Dissertations / Theses on the topic 'Later preterm'

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.

Abstract The main objective of the present follow-up study was to investigate auditory processing by using auditory event related potentials (ERPs), and language development to determine whether a correlation exists between auditory ERPs and language development. Auditory processing was investigated in very low birth weight (VLBW) preterm children and matched controls at mean ages of 4 and 6 years to determine whether there are differences in ERPs between VLBW preterm children and controls. Language development was measured at the mean ages of 2, 4 and 6 years to investigate the developmental course of language learning and to determine whether a relationship exists between ERPs, especially mismatch negativity (MMN), and language development. Auditory ERPs were also measured in children with AS (mean age 9;1 years) and matched controls to assess whether differences can be found between these two groups of children. Language development in children with AS was not investigated for this study. VLBW preterm children exhibited difficulties in the auditory processing at the level of obligatory ERPs, MMN, late MMN (lMMN) and behavioural tests. Both language comprehension and production were deficient in the preterm group compared to their controls. Lexical development was the most prominent phenomenon differentiating preterm children from their controls. MMN and lMMN amplitudes were attenuated most in children with naming difficulty at the ages of 4 and 6 years. Weak or totally missing MMN at the age of 4 years was mainly found in children with naming difficulties. Children with AS also displayed abnormalities in auditory processing, as indexed by delayed MMN latency. MMN was most delayed in the right hemisphere and specifically for tones. In conclusion: VLBW preterm children and children with AS exhibited difficulties in auditory processing. MMN correlated well with language development in preterm children. Therefore, auditory ERPs, especially MMN, should be used in combination with language measures to identify the children at a risk for deficient auditory processing and language delays.

Literature review abstract Background: Domain-general processes, such as working memory (WM), short-term memory (STM), and attention, have been found to be related to mathematical performance in children. The relationship between these abilities, however, is not well understood. Objective: This systematic review aimed to evaluate the literature investigating the relationship between mathematical performance and WM, STM, and attention in typically developing primary school aged children. Methods: Three databases were searched for studies published between January 1974 and February 2015 reporting associations between mathematics performance and at least one measure of WM, STM, and attention. Study selection was undertaken by applying inclusion and exclusion criteria and 43 studies were selected for inclusion. The methodological quality of the included studies was assessed using a validated checklist. Results: WM, STM, and attention were all significantly related to mathematics performance. Visuospatial STM and WM were strongly related to mathematics performance in younger children, while verbal STM and WM were more strongly related in older children; although some studies found the opposite pattern. The relationship between attention and mathematics performance increased in strength with age. Conclusions: There are many factors relevant to the relationship between mathematical performance and WM, STM, and attention which can affect the strength of the association, including the types of tasks used to measure the constructs, the confounding variables considered, and the age of the participants. Future research needs to focus on the construction of an integrated model of mathematical development.   Empirical paper abstract Background: Moderate to late preterm children (MLPT; born between 32 weeks and 36 weeks and 6 days) are at increased risk of developing cognitive difficulties compared to term children (born between 37 weeks and 41 weeks and 6 days). Mathematical attainment is an important area of academic development. Domain-general cognitive abilities, which constrain all learning, and domain-specific mathematical precursors are both important for mathematical development. Objectives: The current study had two aims: 1) to investigate the relationship between gestational age (GA), mathematical attainment, working memory (WM), short-term memory (STM), and attentional control; and 2) to investigate WM, STM, and attentional control as domain-general predictors of mathematical attainment. It was hypothesised that WM would predict additional variance in mathematical attainment after attentional control, STM, and demographic variables (intellectual ability (IQ) and socioeconomic status) were accounted for. Methods: A cross-sectional and correlational design was used to investigate the study aims. Participants were 34 MLPT children and 25 term children who were between 72 and 107 months at the time of the study. Children who weighed less than 1500 grams at birth, had cerebral palsy, epilepsy, severe hearing or vision loss, or had a diagnosed learning disability were excluded. Each participant completed a cognitive assessment which measured their mathematical attainment and components of WM, STM, and attentional control. Results: GA was only significantly correlated with IQ. In the model of mathematical attainment, GA also significantly moderated the relationship between attentional switching and mathematical attainment. The hypothesis regarding the role of WM in predicting mathematical attainment was partially supported as only verbal WM predicted significant additional variance in mathematical attainment. Attention behaviour and IQ also predicted significant additional variance in mathematical attainment. Conclusion: These findings suggest that birth weight greater than 1500g, higher socioeconomic status, and lower levels of co-morbid medical conditions may serve as protective factors against the potential negative consequences of MLPT birth. Findings regarding the domain-general predictors of mathematical attainment supported some previous findings and highlighted the need for a variety of tasks to be used to measure each domain-general ability. Longitudinal studies in MLPT children would be helpful for further understanding the role of GA and domain-general abilities in the development of mathematical attainment.

Neonatal circulatory adaptation at birth is unique. If the transition from an in- to ex-utero circulatory system is unsuccessful, circulatory failure ensues resulting in anaerobic respiration and eventual tissue death. This thesis explores the use of novel non-invasive techniques to assess neonatal circulatory adaptation. Data are reported from three observational cohort studies including infants aged less than 72 hours of age and greater than 33 weeks’ gestational age (GA) who received special care (n=50), intensive care (n=25) or total body cooling (n=14). For the first three days of life infants had routine daily clinical assessments (e.g. blood pressure), echocardiographic (superior vena cava flow and right ventricular outflow) and plethysmographic measurements (modified pleth variability index and pulse transit time). Daily longitudinal, comparative and correlational analysis of these measures within and between cohorts of neonates were performed. In addition, their relationships to assessments of short term neurological outcomes and cardiovascular treatment were explored. Bland Altman plots were used to explore the repeatability of plethysmographic and echocardiographic measures. The results indicate that the cardiovascular systems of between the three cohorts of neonates studied adapt differently over the first three days of life. Specifically, neonates who receive total body cooling exhibited significantly lower blood pressures, heart rates and measures systemic blood flow compared to neonates who are healthy or receiving intensive care. Healthy neonates aged between 33 to < 37 weeks GA exhibited daily significant shortening of modified pulse transit time and increased measures of systemic blood flow indicating these neonate’s systemic vascular resistances increase more gradually compared to term neonates with end organ perfusion maintained through increased cardiac output. The intra- and inter-observer repeatability of echocardiographic and plethysmographic assessments was poor and excellent respectively (repeatability index range 26-64% vs. 3-13%). Future studies should focus on the use of these biomarkers in the identification of neonates at risk of circulatory failure.

Late preterm infants (born at 34-36 weeks gestation) have increasingly been regarded as 'at risk' rather than 'Iow risk' infants. The impact of neonatal morbidity and admission for neonatal care, on the longer term outcomes of LPls has not been fully explored. This thesis has sought to bridge an identified gap in the literature relating to this significant group of neonatal care graduates. The overall aim of this thesis was to consider the significant population of LPls who require admission for neonatal care. Firstly, maternal and perinatal risk factors and neonatal outcomes were considered through a descriptive analysis of neonatal data from the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database. The second component of the thesis then considered specifically the early childhood development (cognition, language, motor development, physical health and growth) at three years of age of LPls who required neonatal Intensive Care (lC) compared with infants of the same gestational age who did not require Intensive Care. LPls who required neonatal care were identified as a unique group, with distinct characteristics and outcomes in the neonatal period when compared to other admitted infants. LPls requiring Intensive Care (IC) had increased maternal and perinatal risk factors and increased adverse neonatal outcomes compared to LPls who required Special Care Only (SCO). Findings from the follow-up study revealed that despite increased maternal and perinatal risk factors and neonatal morbidity, LPls who required admission to IC had similar cognitive, language and motor abilities and growth, compared with their peers, who were not admitted for le. However, LPls who required IC had increased health service usage compared to the non-IC infants. Having considered, for the first time, the neonatal outcomes and early childhood development of LPls on the basis of their requirement for neonatal Intensive Care, this thesis has provided a novel insight into the outcomes of this under-researched group of children.

Die Kaiserschnittrate erhöhte sich in den letzten Jahrzehnten in zahlreichen geburtshilflichen Kliniken. Diese Entwicklung ist problematisch, weil damit eine erhöhte pulmonale Morbidität der Neugeborenen verbunden sein kann. Die vor­ liegende Arbeit untersucht die Anpassung von späten Frühgeborenen (34,0–36,6 SSW) und 2 Gruppen von reifen Neugeborenen (37,0–37,6 und 40,6–40,6 SSW) in einem Level 1 Zentrum in Abhängigkeit vom Geburtsmodus. Eingeschlos­ sen wurden primär gesunde Kinder, die im Verlauf eines Jahres geboren wurden. Ausge­ schlossen wurden Kinder mit nachgewiesener angeborener Anomalie und Kinder mit einer schweren Anpassungsstörung (Apgar 5‘&lt;6). Die Kaiserschnittrate lag bei 22% und war am höch­ sten bei späten Frühgeborenen (39%) im Ver­ gleich zu Kindern der 37. (30 %) und der 40. SSW (11%). Die Rate der Kinder, die mit CPAP behan­ delt werden mussten fiel von 88 % in der 34. SSW auf 17% in der 37. und 8% in der 40. SSW. Kinder nach Kaiserschnitt mussten im Vergleich zur spontan geborenen Kindern signifikant häufiger mit CPAP therapiert werden (50 vs. 12%). Dieser Unterschied war für späte Frühgeborene deutlich (82 vs. 36 %) und lag niedriger bei in der 37. (33 vs. 9 %) und 40. (26 vs. 6 %) SSW geborenen Kindern. Der deutlichste Unterschied fiel bei in der 36. SSW geborenen Kindern auf (66 vs. 9%). Die Ergebnisse der Analyse dokumentieren, dass ein Kaiserschnitt bei primär gesunden Kindern zu einer schlechteren respiratorischen Anpassung führt. Dies gilt besonders, jedoch nicht nur, für späte Frühgeborene und dort besonders für Kinder, die in der 36. SSW geboren werden. Die weltweit wachsende Rate von Kaiserschnittent­ bindungen sollte immer wieder kritisch hinter­ fragt werden. Eine Kaiserschnittentbindung ohne klare Indikation führt zu einer erhöhten Rate an respiratorischen Anpassungsstörungen, zur neo­ natologischen Aufnahme der Kinder und damit verbunden zu einer Störung der Mutter­Kind­Bindung, sowie zu einer unnötigen finanziellen Belastung des Gesundheitssystems. Es ist zu wünschen, dass die Daten der Studie benutzt werden, um in der Diskussion zwischen Eltern, Geburtshelfern und Neo­ natologen immer den besten Geburtsweg für das Kind zu finden<br>The rates of delivery by Cesarean section (CS) have been trending upwards in recent decades, perhaps leading to higher rates of dysfunction in respiratory adaptation in newborns. We present epidemiological data for pulmonary adaptation by mode of delivery for healthy late preterm and term infants born at a regional tertiary care center. The overall CS rate was 22 % with the lar­ gest proportion of these in late preterms (39%). This drops to 30% in infants born after 37 weeks gestation and to 11% for those born after 40 weeks. Infants needing respiratory support de­ creased significantly as gestational age increased: 88% at 34 weeks, 67% at 35 weeks, 28% at 36 weeks, 17% at 37 weeks and 8% at 40 weeks. The risk of respiratory morbidity following CS as compared to vaginal delivery (VD) was substan­ tially higher. 50% of infants born by CS needed respiratory support compared to only 12% fol­ lowing VD. 82% of all late preterm infants born by CS developed respiratory morbidity compared to 36 % following VD. Comparable data for infants born after 37 and 40 weeks gestation were 33% compared to 9 % and 26 % compared to 6 % respec­ tively. Late preterm infants born after 36 weeks gestation showed the most marked difference by mode of birth with 66 % needing respiratory sup­ port following CS as compared to only 9 % follow­ ing VD. Our data could be useful in counselling parents about risk associated with delivery by Cesarean section. A critical view should be taken of increasing CS rates worldwide because of a clear correlation in increased morbidity in infants, especially late preterm infants

Made available in DSpace on 2016-03-22T17:27:16Z (GMT). No. of bitstreams: 1 luciana correa.pdf: 746120 bytes, checksum: 09a2aa7fea7c4deef3b1adf8c970878b (MD5) Previous issue date: 2013-12-16<br>Objective: Assess the characteristics of late pre term newborns admitted in a neonatal intensive care unit. Methods: Descriptive, cross-sectional, retrospective study with all the patients in the neonatal intensive care unit of a university hospital in a mid-size city, between January 2011 and December 2012. Perinatal and neonatal variables were avalued throughout hospitalization. Results: The study population consisted of 330 patients. Newborns under 33 weeks of gestational age accounted for 50% of hospitalizations, late preterm infants, for 27,3% and full-term newborns, for 20%. The majority of the population had adequate weight for gestational age, with a rate of 67.8% among late preterm. Over seventy percent of the general population and those born cesarean; whose primary indication was fetal distress. The main cause of hospitalization for all groups was infant respiratory distress syndrome, accounting for 70% of admissions of late preterm. Sepsis reached 66.7% of this group requiring several therapeutic measures during hospitalization. The mortality rate of late preterm infants was 5.6%, the lowest among groups of gestational age. Conclusion: The need for emergency neonatal care and increased occupancy rate in intensive care units show us the importance of this premature group and warns us that are not functionally "near term" and that their particularities physiological and metabolic put them on a different level to be disregarded at the time of his birth<br>Objetivo: Determinar a prevalência e as características dos recém-nascidos prematuros tardios admitidos em uma unidade de tratamento intensivo neonatal. Métodos: Estudo descritivo, transversal, retrospectivo com todos os pacientes internados na unidade de tratamento intensivo neonatal de um hospital universitário, entre Janeiro de 2011 e Dezembro 2012. Variáveis perinatais e neonatais foram avaliadas durante todo período de internação. Resultados: A população do estudo foi constituída de 330 pacientes. Recém-nascidos com idade gestacional menor ou igual a 33 semanas foram responsáveis por 53,3% das internações, prematuros tardios por 27,3% e nascidos a termo por 20%. A maioria da população tinha peso adequado para a idade gestacional, com uma taxa de 67,8% entre os pré-termos tardios. Mais de setenta por cento destes e da população geral nasceram de cesareana; cuja principal indicação foi sofrimento fetal agudo. A principal causa de internação para todos os grupos foi síndrome do desconforto respiratório, responsável por 70% das admissões dos prematuros tardios. Sepse atingiu 66,7% deste grupo que necessitou de várias medidas terapêuticas durante a internação. A taxa de mortalidade dos pré-termos tardios foi de 5,6%, a mais baixa dentre os grupos de idade gestacional. Conclusão: A necessidade de atendimento emergencial neonatal e a crescente taxa de ocupação de leitos de intensivismo nos demonstra a importância deste grupo de prematuros e nos alerta que funcionalmente não são quase a termo 60 e que suas particularidades fisiometabólicas os colocam num patamar diferenciado que devem ser respeitados no momento do seu nascimento

Nas últimas semanas gestacionais ocorrem importantes alterações na atividade cerebral, tornando-se relevante monitorar o desenvolvimento neurológico de recém-nascidos pré-termos tardios (RNPT-T). Além disso, com os avanços nas unidades de terapia intensiva neonatais (UTIN) os profissionais de reabilitação, fisioterapeutas (FT), terapeutas ocupacionais (TO) e fonoaudiólogos (FG), são considerados integrantes fundamentais na equipe multidisciplinar. Objetivo: (1) avaliar o estado neurocomportamental de recém-nascidos (RNs) de 36 a 36 semanas e 6 dias de idade gestacional (IG) e de 37 a 37 semanas e 6 dias de IG; (2) examinar o papel atual dos profissionais de reabilitação (FT, TO e FG) nas UTINs canadenses e comparar com os dados de um survey de 15 anos atrás. Método: (1) Trata-se de um estudo de corte transversal. A amostra foi definida por conveniência e constitui-se de 20 RNs, sendo 8 RNPT-Ts e 12 recém-nascidos a termo (RNT), de ambos os sexos, internados no Alojamento Conjunto do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, São Paulo, Brasil. Foi realizada uma avaliação do desenvolvimento neurocomportamental através da Neurobehavioral Assessment Preterm Infant (NAPI), em que os bebês foram avaliados em uma sequência invariável nos sete domínios da escala: sinal do cachecol, desenvolvimento motor/vigor, ângulo poplíteo, alerta e orientação, irritabilidade, qualidade do choro e percentual adormecido. Foi realizada uma análise descritiva dos dados. O teste de Mann-Whitney foi utilizado para a comparação dos escores entre os RNPT-T e RNT e comparação entre o gênero e o teste-t de Student para duas amostras independentes foi utilizado para a comparação do grupo de RNPT-T com três estudos nacionais envolvendo o NAPI. (2) Trata-se de um survey do tipo entrevista, via telefone no qual foi conduzido em todas as UTINs canadenses que integram a Canadian Neonatal Network. Um total de 42 questionários foi completado proveniente de 31 instituições de saúde canadenses. Foram realizadas uma análise descritiva das variáveis e a comparação dos dados com o survey realizado há 15 anos.O teste Exato de Fisher foi utilizado para investigar a relação entre a disponibilidade do profissional de reabilitação e o tipo de intervenção por ele conduzida. Em ambos os estudos foi adotado o valor de p 0,05. Resultados: (1) Não houve diferença significativa entre os escores do NAPI comparados entre os grupos RNPT-T e RNT. Houve diferença significativa entre o grupo de RNPT-T com os outros três estudos, em todos os domínios da escala NAPI. (2) Pelo menos um profissional de reabilitação oferece serviço em hospitais pediátrico, adulto e geral. Os profissionais participam de grupos para promover a educação do processo do cuidado, principalmente para os membros da equipe multidisciplinar das unidades e para os pais e familiares dos RNs. Além disso, estão envolvidos com discussão de caso, processo de tomada de decisão, planejamento da alta hospitalar e referenciam RNs para outros serviços. Em relação às intervenções, splinting e amamentação, foram identificadas como sendo atividades realizadas mais por TO, sendo que fisioterapia respiratória e exercícios que englobam amplitude de movimento são realizados mais por FT. Conclusão: (1) Não há diferenças entre o grupo RNPT-T e RNT em relação ao desenvolvimento neurocomportamental na amostra estudada. Os RNPT-Ts demonstram-se mais acordados e ativos durante a avaliação, entretanto, com baixo estado de alerta e orientação, sugerindo que atenção em fatores ambientais e ações no cuidado do RNPT-T na unidade de alojamento conjunto devem ser investigadas. (2) Ao longo da última década, as mudanças no papel dos profissionais de reabilitação evidenciaram maior participação com a equipe multidisciplinar, colaboração nas discussões e planejamento das atividades nas unidades, educação continuada e maior tempo despendido no cuidado com os RNs nas UTINs.<br>Neonatal neurobehavioral examinations describe newborns behavioral repertoire and observable responses to environmental stimulus and in the neonatal intensive care unit (NICU), rehabilitation specialists are considered an integral part of the multidisciplinary team. New approaches to rehabilitation practice have evolved to promote child health and developmental outcomes. Aim: This study aimed (1) to evaluate the neurobehavioral of healthy late preterm (LP) and full-term infants (FTI) using Neonatal Neurobehavioral Assessment Preterm Infant (NAPI). (2) To describe the current roles in the NICU of the occupational therapist (OT), physical therapist (PT) and speech language pathologist (SLP) in Canadian NICU and compared to these roles documented 15 years ago. Method: (1) In this cross-sectional study, 20 babies were assessed. Eight infants born with 36 weeks gestational age (GA) and 6 days late preterm group (LPG) 12 infants born with 37 weeks GA and 6 days the full-term infants (FTI) in a tertiary health care institution of São Paulo state, Brazil were assessed 24 hour after birth, using NAPI. The infants were assessed in seven clusters of NAPI: scarf sign, motor development and vigor, popliteal angle, alertness and orientation, irritability, cry quality and percent asleep ratings. A descriptive analysis was conducted and Mann-Whitney test was used for comparison between groups and Students t test for two independent sample was conducted for comparison with three Brazilian studies. (2) In total, 42 questionnaires were completed from rehabilitation departments in 31 Canadian health care institutions. A descriptive analysis was conducted and The Fisher Exact Test was conducted to investigate the relationship between availability of rehabilitation specialist and type of intervention. In both studies the p value was 0,05. Results: (1) There was no statistical difference between LPG and FTI groups. The infants of LPG group were more awake during the NAPI exam, although with lower alertness and orientation score. (2) Results demonstrate that all have some rehabilitation coverage and they provide service in pediatric, general and adult hospitals. All therapists provide education to staff and to families. Typically therapists are involved with case discussion, decision-making, referrals to other services and discharge planning. Splinting and feeding were most often carried out by OT whereas chest physiotherapy and range of motion (ROM) were predominantly accomplished by PT. Conclusion: (1) The comparison between LPG and FTI showed no statistical difference. New strategies in terms of care must be stimulated in the unit of data collect to promote best practice in late preterm infants. (2) Changes to the role of rehabilitation specialists over the last decade were perceived as participation with the NICU team, education and training, collaboration and discussion and modifications/interventions.

Made available in DSpace on 2016-06-02T19:44:17Z (GMT). No. of bitstreams: 1 6036.pdf: 5242612 bytes, checksum: 3cb0e318b6cda04ede7a26d39cfc78d5 (MD5) Previous issue date: 2014-02-25<br>Universidade Federal de Sao Carlos<br>Learning to read is preceded by the acquisition of vocabulary, and premature birth is a risk factor for the delayed development of language. However, few studies have investigated the association between prematurity and delays in expanding vocabulary and learning to read and write. The present study was conducted with 20 students, aged 5 years 8 months to 6 years 6 months, 10 of whom were born late preterm and 10 were born full term. Their receptive and expressive vocabulary was initially assessed. A computerized program was then implemented to expand vocabulary and teach reading and writing. The late preterm students average gestational age was 35 weeks, and their average birth weight was 2,450 g. The full term students gestational age was 39 weeks, and their average birth weight was 3,146 g. The predominant classification of nutritional status among the students was appropriate for their gestational age and weight. The results showed similar performance between late preterm students and full term students in receptive skills, such as expressive vocabulary, which was lower than expected for their ages. In expansive vocabulary, all of the students achieved 100% accuracy in the selection of figures. In the picture-naming task, late learners who were born preterm had higher scores than those born full term (93% vs. 76%). None of the students read or wrote (dictation) any of the words presented in the pretest. In the post-test, we found the partial emergence of reading and speaking repertoires among the students. The two groups read 50% and 40% of the words correctly and wrote 29% and 12% of the words correctly, respectively. Therefore, the performance of late preterm students was higher compared with full term students in both reading and writing. Prematurity is a multifactorial event, and other factors may have potentially interfered with linguistic development in these children. Regardless of the condition of their birth, all of the students scored below the expected range for typical development in word recognition and naming. The correlation that was observed in the post-test confirmed the predictive relationship described in the literature between receptive vocabulary and reading acquisition in late preterm and full term infants and expressive vocabulary acquisition and writing in late preterm infants. Differences were found between oral reading among late preterm students and receptive reading (or recognition) among full term students. Similar to writing, speaking was correlated with expressive vocabulary only among late preterm students. These results strongly suggest the need to implement and maintain literacy interventions in the study participants using different classes of verbal operants that feature oral language.<br>O aprendizado de leitura é precedido pela aquisição de vocabulário e a prematuridade é um fator de risco para o desenvolvimento da linguagem, de forma que alguns estudos têm investigado a associação da prematuridade com atrasos em vocabulário, leitura e escrita. Este estudo, conduzido com vinte alunos na faixa etária de cinco anos e oito meses a seis anos e seis meses, dez pré-termo tardios e dez a termo, avaliou, inicialmente, seu vocabulário receptivo e expressivo. Em seguida, implementou e avaliou efeitos de um programa informatizado para ampliação de vocabulário no ensino de leitura e emergência de escrita dos mesmos alunos. Os valores médios para idade gestacional e peso ao nascimento foram de 35 semanas e 2.450 g entre os alunos prétermo tardios e de 39 semanas e 3.146 g entre os nascidos a termo. Na relação idade gestacional e peso ao nascimento, a classificação predominante entre os alunos foi de peso adequado para idade gestacional. Os resultados evidenciaram desempenhos similares entre os alunos pré-termo tardios e a termo tanto nas habilidades receptivas quanto nas expressivas de vocabulário, ambas avaliadas como inferiores ao esperado para as respectivas faixas etárias. Na ampliação de vocabulário, todos os alunos alcançaram 100% de acertos na seleção de figuras. Na nomeação de figuras os alunos pré-termo tardios acertaram mais que os nascidos a termo (93% versus 76%). Nenhum dos alunos lia ou escrevia (ditado) quaisquer das palavras apresentadas no pré-teste. No pós-teste, verificou-se a emergência parcial de repertórios de leitura e ditado entre os alunos: os dois grupos leram, respectivamente, 50% e 40% das palavras e escreveram corretamente 29% e 12% das palavras. Portanto, o desempenho dos pré-termo tardios foi superior ao dos nascidos a termo tanto em leitura quanto em escrita. Como a prematuridade é um evento multifatorial, potencialmente outros fatores interferiram no desenvolvimento linguístico destas crianças, uma vez que, independente da condição de nascimento, todos os alunos pontuaram abaixo do esperado para o desenvolvimento típico no reconhecimento de palavras e na nomeação de figuras. As correlações verificadas no pós-teste confirmaram a relação preditiva descrita na literatura entre vocabulário receptivo e aquisição de leitura (para pré-termo tardios e nascidos a termo) e vocabulário expressivo e aquisição de escrita (apenas entre pré-termo tardios); porém, indicaram diferenças entre leitura oral entre prétermo tardios e leitura receptiva (ou reconhecimento) entre os alunos nascidos a termo. Quanto à escrita, o ditado foi correlacionado ao vocabulário expressivo apenas entre os pré-termo tardios. Os resultados sugerem fortemente a necessidade de intervenções para instalar e manter, nas crianças dessa amostra, as diferentes classes de operantes verbais que caracterizam a linguagem oral e que serão críticas para a alfabetização.

abstract: Late preterm infants (LPIs), born between 34 and 37 weeks gestation, are at risk for a myriad of health conditions related to neuro-muscular and physiologic immaturity. However, relative stability allow many of these infants to avoid care in specialty nurseries and discharge home with their mothers after birth. Due to underlying immaturity, feeding difficulty is the most common issue LPIs experience, resulting in early breastfeeding cessation, increased risk for secondary diagnoses, and hospital readmission. The purpose of this study was to assess early breastfeeding behavior of LPIs, including testing inter-rater reliability of an assessment tool and the feeding patterns of infants over time. An extensive review of breastfeeding assessment tools resulted in the selection of the Premature Infant Breastfeeding Behavior Scale (PIBBS) based on its reliability and validity in the preterm infant population. A convenience sample of LPI dyads was recruited and used to conduct inter-rater reliability testing of PIBBS. A longitudinal one-group non-experimental study was used for observational follow-up. A strong statistical agreement of PIBBS scores occurred between mothers and a healthcare professional (Cohen’s kappa values of items ranged from .776 to 1.000, p = <.001). Participants continued using the PIBBS tool after hospital discharge until their infants expected due dates (40 weeks adjusted age). T-test analyses were conducted to examine changes in scores over time indicating increase in item scores (p = .003 - .193). PIBBS appears to be a valid and reliable tool to assess breastfeeding among LPI dyads. Incorporation of PIBBS into a comprehensive plan of care could better support and protect breastfeeding among the LPI population.<br>Dissertation/Thesis<br>Doctoral Dissertation Nursing and Healthcare Innovation 2018

碩士<br>國立成功大學<br>職能治療學系<br>102<br>In this study, we aimed to compare the developmental outcomes of late preterm and term children at 2 years of age. Factors related to developmental outcomes in late preterm children were also investigated. Twenty-five late preterm and 42 term children were recruited. Bayley Scales of Infant and Toddler Development (Third Edition) was used to assess child’s motor and cognition at 2 years of corrected or chronological age. Parents were asked to complete Mandarin-Chinese Communicative Development Inventory-Taiwan, Infant/Toddler Sensory Profile-Chinese version, and 1.5-5Y Child Behavior Checklist. A higher percentage of preterm children had vocabulary delay (p〈.05) and atypical oral sensory processing function (p〈.001) than children born at term. No significant difference was found in other developmental and behavioral outcomes between the two groups of children. Gender, multiple birth, family socioeconomic status and the time spent in various leisure activities were found to be related to developmental outcomes in late preterm children. The present findings suggest that parents and clinicians need to pay more attention to language and oral sensory processing function in late preterm children. In addition, proper participation in leisure activities such as decreasing time to watch TV and increasing time in reading and outdoor activities may help to improve their developmental outcomes.

Background/Project Description: There is a growing interest in the contribution of late preterm (34 – 36 week gestational age (GA)) birth to neonatal morbidity and mortality. Late preterm infants have an increased incidence of both respiratory and non- respiratory complications over the first year of life. Rates of prematurity as well as morbidity/mortality in infancy are higher in lower socioeconomic status (SES) groups but how GA and SES interact is relatively unexplored. Methods/Participant Population: A retrospective cohort study was undertaken utilizing anonymized data housed at the Manitoba Centre for Health Policy (MCHP). A population-based cohort of infants born at 34 to 41 weeks of GA was assembled; individual and area-level income information was used to develop SES groups. Outcomes studied included diagnoses received during the birth hospitalisation, neonatal and post-neonatal admissions. Regression models were constructed to explore the effects of GA and SES as well as control for multiple perinatal variables. Appropriate approvals and safeguards for data privacy were maintained. Results: GA and SES exerted a gradient effect on morbidity, which persisted after controlling for multiple confounding variables. The effect of GA was strongest during the birth hospitalisation but persisted throughout the first year with increased morbidity evident with each week of decreasing GA. The detrimental association of low SES with morbidity increased in effect size throughout the first year surpassing that of GA for post-neonatal admissions. An interaction effect of maternal diabetes, respiratory morbidity and SES was suggested and merits further investigation. Neonatal stays of 3 days or longer negated the association of GA with readmission within the first 28 days; in addition shorter stay infants had the highest risks of readmission at 37 weeks as compared to the late preterm gestations. Conclusions: The consistent associations between poverty, prematurity and morbidity require both further study and attention. Attention to the neonatal health of both late preterm and term infants is important due to their large numbers and population impact. The added risk of poverty merits urgent and multifaceted interventions to lay the groundwork for healthy childhood and long-term success.

碩士<br>長庚大學<br>早期療育研究所<br>102<br>Background and purpose: Late-preterm infants are defined as infant born between 34 0/7 and 36 6/7 weeks' gestation and account for majority of all preterm births. In clinical practice, late preterm infants are often considered functionally and developmentally mature and managed as term neonates. Accumulating data indicate that risks of mortality, morbidity and neurodevelopment problems are significantly greater in late preterm infants than previously believed. However, the extent of developmental outcomes of late preterm infants in their early years remains largely under-researched in Taiwan. Apart from biological factors, child development is affected by home environment and caregivers’ characreristics based on the theories of Ecological or Transactional Model. To our knowledge, the risk factors for poorer development outcome of late-preterm infants have not been exhaustively investigated in Taiwan using cohort studies. Therefore, the purpose of this study was to explore the predictability of late preterm (vs full term) and the related covariant (biological and environmental factors) on the development outcomes using cohort study design. Methods: We use cohort study design. The multiple developmental outcomes are used to compared the group differences between 18 late preterm infants (34 0/7 to 36 6/7 weeks of gestation) at corrected age of 4 months and 100 full term infants ( >37 weeks of gestation) at chronological age of 4 months, including the Comprehensive Development Inventory for Infants and Toddlers (CDIIT), the Alberta Infant Motor Scale (AIMS) and the Peabody Developmental Motor Scales Second Edition (PDMS-2). The predictors of developmental outcomes included biological factors, maternal and environmental factors (family characteristics) and General movements assessment (GMs). Chi-square test was conducted to investigate the associations between biological / environmental factors and late preterm (vs full-term). Multiple logistic regression and multiple linear regression were used to examine the predictability of pre-term (vs full-term) on dichotomous developmental outcome (AIMS <10 percentile) and continuous developmental outcomes (CDIIT developmental quotients [DQs] and PDMS-2 DQs) controlling for related biological and environmental factors. Results: Mothers of the late preterm infants, compared with mothers of term infants, were more likely to have perinatal illness history (33.3% vs 6%, respectively, p= .000). Hypoglycemia and hyperbilirubnemia requiring phototherapy were more likely to occur in late preterm infants (2% vs 0%, respectively, p= .02; 50% vs 19%, respectively, p= .01). Late preterm infants had statistically significant higher percentage of AIMS <10 percetile (50% vs 10%, respectively, p= .000). Multiple logistic regression analysis indicates that late preterm was a significant factor for adverse motor outcome measured by AIMS (Adjusted OR=6.8, 95% [1.61~28.68], p= .01) controlling for related biological and environmental factors. Regarding the developmental outcomes measured by CDIIT and PDMS-2, though late-preterm itself was not a significant predicator for developmental outcomes, we found phototherapy requiring phototherapy predict significant lower DQs for late-preterm infants than full-term infants in CDIIT cognition DQs(CDIIT cognition DQs, B=-8.51, 95% [-14.43~-2.58], p= .005), CDIIT motor DQs (CDIIT fine motor DQs, B=-6.19, 95 % [-11.46~-.93], p= .022), PDMS-2 total motor DQs (PDMS-2 total motor DQs, B=-4.79, 95% [-7.41~-2.11], p=.000); PDMS-2 gross motor DQs (PDMS-2 gross motor DQs, B=-4.26, 95% [-6.73~1.79], p=.001) and PDMS-2 fine motor DQs (PDMS-2 fine motor DQs, B=-4.5, 95% [-7.21~-1.68], p= .002). Infants of mother with higher education level had lower CDIIT self-help DQs (CDIIT self-help DQs, B=-3.1, 95 % [-6.19~-.01], p= .049. Small for gestational age (SGA) infants were more often had lower PDMS-2 total motor DQs (PDMS-2 total motor DQs B= 4.66, 95 % [.16~9.16], p= .042) and PDMS-2 gross motor DQs (PDMS-2 gross motor DQs, B= 4.56, 95 % [.34~8.78], p=.035). Conclusions: Late preterm infants at mean corrected age 4 months old are at a relatively higher risk of motor-related developmental problems compared with full-term infants at mean chronological age 4 months old. Based on the multiple outcome indexes, the risk factors for the development of infants at 4 month age were late-preterm and hyperbilirubnemia requiring phototherapy, maternal higher educational level and small for gestational age (SGA). Clinical implications: Though late-preterm infants are at relative lower biologically risks for developmental outcomes, the delay in motor development can be recognized as early as 4 months of age. Further research regarding long-term follow-ups is needed to explore whether “catch-up” in later life emerge for infants born late preterm. The strategies of preventing pregnant women from having late-preterm infants, periodically surveillance and follow-ups for late-preterm infants, and instructions and support for their families would be the responsibilities of related health care providers and early interventionists.

碩士<br>長庚大學<br>早期療育研究所<br>105<br>Background and purpose: Late-preterm infants are defined as infant born between 340/7 and 366/7 weeks gestation and account for the majority of preterm infants. Current researches on late-preterm infants focus on the high morbidity and mortality, delay of neurodevelopment, cerebral palsy, and even hyperactivity, learning disabilities and special education needs in school age. Differing from the traditional neurodevelopmental assessment, the General Movements Assessment (GMsA) has been reported that it can predict the development and prognosis of cerebral palsy and mild neurological dysfunction with extremely high sensitivity of its nervous system by observing the spontaneous movement. There is less evidence about to GMs as an early screening tool with its excellence predictability. Therefore, the purpose of this study were: (a) to assess late-preterm infants in three stage of observing GMsA, namely preterm, writhing movement and fidgety movement periods; (B) to test the diagnosis validity of GMsA with Cranial Ultrasonography; (c) to test the concurrent validity of GMsA with traditional neurobehavioral assessment. Methods: This study applied a longitudinal study design. A total 13 late-preterm infants participated in this project at the department of newborn intensive care unit in a medical center in Taipei. The infants were followed up in Neonatal Neurobehavioral Examination Chinese Version (NNE-C), Cranial Ultrasonography, GMsA and Alberta Infant Motor Scales (AIMS) until the corrected age of three months. After each assessment, families were guided by the Child Health Handbook issued by the Health Promotion Administration, Ministry of Health and Welfare as a material to instruct the normal development of infants. Correlation between quality of GMsA and traditional neurobehavioral assessment was calculated with kappa value to determine concurrent validity. Also the infant’s GMsA outcomes will be compared with the result of Cranial Ultrasonography to determine diagnosis validity. Results: Due to the small sample size in this study, short follow-up period and special characteristics of late-preterm infants, we collected the data until three months of corrected age for each infants. The diagnosis validity was moderate between Cranial Ultrasonography and GMsA (κ=0.421), the sensitivity was 33%. GMsA and AIMS had a moderate correlation (κ = 0.316) at one month of corrected age, and showed no correlation at three months of corrected age. Conclusions: There was inconsistent between the validity of the test GMsA and the traditional neurological examination, showing no correlation or moderate correlation, and the diagnostic validity of the Cranial Ultrasonography showed moderate correlation. Clinical implications: Late-preterm infants have better prognosis than extremely preterm infants. In this course of the study, it was found that there will still lots of late preterms who had poor quality of movement and delay. Expect to GMsA can be utilized with the traditional neurological examination, early screening of high-risk neonates, early intervention, to reduce the delay of development.

碩士<br>國立臺灣大學<br>職業醫學與工業衛生研究所<br>101<br>I. Objective: To determine the health-related quality of life (HRQOL) in parents after the birth of a late preterm infant at 18 months. Methods: Mother and child were chosen via a stratified sampling from Taiwan national birth registration database in 2005.Subjects underwent a home interview 18 months after their deliveries between Jan 2007 and Feb 2008.We used the Medical Outcomes Study 36-itemShort-Form (SF-36) to measure the HRQOL of 14,578 parents of 813 late preterm infants versus 13,765 term infants. Results: The mothers with late preterm infants lowered on score of HRQOL compared to those with full-term infants. After controlling for potential confounding factors, of the eight domains score of the SF-36, the four domains including role limitations due to physical health, general health perception, energy vitality and mental health, the HRQOL were significantly different between these two groups of mothers (P < 0.05). Interestingly, no significant decreasing scores of the HRQOL were noted between the father with a late preterm infant and those with a term infant. Conclusion: In our knowledge, this is the first study to primarily explore the difference in the HRQOL among the parents with LPIs and the parents with term infants. In our study, being a mother of LPIs decreased the health-related quality of life included physical and mental domains as compared to those of full-term infants at 18 months of age. II. Objective: To determine the change of health-related quality of life (HRQOL) experienced over time by mother with late preterm infants (LPIs). Methods: The mother and infant were chosen via a stratified sampling from Taiwan national birth registration database in 2005. Longitudinal prospective follow-up study of mothers with late preterm infants and infants from birth to 3 years was performed. We used the Medical Outcomes Study 36-itemShort-Form (SF-36) to measure the health-related quality of life by 13,077 parents of 730 late preterm infants versus 12,347 term infants. Results: There was negative association with LPIs and maternal quality of life at 6 months and 18 months after birth. The differences among three out of the eight domains at 6 months were statistically significant (P<0.05) including physical functioning, role limitation due to Emotional problems and mental health. The differences among two out of the eight domains at 18 months were statistically significant (P<0.05) including general health perception and mental health. The difference with regards to maternal quality of life between LPIs and full-term infant was disappeared at 36 months after birth. Conclusion: In our knowledge, this is the first study to primarily explore the longitudinal change in the HRQOL experienced over time by mother with LPIs. In our study, being a mother of LPIs decreased the health-related quality of life included physical and mental domains as compared to those of full-term infants at 6 and 18 months of age.

Preterm birth continues to be an important public health concern globally. Born only 3 to 6 weeks premature, findings increasingly demonstrate that the late preterm population (34-36 weeks gestational age) is not exempt from long-term risk, as the last few weeks of gestation are important for both physical and cognitive development. This study examined whether late preterm birth was associated with poorer health, development and educational outcomes in the early childhood period, after controlling for a range of medical and social factors.<br>February 2016

Trabalho de Projeto do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina<br>Objetivo: Este estudo é uma revisão sistemática e tem como objetivo avaliar as complicações a longo prazo nas áreas do neurodesenvolvimento, comportamento e aprendizagem escolar em crianças com antecedentes de prematuridade tardia (nascidas entre as 34 e as 36 semanas e 6 dias de idade gestacional) em comparação com os recém-nascidos de termo. Métodos: Foi realizada uma revisão sistemática utilizando o protocolo PRISMA, com recurso à base de dados PubMed. Foram selecionados artigos publicados entre janeiro de 2006 e janeiro de 2016. Os artigos incluídos foram analisados de forma a avaliar o desempenho dos prematuros tardios, relativamente aos recém-nascidos de termo, nas áreas em estudo.Resultados: Foram identificados 339 artigos, dos quais 10 foram selecionados após aplicação dos critérios de elegibilidade e exclusão. Esta revisão sistemática evidenciou a existência de atrasos na capacidade cognitiva, comportamento e desempenho escolar dos prematuros tardios em relação aos recém-nascidos de termo, sobretudo nos primeiros anos de vida. A maioria dos artigos referiram fatores do meio ambiente da criança, sobretudo pertencer a um estrato social mais baixo e a baixa escolaridade materna, como determinantes no desenvolvimento da criança.Conclusões: Estes atrasos detetados no início de vida bem como a importância do meio no desenvolvimento da criança, sugerem que um bom acompanhamento e estimulação durante a infância poderão ter um papel importante para um adequado neurodesenvolvimento.<br>Objective: This study is a systematic review and aims to evaluate the neurodevelopment, behavior and school outcomes of children with history of late prematurity ( born between 34-36 weeks and 6 days of gestation) compared with full term counterparts. Methods: A systematic review was performed using the PRISMA protocol, applying the PubMed database. Articles published between january 2006 and january 2016 were selected. Articles were included in order to evaluate the performance of late preterm infants in comparison with full term children, in the domains under evaluation. Results: A total of 339 articles were identified, but only 10 were selected after applying the eligibility and exclusion criteria. This systematic review showed delays concerning the cognitive function, behavior and school performance of late preterm infants comparing to full term children, especially in the first years of life. Most of the articles presented environmental factors regarding the infant, especially such as a lower social stratum or low maternal education, as determinants for the correct development of the child. Conclusions: Neurodevelopment delays detected in the first years of life, as well as the importance of the the child´s environment, suggest that a good follow-up and early stimulation may play an important role for their correct neurodevelopment.

Die Kaiserschnittrate erhöhte sich in den letzten Jahrzehnten in zahlreichen geburtshilflichen Kliniken. Diese Entwicklung ist problematisch, weil damit eine erhöhte pulmonale Morbidität der Neugeborenen verbunden sein kann. Die vor­ liegende Arbeit untersucht die Anpassung von späten Frühgeborenen (34,0–36,6 SSW) und 2 Gruppen von reifen Neugeborenen (37,0–37,6 und 40,6–40,6 SSW) in einem Level 1 Zentrum in Abhängigkeit vom Geburtsmodus. Eingeschlos­ sen wurden primär gesunde Kinder, die im Verlauf eines Jahres geboren wurden. Ausge­ schlossen wurden Kinder mit nachgewiesener angeborener Anomalie und Kinder mit einer schweren Anpassungsstörung (Apgar 5‘<6). Die Kaiserschnittrate lag bei 22% und war am höch­ sten bei späten Frühgeborenen (39%) im Ver­ gleich zu Kindern der 37. (30 %) und der 40. SSW (11%). Die Rate der Kinder, die mit CPAP behan­ delt werden mussten fiel von 88 % in der 34. SSW auf 17% in der 37. und 8% in der 40. SSW. Kinder nach Kaiserschnitt mussten im Vergleich zur spontan geborenen Kindern signifikant häufiger mit CPAP therapiert werden (50 vs. 12%). Dieser Unterschied war für späte Frühgeborene deutlich (82 vs. 36 %) und lag niedriger bei in der 37. (33 vs. 9 %) und 40. (26 vs. 6 %) SSW geborenen Kindern. Der deutlichste Unterschied fiel bei in der 36. SSW geborenen Kindern auf (66 vs. 9%). Die Ergebnisse der Analyse dokumentieren, dass ein Kaiserschnitt bei primär gesunden Kindern zu einer schlechteren respiratorischen Anpassung führt. Dies gilt besonders, jedoch nicht nur, für späte Frühgeborene und dort besonders für Kinder, die in der 36. SSW geboren werden. Die weltweit wachsende Rate von Kaiserschnittent­ bindungen sollte immer wieder kritisch hinter­ fragt werden. Eine Kaiserschnittentbindung ohne klare Indikation führt zu einer erhöhten Rate an respiratorischen Anpassungsstörungen, zur neo­ natologischen Aufnahme der Kinder und damit verbunden zu einer Störung der Mutter­Kind­Bindung, sowie zu einer unnötigen finanziellen Belastung des Gesundheitssystems. Es ist zu wünschen, dass die Daten der Studie benutzt werden, um in der Diskussion zwischen Eltern, Geburtshelfern und Neo­ natologen immer den besten Geburtsweg für das Kind zu finden.<br>The rates of delivery by Cesarean section (CS) have been trending upwards in recent decades, perhaps leading to higher rates of dysfunction in respiratory adaptation in newborns. We present epidemiological data for pulmonary adaptation by mode of delivery for healthy late preterm and term infants born at a regional tertiary care center. The overall CS rate was 22 % with the lar­ gest proportion of these in late preterms (39%). This drops to 30% in infants born after 37 weeks gestation and to 11% for those born after 40 weeks. Infants needing respiratory support de­ creased significantly as gestational age increased: 88% at 34 weeks, 67% at 35 weeks, 28% at 36 weeks, 17% at 37 weeks and 8% at 40 weeks. The risk of respiratory morbidity following CS as compared to vaginal delivery (VD) was substan­ tially higher. 50% of infants born by CS needed respiratory support compared to only 12% fol­ lowing VD. 82% of all late preterm infants born by CS developed respiratory morbidity compared to 36 % following VD. Comparable data for infants born after 37 and 40 weeks gestation were 33% compared to 9 % and 26 % compared to 6 % respec­ tively. Late preterm infants born after 36 weeks gestation showed the most marked difference by mode of birth with 66 % needing respiratory sup­ port following CS as compared to only 9 % follow­ ing VD. Our data could be useful in counselling parents about risk associated with delivery by Cesarean section. A critical view should be taken of increasing CS rates worldwide because of a clear correlation in increased morbidity in infants, especially late preterm infants.