i.e. inscribed documents) that suggests the widespread and, in practical effect, unrestricted nature of Roman associations. It suggests that the appearance of governmental interference and regulation, from the late Republic throughout the Principate, was itself merely a pretext, as the government continued to encourage the development and proliferation of collegia as a means of social and political control. It questions whether the senate and the emperors had an interest in actually regulating and licencing collegial assembly, and whether legal texts can be reconciled with the inscriptional material attesting extensive collegial organisation, particularly in Italy and the Empire’s western provinces.

In the past few decades, the overall incidence of acute kidney injury (AKI) in paediatric patients has increased and the aetiological spectrum has shifted from infection-related and intrinsic renal causes towards secondary forms of AKI related to exposure to nephrotoxic drugs and complex surgical, oncological, and intensive care manoeuvres. In addition, neonatal kidney impairment and haemolytic uraemic syndrome continue to be important specific paediatric causes of AKI raising unique challenges regarding prevention, diagnosis, and treatment. The search for new biomarkers is a current focus of research in paediatric as in adult AKI research.Pharmacological intervention studies to prevent or attenuate AKI have provided positive evidence only for the prophylactic use of theophylline in severely depressed neonates, whereas dopamine and loop diuretics did not demonstrate any efficacy. Preliminary findings support a dose-dependent renoprotective action of fenoldopam in infants undergoing cardiac surgery.Critical issues in the management of AKI in children include fluid handling, maintenance of adequate nutrition, and the choice of renal replacement therapy modality. Observational studies have suggested an adverse impact of fluid overload and late start of renal replacement therapy, and a randomized clinical trial revealed detrimental effects of aggressive fluid bolus therapy in volume-depleted children.Technological advances have made it possible to apply continuous replacement therapies in children of all ages, including preterm neonates, using appropriately sized catheters, filters, tubing, and flow settings adapted to paediatric needs. However, the majority of children with AKI worldwide are still treated with peritoneal dialysis, and comparative studies demonstrating superiority of extracorporeal techniques over peritoneal dialysis are lacking.The outcomes of paediatric AKI are comparable to adult patients. In critically ill children, mortality risk increases with each stage of AKI; mortality rates typically range between 15% and 30% for all AKI stages and 30% to 60% in children requiring renal replacement therapy. Chronic kidney disease develops in approximately 10% of children surviving AKI.

This book draws upon cognitive poetics and uses an assortment of works written in Britain and the US for preteen and adolescent readers from 1906 to 2018 to argue that authors typically employ a limited and powerful set of spatial metaphors to organize the classical past for young readers. Popular models include palimpsest texts, which see the past as a collection of strata in which each new era forms a layer superimposed upon a foundation laid earlier; map texts, which use the metaphor of the mappable journey to represent a protagonist’s process of maturing while gaining knowledge of the self and/or the world; and fractal texts, in which small parts of the narrative are thematically identical to the whole in a way that implies that history is infinitely repeatable. While a given text may embrace multiple metaphors in presenting the past, we argue for associations between dominant metaphors, genre, and outlook. Map texts highlight problem-solving and arrival at one’s planned destination; they model an assertive, confident outlook. Palimpsest texts position character and reader as occupying one among many equally important temporal layers; they emphasize the landscape’s continuity but the individual’s impermanence, modeling a more modest vision of one’s place in time. Fractal texts work by analogy, denying difference between past and present and inviting readers to conclude that significant change may be impossible. Thus each model uses the classical past to urge and thus perhaps to develop a particular approach to life.

Because many patients reduce exercise following outpatient cardiac rehabilitation (CR), we developed an intervention to assist with the transition and evaluated its feasibility and preliminary efficacy using a one-group pretest–posttest design. Five CR patients were enrolled ~1 month prior to CR discharge and provided an activity tracker. Each week during CR they received a summary of their physical activity and steps. Following CR discharge, participants received an individualized report that included their physical activity and step history, information on specific features of the activity tracker, and encouraging messages from former CR patients for each of the next 6 weeks. Mixed model trajectory analyses were used to test the intervention effect separately for active minutes and steps modeling three study phases: pre-intervention (day activity tracking began to CR discharge), intervention (day following CR discharge to day when final report sent), and maintenance (day following the final report to ~1 month later). Activity tracking was successfully deployed and, with weekly reports following CR, may offset the usual decline in physical activity. When weekly reports ceased, a decline in steps/day occurred. A scaled-up intervention with a more rigorous study design with sufficient sample size can evaluate this approach further.