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1
Ohlin, Andreas. "Aspects on early diagnosis of neonatal sepsis." Doctoral thesis, Örebro universitet, Hälsoakademin, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-11928.
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This thesis presents four studies, all designed to improve the problematic diagnostic situation concerning infants with suspected sepsis. Study I included 401 neonates with suspected sepsis. Nine signs of sepsis and C-reactive protein were prospectively recorded and logistic regression was used to assess associations between these signs and a subsequently confirmed diagnosis of sepsis. C-reactive protein and five of the clinical signs were statistically significantly associated with a positive bloodculture. When the material was stratified by gestational age, differences between premature and full term infants were detected.Studies II and III were prospective studies that used samples collected from neonates with suspected sepsis to evaluate a novel real-timepolymerase chain reaction (PCR) method. The results where compared with simultaneously collected blood cultures. Study II used plasma samples and resulted in a sensitivity of 42% and specificity of 95%. In study III, the protocol was improved and adapted to whole blood samples which resulted in a sensitivity of 79% and specificity of 90%. Both protocols included species-specific probes and study III indicated that PCR has the potential to detect bacteria in culture-negative sepsis.Staphylococcus epidermidis is the most common pathogen in neonatal sepsis, but there is still a lack of typing methods suitable for large materials of S. epidermidis. In Study IV we therefore evaluated a new S. epidermidisgenotyping method based on PCR for the repeat regions of four genes thatencode for cell wall anchoring proteins. The method was applied to 49well-defined neonatal blood isolates of S. epidermidis. The combination ofsdrF and aap seemed to be optimal, resulting in a diversity index of 0.92.Conclusions • Bradycardia, apnoea, low blood pressure, feeding intolerance and distended abdomen are obvious early signs of neonatal sepsis. Premature and full-term infants differ in terms of the signs they display in neonatal sepsis. • Blood is superior to plasma for developing PCR methods for bacterial DNA detection. The PCR method described in study III can detect neonatal bacteraemia, but it can be further improved before it is used in routine care. • There has been a lack of useful typing methods for S. epidermidis.We can now present PCR of the genes for the cell wall anchoring proteins sdrF and aap as a novel and feasible approach when there is a need to type a large number of S. epidermidis isolates.
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Troxler, Joyce. "Quick Notes on Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/6512.
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Funkquist, Eva-Lotta. "Policies and Practice in Neonatal Nursing Related to Nutrition." Doctoral thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-130316.
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The aim of these studies was to increase knowledge about hospital feeding routines in high-risk neonates. A retrospective medical chart review procedure was used to study routines at the neonatal units of two Swedish hospitals. In Papers I and II, the sample (Uppsala n=21 and Umeå n=21) comprised of small for gestational age (SGA) infants, in Papers III (Uppsala n=64 and Umeå n=59) and IV (n=127), the samples comprised of appropriate for gestational age (AGA) infants. Paper I indicated large enteral/oral milk volumes rendered i.v. administration of glucose unnecessary, reduced weight loss and helped SGA infants regain birth weight earlier. More rapid postnatal growth did not remain up to 18 months with corrected age in any growth variable (Paper II). In Paper III, effects were compared whether the infants’ volume of breast milk intake in hospital was estimated by “clinical indices” or determined by test-weighing. Infants treated in hospitals where test-weighing was practised attained exclusive breastfeeding at an earlier postmenstrual age (PMA), and they were discharged at an earlier PMA. However, the two study units were similar regarding the proportion of infants attaining exclusive breastfeeding. Paper IV revealed preterm AGA infants with higher standard deviation scores (SDS) at birth had more negative changes from birth to discharge for all growth variables. Conclusions: Papers I and II indicated that early initiation of enteral/oral feeding with proactive increases in milk volume was beneficial short term. No evidence was found for a proactive nutrition regimen with initial large volumes of milk resulting in a different pattern of growth up to the corrected age of 18 months. Test-weighing before and after breastfeeding might help infants to attain exclusive breastfeeding at an earlier PMA (study III). Finally, preterm AGA infants with higher SDS at birth are at higher risk of inadequate growth during their hospital stay (study IV).
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Chumas, Paul D. "Cerebral metabolic changes occurring in feline neonatal hydrocephalus." Thesis, Queen Mary, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.268905.
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Fernandez, Maria Isabel. "Comparison of perceived needs of mothers of neonates and nurses in the neonatal intensive care unit." FIU Digital Commons, 1996. http://digitalcommons.fiu.edu/etd/3298.
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The transition to motherhood is not easy for any new parent but it is especially difficult for the mother of an infant in the Neonatal Intensive Care Unit (NICU). There may be instances in the NICU where the nurses' perception of maternal needs may be incongruent with the mother's perception. Many NICU nurses focus on the physical needs of infants such as cardiorespirartory monitoring, mechanical ventilator support, and I.V. therapy. Mothers may instead be focused on their own need for emotional and psychological support.
This study investigated the differences and similarities regarding maternal needs as perceived by the mothers and NICU nurses. A 30 item questionnaire called the Perceived Needs of Family Members of Critically Ill Patients (Norris and Grove, 1986) was given to a group of mothers and a group of NICU nurses. The instrument consists of "needs" statements which are ranked on a Likert Scale from "very important" to "not important". The rankings by mothers and the rankings by nurses were compared.
The results of this study demonstrated that the mothers' perceptions and the nurses perceptions of maternal needs were similar in most instances, althought there were some differences. Therefore, it is important that the mothers' needs are accurately identified so that nursing interventions can be developed to meet them.
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Thomson, Anne H. "The measurement of lung mechanics during neonatal intensive care." Thesis, University of Aberdeen, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.377624.
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The aim of this thesis was to establish methods of measuring the mechanical properties of the respiratory system in small infants while they were being ventilated in the intensive care unit. A double pneumotachograph system which fitted in the ventilator bias flow-circuit was used to measure flow, overcoming the problems of adding resistance or dead space to the infant's breathing circuit. Two methods for measuring compliance in infants (< 1500 g) breathing spontaneously through endotracheal tubes were assessed. The traditional measurement of dynamic lung compliance (Cdyn) using oesophageal pressue was compared with a technique for measuring total respiratory compliance (Crs) based on the utilisation of the Hering-Breuer reflex (Olinsky 1976) and using airway pressure. Values of Cdyn were poorly reproducible and correlated poorly with Crs and this was due to variability and inaccuracy of oesophageal pressure measurement in infants with chest wall distortion. Total respiratory compliance was reliably measured in intubated infants both when breathing spontaneously and when fully ventilated. Another approach based on the passive expiratory flow-volume relationship (Zin 1982) was developed for use in ventilated infants. The expiratory time constant (Trs) was measured and total respiratory resistance (Rrs) calculated from the relationship Trs = Rrs.Crs. This technique was validated by adding resistive loads and deriving new volumes for Rrs from the altered Trs. The first measurements of the time constant and respiratory resistance of preterm infants during the acute stage of illness were made using this technique. Representative mean values from 12 infants < 1500 g with hyaline membrane disease were Crs = 0.41 ml.cmH2O-1; Trs = 0.073 s; Rrs = 219 cmH2O.ℓ-1.s. A computerised technique was developed to enable these measurements to be made at the cotside. This provided a preliminary model for a lung function monitor to assess mechanical lung function continuously during neonatal ventilation.
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Klüttgens, Bettina Ursula. "Pan-European investigation of neonatal and paediatric parenteral nutrition." Thesis, University of Bath, 2003. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275829.
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Sibbons, Paul David. "Investigations into the aetiology and pathogenesis of neonatal necrotising enterocolitis." Thesis, Brunel University, 1990. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.278404.
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Allie, Nazneen. "Abdominal surgery in very low birth weight neonates in a developing world neonatal unit- Short term outcomes and risk factors for mortality." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33439.
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Background The surgical infant requires care in specialized neonatal units. Very low birth weight (VLBW) infants are a group particularly vulnerable to the risks and outcomes associated with preterm birth. There is an increased number of abdominal emergencies seen, attributed to improved survival in this birthweight category. Objectives To describe the short-term survival to discharge in VLBW infants following abdominal surgery at a South African public tertiary hospital and to examine the utility of common scoring systems for prognostication. Methods A retrospective study of VLBW infants with abdominal surgery was conducted in patients admitted to the neonatal unit at Groote Schuur Hospital between 2012 and 2016. CRIB and SNAPPE scores were calculated for patients where sufficient data was available. Results Fifty-two patients were included. The mean gestational age (GA) and birthweight (BW) were 29.5 weeks (SD 2.1) and 1102g (SD 197.8) respectively. Necrotizing enterocolitis was the most common (50%) surgical emergency. The leading postoperative complication was sepsis (37%). Fourty-two (81%) infants survived to discharge, the mean age at presentation 21 days (SD 21.1) with a mean hospital stay of 74 days in survivors vs 52 days in the non-survivors (p=0.06). There was no statistically significant difference in SNAPPE scores between survivors and non-survivors. Conclusion Abdominal emergencies have a high mortality and adds to the overall length of stay in VLBW infants. Neonatal scoring systems have proven to be useful adjuncts in predicting neonatal mortality, further study is warranted in infants who deteriorate due to surgical abdominal complications.
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Farrell, John G. "Computerised post neonatal cry analysis and its use in general practice." Thesis, Queen's University Belfast, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.317017.
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Thompson, K. N., Ivy A. Click, R. A. Best, S. K. Thacker, and Russell W. Brown. "Acute Eticlopride Treatment Alleviates Cognitive Deficits Produced by Neonatal Quinpirole Treatment." Digital Commons @ East Tennessee State University, 2004. https://dc.etsu.edu/etsu-works/6408.
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This study was designed to investigate the effects of acute eticlopride (0.02 mg/kg, D2 antagonist) treatment, given immediately before training, in rats neonatally treated with quinpirole, which has been shown to produce long-term D2 receptor supersensitization. Rats were given quinpirole (1mg/kg) or saline treatment from P1-21. Beginning on P22, rats were administered eticlopride or saline (i.p.) fifteen mins before each of seven days of training. Rats were tested on the Morris water task (MWT). For the first three consecutive days, rats were tested on the place version of the MWT with a stationary platform. Animals were given 24 training trials followed by a probe trial, and swim patterns were analyzed with platform removed. The next day, animals began testing on the match-to-place version for four consecutive days and two daily trials were given with the platform moved to a new location each day. On both the search time and target visit measures of the probe trial, animals neonatally treated with quinpirole demonstrated a deficit, and eticlopride eliminated this deficit. Interestingly, animals neonatally treated with saline but given eticlopride before training also demonstrated a deficit on both measures. On the match-to-place version, the difference in latency to locate the platform between the two daily trials served as the dependent measure. Similar to the MWT place version, eticlopride treatment eliminated deficits produced by neonatal quinpirole treatment on this task, and eticlopride produced a deficit in saline controls. This study demonstrates that in a model of dopamine D2 supersensitivity, it appears that the increased sensitivity of the D2 receptor is important for cognitive function.
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Black, Rebecca Slain. "The maternal, fetal and neonatal effects of nitric oxide donors in pregnancy." Thesis, University of London, 2002. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.271106.
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St, Clair Caryn M. "Neonatal Respiratory Distress Syndrome as a Function of Gestational Age and the Lecithin/Sphingomyelin Ratio." [New Haven, Conn. : s.n.], 2007. http://ymtdl.med.yale.edu/theses/available/etd-08272007-123115/.
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Bailey, Beth Ann, and Ivy A. Click. "Children with Neonatal Abstinence Syndrome (NAS) at 15 Months of Age: Preliminary Small Sample Findings." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/6414.
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Janicic, Natasa. "Molecular genetics of familial hypocalciuric hypercalcemia and neonatal severe hyperparathyroidism." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1998. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0001/NQ44464.pdf.
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Carter, Ashley. "Fetal and early neonatal death: Do the determinants vary?" VCU Scholars Compass, 2008. http://scholarscompass.vcu.edu/etd/1659.
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Purpose: To compare the determinants and distribution of fetal and early neonatal deaths in the Commonwealth of Virginia. Background: Much attention is devoted to reducing the infant mortality rate which was declining up until 2002. The recent rise was parsed and found to stem from an increase in deaths during the early neonatal period. Fetal deaths are not well understood and are not routinely included when evaluating infant mortality. Methods: Using data collected from 2001 to 2006 fetal death and linked infant birth and death certificates by the Virginia Department of Health, crude mortality rates and leading causes of death were calculated for fetal and early neonatal mortality. Rates were calculated for each period of death by locality and mapped to determine if the distribution differed. Logistic regression was also used to evaluate sociodemographic and pregnancy risk factors and chi-square analyses were used to determine if the determinants varied significantly by timing of death outcome. Results: During the study period, the fetal death rate was 5.4 per 1,000 fetal deaths plus live births, the early neonatal death rate was 2.5 deaths per 1,000 live births and perinatal mortality rate was 7.9 deaths per 1,000 fetal deaths plus live births. Trends over time, gestational age specific mortality, geographic distribution, cause of death and many determinants were comparable between both death periods. Extremely low birth weight was the most significant risk factor for early neonatal death (OR = 1747.06). Congenital anomalies of the child were the leading predictor of fetal death (OR = 26.24, 95% CI: 19.62, 35.10) and second highest for early neonatal death (OR = 52.26, 95% CI: 35.21, 77.56). Conclusions: Because of the similarities in geographic distribution, sociodemographic factors, pregnancy risk factors and causes of death, analyzing neonatal and infant mortality rates in isolation from fetal deaths does not accurately depict the burden of adverse pregnancy outcomes.
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Kodituwakku, Susima Nandanie. "Epizootiology of microorganisms associated with neonatal calf diarrhoea, with special reference to rotavirus." Thesis, University of Bristol, 1989. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.346412.
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Biswas, Animesh. "Maternal and Neonatal Death Review System to Improve Maternal and Neonatal Health Care Services in Bangladesh." Doctoral thesis, Örebro universitet, Institutionen för hälsovetenskap och medicin, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-46379.
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Bangladesh has made encouraging progress in reducing maternal and neonatal mortality over the past two decades. However, deaths are much higher than in many other countries. The death reporting system to address maternal, neonatal deaths and stillbirths is still poor. Moreover, cause identification for each of the community and facility deaths is not functional. The overall objective of this thesis is to develop, implement and evaluate the Maternal and Neonatal Death Review (MNDR) system in Bangladesh. The study has been conducted in two districts of Bangladesh. A mixed method is used in studies I and II, whereas a qualitative method is used in studies III-V, and cost of MNDR is calculated in study VI. In-depth interviews, focus group discussions, group discussions, participant observations and document reviews are used as data collection techniques. Quantitative data are collected from the MNDR database. In study I, community death notification in the MNDR system was found to be achievable and acceptable at district level in the existing government health system. A simple death notification process is used to capture community-level maternal and neonatal deaths and stillbirths. It was useful for local-level planning by health managers. In study II, death-notification findings explored dense pocket areas in the district. The health system took local initiatives based on the findings. This resulted in visible and tangible changes in care-seeking and client satisfaction. Death numbers in 2012 were reduced in comparison with 2010 in the specific area. In study III, verbal autopsies at community level enabled the identification of medical and social causes of death, including community delays. Deceased family members cordially provided information on deaths to field-level government health workers. The health managers used the findings for a remedial action plan, which was implemented as per causal findings. In study IV, social autopsy highlights social errors in the community, and promotes discussion based on a maternal or neonatal death, or stillbirth. This was aneffective means to deliver some important messages and to sensitize the community. Importantly, the community itself plans and decides on what should be done in future to avert such deaths. In study V, facility death review of maternal and neonatal deaths was found to be possible and useful in upazila and district facilities. It not only identified medical causes of death, but also explored gaps and challenges in facilities that can be resolved. The findings of facility death reviews were helpful to local health mangers and planners in order to develop appropriate action plans and improve quality of care at facility level. Finally, in study VI, the initial piloting costs required for MNDR implementation were estimated, including large capacity development and other developmental costs. However, in the following year, costs were reduced. Unit cost per activity was 3070 BDT in 2010, but, in the following years, 1887 BDT and 2207 BDT, in 2011 and 2012 respectively.
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Dare, Shadrach. "A multilevel mixed methods study of neonatal mortality in Ghana." Thesis, University of Glasgow, 2018. http://theses.gla.ac.uk/30943/.
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Background: Reducing neonatal mortality rates [NMR] (deaths/1,000 live births within 28 days of delivery) is a key global health goal. Using comparable data from Ghana (West Africa) and Scotland, I investigated NMR, specific causes of death and risk factors in the two countries. By identifying the main causes of excess mortality in Ghana and where they occur, it is hoped more effective strategies can be developed. Methods: This thesis used a multilevel mixed methods study design. Data on live births were obtained from three Health and Demographic Surveillance Systems (HDSS) in the north, middle and south of Ghana respectively: Navrongo (2004-12; 17,016 live births, 320 deaths); Kintampo (2005-10; 11,207 live births, 140 deaths); Dodowa (2006-14; 21,647 live births, 135 deaths). Comparable Scottish data were obtained from the Information Services Division (1992 to 2015; 1,278,846 live births, 2,783 deaths). Each dataset was analysed by neonatal death (dead/alive), using univariate and multivariable logistic regression. The multivariable analyses adjusted for maternal demographic and obstetric characteristics. Missing data were analysed using multiple imputation techniques. Data analyses were complemented by a researcher-developed questionnaire survey of 71 maternity care providers in the three regions of Ghana followed by face-to-face in-depth interviews with 48 maternity care providers who had experience of prematurity, birth asphyxia, neonatal infection and neonatal death. Results: The NMRs in the three HDSS were: Navrongo: 18.8; Kintampo: 12.5; and Dodowa 6.2 and in Scotland it was 2.2; the NMR in both countries is reducing. More than 99% of the neonatal deaths in Scotland occurred in the first week compared to 74% in Ghana. The leading causes of neonatal deaths (NMR) in Ghana were infection (4.3), asphyxia (3.7) and prematurity (2.2). In Scotland, they were congenital malformations (0.6), asphyxia (0.4) and prematurity (0.3). Only 88 deaths (0.07) of neonatal deaths in Scotland were due to infection. Ninety-eight percent of babies born in Scotland were born in a health facility compared to 60% of babies born in Ghana (hospital: 38.1%; clinic: 21.1%). In Ghana, babies born in hospitals had a higher risk of neonatal mortality compared to those born at home (NMR-hospital: 15.6; clinic: 7.1; home: 11.8). Most of the neonatal deaths in Ghana occurred at home (54%); there were more deaths among babies who were born in a hospital but died at home (hosp/home) compared to those born at home but died in a hospital (home/hosp). Asphyxia was the leading cause of death among hosp/hosp, and infection was the leading cause of death among hosp/home, home/home and home/hosp. Neonatal mortality in Ghana was largely influenced by where mothers sought maternity service, or the type of personnel who provided maternity care service. Mothers and babies who were cared for in hospitals by doctors and midwives received relatively better care and proper management of birth complications. Those who were cared for in clinics received basic delivery services and management of uncomplicated asphyxia. Mothers and babies who were cared for at home by traditional birth attendants (TBA) received poor care and poor management of neonatal illnesses based on traditional approaches which increased the risk of death. Women’s maternity choices were influenced by wider societal factors including prominent cultural values, family hierarchical structures and the cost of maternity services, and individual/ family factors including place of residence and availability of transport and beliefs about the cause of disease. Conclusion: There is considerable opportunity for reducing NMR in Ghana, especially deaths due to asphyxia and infections. Most uncomplicated deliveries should be performed by midwives in community clinics. The number of community maternity clinics should gradually be increased to enable home deliveries by TBAs to be phased out. Facilities should be improved for delivery and postnatal care in hospitals and the proportion of sick babies managed by health care workers trained in their care should be increased. Regular postnatal checks in the community by trained staff should be standard.
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Gonzales, Marin Cecilia. "Molecular detection of bacteria from a possible material oral origin in neonatal gastric aspirates obtained from complicated pregnancies." Thesis, Queen Mary, University of London, 2011. http://qmro.qmul.ac.uk/xmlui/handle/123456789/1299.
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It has been suggested that periodontal disease, a disease that affects the supporting tissues of the teeth, represents a risk factor for adverse pregnancy outcomes. Certain oral pathogens possess a demonstrated ability to translocate and invade the amniotic tissues. Once in the amniotic environment, these opportunistic colonisers could then initiate or contribute to a perinatal infection, and in this way be involved in the complications. The overall aim of this study was to determine the presence, and confirm the origin, of suspected maternal oral microbiota in neonatal gastric aspirates (swallowed amniotic fluid) collected due to complications during pregnancy and/or evidence of neonatal sepsis. Non-cultural PCR-based methods directed to the ribosomal encoding genes (rDNA) were applied to analyse neonatal and maternal samples. The use of universal and species-specific primers that target the bacterial 16S rRNA gene allowed identification and quantification of broad-range and specific bacteria to the species level. Sequence comparative analysis of a more variable fragment, the intergenic spacer region located between the 16S and the 23S rDNA, was finally used to compare strains obtained from the neonates and their counterparts in the respective mother’s oral and vaginal samples. Data analysis allowed identification of a range of potential confounding factors for presence of bacteria in the infants, such as vaginal delivery and prolonged rupture of membranes. However, bacteria with a possible oral origin were mostly identified in the neonatal samples in low prevalence and not associated with any particular variable. Quantitative analysis of potential periodontal pathogens demonstrated the presence of Porphyromonas gingivalis (1%) and Fusobacterium nucleatum (16%) in the neonates. F. nucleatum was detected at relatively high levels (mean=4.41E+02 cells/ml); representing up to 50% of the total bacterial load, which strongly supports its possible role in pregnancy complications. Also, F. nucleatum subspecies analysis and comparisons at the strain level suggest the oral cavity as the most likely origin of this infectious agent. This study supports the need for further studies.
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Del, Duca Danny. "The influence of neonatal hypoxia on cardiovascular structure and function in the rat at maturity." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110371.
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Innovations in the practice of pediatric cardiology and cardiovascular surgery have resulted in significant improvements in the survival of children born with congenital heart disease. This has resulted in a growing population of adults with repaired or palliated congenital heart disease. However, these patients are at increased risk of impaired cardiovascular health, including mortality, particularly under conditions of physiological stress, such as operative reintervention, in later life. We hypothesized that neonatal hypoxia engenders lasting changes in cardiovascular structure and function which may adversely influence myocardial and vascular responses to physiological stress at maturity. To test this hypothesis, Sprague-Dawley rats reared initially in hypoxic conditions (FiO2 = 0.12) for days 1 to 10 of life were compared to rats reared only in ambient air. Neonatal hypoxia was associated with significant changes in the left ventricular expression of 1945 and 422 genes in 10- and 90-day-old animals, respectively. Functional annotation revealed several genes involved in adaptive vascular remodeling and energy metabolism, as well as the regulation of apoptosis. Trends in gene expression suggested a proapoptotic paradigm which was corroborated by data showing decreased survival, following an ischemia-reperfusion insult, of cardiomyocytes isolated from adult animals exposed to neonatal hypoxia. Based on the above observations, we next sought to characterize additional changes in cardiovascular structure and function, induced by neonatal hypoxia, which might enhance cardiomyocyte vulnerability to physiological stress in the adult animal. Hypoxic animals had significant left ventricular hypertrophy, as well as impaired cardiomyocte calcium homeostasis and sarcomere relaxation, observations which were consistent with in vivo echocardiographic evidence of severe diastolic dysfunction. Neonatal hypoxia was also associated with the development of significant remodeling of left ventricular arterioles resulting in decreased lumen area. Significant reduction in agonist-induced activation of Akt and ERK1/2 survival signalling, as well as decreased mitochondrial hexokinase 2 expression, were observed. Finally, the left ventricular protein expression of Gαi3, Gαi2, and HIF-1α was significantly increased in adult animals following neonatal hypoxia.The above observations were evaluated in the context of the clinical challenges associated with the care of adult patients with congenital heart disease, and the potential clinical implications of these data are discussed.Les innovations dans la pratique de la cardiologie et de la chirurgie cardio-vasculaire pédiatrique ont entraîné des améliorations importantes dans la survie des enfants nés avec une cardiopathie congénitale. Cela a mené à une population croissante d'adultes ayant une maladie cardiaque congénitale réparée ou palliée. Cependant, ces patients sont à risque de santé cardio-vasculaire affaiblie, y compris la mortalité, en particulier dans des conditions de stress physiologique, tel que la réintervention opératoire. Notre hypothèse est que l'hypoxie néonatale engendre des changements durables dans la structure et la fonction cardio-vasculaire qui peuvent influencer négativement les réponses du myocarde au stress physiologique.Pour vérifier cette hypothèse, des rats Sprague-Dawley élevés initialement dans des conditions hypoxiques (FiO2 = 0,12) pour les jours 1 à 10 de vie ont été comparés à des rats élevés dans l'air ambiant. L'hypoxie néonatale a été associée à des changements significatifs dans l'expression, au niveau du ventricule gauche, de 1945 et de 422 gènes chez les animaux âgés de 10 et de 90 jours, respectivement. L'annotation fonctionnelle a révélé plusieurs gènes impliqués dans le remodelage vasculaire adaptatif et le métabolisme énergétique, ainsi que dans la régulation de l'apoptose. Les tendances dans l'expression des gènes ont suggéré un paradigme proapoptotique qui a été corroboré par des résultats montrant une diminution de la survie, suite à une insulte ischémie-reperfusion, de cardiomyocytes isolés chez les animaux adultes exposés à l'hypoxie néonatale.Sur la base des observations ci-dessus, nous avons ensuite cherché à caractériser les changements dans la structure et la fonction cardio-vasculaire, induits par l'hypoxie néonatale, qui pourraient accroître la vulnérabilité des cardiomyocytes au stress physiologique chez l'animal adulte. Les animaux hypoxiques avaient une hypertrophie ventriculaire gauche significative, ainsi que des altérations de l'homéostasie du calcium dans le cardiomyocyte et de la détente des sarcomères, des observations compatibles avec des observations échocardiographiques montrant une dysfonction diastolique sévère. L'hypoxie néonatale a également été associée au développement du remodelage des artérioles du ventricule gauche. Nous avons observé une réduction significative de l'activation d'Akt et ERK1/2 induite par l'isoproterenol, ainsi qu'une diminution de l'expression mitochondriale de hexokinase 2. Enfin, l'expression des protéines Gαi3, Gαi2, et HIF-1α a été significativement augmentée, au niveau du ventricule gauche, chez les animaux adultes suivant l'hypoxie néonatale.Les observations ci-dessus ont été évaluées dans le contexte des défis cliniques associés aux soins des patients adultes atteints de cardiopathies congénitales, et les implications cliniques potentielles sont discutées.
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Målqvist, Mats. "Who can save the unseen? : Studies on neonatal mortality in Quang Ninh province, Vietnam." Doctoral thesis, Uppsala universitet, Internationell mödra- och barnhälsovård (IMCH), 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-129242.
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Globally, neonatal mortality has remained basically unchanged for the last three to four decades and every year almost four million newborns die before reaching one month of age. This persistent mortality is related to an invisibility of the newborn child in policies and statistics and a neglect of health care decision-makers, planners and practitioners to deliver a perinatal continuum of care. In recent years attention has however been brought to the unchanged neonatal mortality in an effort to improve survival. The present thesis seeks to increase understanding of obstacles for better neonatal survival. The studies performed are undertaken as sub-studies to the NeoKIP project in Quang Ninh province in northern Vietnam, a randomized controlled trial of knowledge implementation for improved neonatal survival (Neonatal Health – Knowledge Into Practice, ISRCTN 44599712). In the first paper we investigated and discussed the scope of invisibility of neonatal mortality through measuring the accuracy of official statistics on neonatal deaths. The second paper reports an inquiry of determinants of neonatal mortality by use of a population-based case-referent design. Paper III and IV analyse delivery care utilization and care seeking patterns prior to and at delivery using narratives and GIS technique. There was a substantial under-reporting of neonatal mortality in the official statistics, with study results showing a four times higher neonatal mortality rate in Quang Ninh province than reported to the Ministry of Health. This neonatal mortality rate of 16/1000 live births (as compared to 4.2/1000 in official reports) was unevenly distributed in the province, showing large geographical discrepancies. In the rural and remote areas of Vietnam education level is lower and the concentrations of ethnic minorities and poor households are higher. Ethnic minority belonging was associated with a more than doubled risk of neonatal death compared to the hegemonic group of Kinh (OR 2.08 CI 95 % 1.39 – 3.10). This increased risk was independent of household economic status or maternal education level. Neonatal mortality was also associated with home deliveries, non-attendance to antenatal care and distance to the health care facilities. However, ethnic minority mothers still had an increased risk of experiencing a neonatal death even if they attended antenatal care, delivered at or lived close to a health facility. The invisibility of the neonatal period in health information systems hides the true width of the neonatal mortality challenge. By not acknowledging the problem, the marginalization of already disadvantaged groups continues, leaving ethnic minority babies with an elevated risk of dying during the first month in life. This example of ethnic inequity highlights the importance to target those most in need. The studies of the present thesis should therefore be looked upon as a contribution to the struggle to illuminate the global burden of neonatal mortality.
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Smithgall, Lisa M. "Perceptions of Maternal Stress and Neonatal Patient Outcomes in a Single Private Room versus Open Room Neonatal Intensive Care Unit Environment." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etd/1772.
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Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in an open room environment (n=52) were matched by gestational age to infants in a single private room NICU (n=52). Mothers of the infants from the open room (n=26) and the single private room (n=20) groups completed the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) survey instrument. The t-test for independent groups demonstrated a difference for the number of parent visits (t=6.672, df=60.13, p<.001) with a significant increase in visitation frequency for infants in the single private room NICU. Maternal perceptions of stress were not different (t=.154, df=44, p=.878), and high stress scores were reported for both groups regardless of the infant's environment of hospitalization. This study demonstrates that the single private room environment promotes increased parental access to their infants. The finding of high levels of maternal perception of stress in both the open room and single private room NICU's demonstrates that the environment did not impact the perception of maternal stress. This finding supports the implication that mothers of hospitalized infants need nursing support regardless of the type of NICU environment.
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Rocha, Hermano Alexandre Lima. "Desenvolvimento de aplicativo para avaliaÃÃo institucional colaborativa da saÃde neonatal intensiva." Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16012.
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nÃo hÃA mortalidade infantil apresentou importante reduÃÃo no Brasil e no mundo entre 1990 e 2014, concentrando os Ãbitos na mortalidade neonatal (50% dos Ãbitos infantis, atualmente), que à menos sensÃvel Ãs intervenÃÃes mais simples de cuidado infantil direto. O Brasil hoje tem elevada mortalidade neonatal, iniquamente dividida entre as regiÃes do paÃs. As principais causas de mortalidade neonatal sÃo evitÃveis, e dependentes do acesso e da qualidade do serviÃo prestado no atendimento hospitalar ao parto e ao neonato. Hà evidÃncia que à mais custo-efetivo realizar intervenÃÃes em regiÃes com piores indicadores e mais necessitadas. Este trabalho justifica-se pela prioridade da melhoria da qualidade da assistÃncia neonatal para reduÃÃo da mortalidade neonatal. O objetivo deste trabalho à contribuir para a reduÃÃo da mortalidade neonatal, atravÃs do desenvolvimento de uma ferramenta avaliativa comparativa dinÃmica das unidades de terapia intensiva neonatal, que identifique os pontos que precisam ser melhorados. Utilizou-se dados oriundos do estudo RENOSPE (Rede Nordeste de SaÃde Perinatal), coorte prospectiva multicÃntrica de base hospitalar nos nove estados da regiÃo Nordeste, no perÃodo de julho a dezembro de 2007, compreendendo 5.148 nascidos vivos. Inicialmente, foram utilizados modelos de riscos proporcionais para avaliar a associaÃÃo entre os fatores determinantes e a sobrevivÃncia dos recÃm-nascidos, com o modelo regressivo de Cox. ApÃs a identificaÃÃo dos determinantes, foram realizados mÃltiplos modelos regressivos simples de Cox com estas variÃveis e a variÃvel instituiÃÃo de origem do caso como fatores do modelo e o tempo de sobrevida como dependente. ApÃs, foi realizada anÃlise de comparaÃÃo das variÃveis representativas do atendimento prestado nas unidades atravÃs de grÃficos de controle do tipo mÃdia menos desvio padrÃo e controles de atributos. Para as representativas, foi criado aplicativo na web para utilizaÃÃo continuada pelas instituiÃÃes. Foram identificados diversos fatores determinantes de reduÃÃo da sobrevida neonatal, e dentre estes vÃrios impactados pela instituiÃÃo. Os grÃficos de controle mostraram-se relevantes para a sinalizaÃÃo grÃfica de variÃveis importantes. O aplicativo està totalmente funcional, hospedado no site www.renospeweb.org. Conclui-se que este trabalho fornece ferramenta efetiva aos gestores das unidades de terapia intensiva neonatal, com a utilizaÃÃo de variÃveis criteriosamente selecionadas, para melhoria da assistÃncia prestada aos recÃm-nascidos. Palavras Chave: 1. AssistÃncia Perinatal; 2. Qualidade da AssistÃncia à SaÃde; 3. Medicina Preventiva; 4. InstituiÃÃes de SaÃde. ABSTRACT Infant mortality showed important reduction in Brazil and in the world between 1990 and 2014, focusing mortality on neonatal deaths (50% of infant deaths, currently), which is less sensitive to the simplest direct interventions of child care. Brazil today has high neonatal mortality, unevenly divided between regions of the country. The main causes of neonatal mortality are preventable, and dependent on the access to and the quality of service provided in the inpatient delivery and to the neonate. There is evidence that it is more cost-effective to carry out interventions in regions with worst indicators and most in need. This work is justified by the priority of improving the quality of neonatal assistance for neonatal mortality reduction. The aim of this study is to reduce neonatal mortality, through the development of an evaluative tool dynamic comparative neonatal intensive care units, which identify the points that need to be improved. We used data from the RENOSPE study (Northeast of Perinatal Health Network), a prospective multicentric cohort of hospital based in the nine States of the Northeast region in the period from July to December 2007, comprising 5,148 live births. Initially, proportional hazards models were used to evaluate the association between the determining factors and survival of newborns, with the regressive model of Cox. After the identification of the determinants, multiple regressive models were made simple to Cox with these variables and the variable home institution of the case as the model factors and survival time as dependent. After analysis, comparison of variables representing the service provided in the units by means of control charts of type less average standard deviation and attributes. To the representative, was created in the web application for continued use by the institutions. Several factors were identified determinants of reducing neonatal survival, and among these various impacted by the institution. The control charts were relevant for signaling graphically important variables. The application is fully functional, hosted on the website www.renospeweb.org. It is concluded that this job provides an effective tool to managers of neonatal intensive care units, with the use of carefully selected variables, to improving the assistance provided to newborns.
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De, Vries Shaheem. "A retrospetive evaluation of the impact of a dedicated obstetric and neonatal transport service on transport times within an urban setting." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/11848.
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Includes abstract.Includes bibliographical references (leaves 65-73).
To determine whether the establishment of a dedicated obstetric and neonatal flying squad resulted in improved performance within the setting of a major metropolitan area. The Cape Town metropolitan service of the Emergency Medical Services was selected for a retrospective review of the transit times for the newly implemented Flying Squad programme. Data were imported from the Computer Aided Dispatch programme. Dispatch, Response, Mean Transit and Total Pre-hospital times, relating to the obstetric and neonatal incidents was analysed for 2005 and 2008.
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Buwembo, Alice. "The role of maternal diet and endocannabinoids in mediating stress responses and glucocorticoid feedback in the neonatal rat." Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=117204.
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The quality and quantity of fat in the diet have been shown to influence the composition of neuronal membranes, in particular the amount of phospholipid fatty-‐acid content in the brain. In addition, dietary fat can modify neurotransmitter-‐ mediated and neuroendocrine functions including the stress response in rodents. Indeed, fatty-‐acid derivatives such as endocannabinoids (eCBs) have been identified as important signaling molecules that mediate, in part, the nongenomic glucocorticoid (GC) fast-‐feedback inhibition on corticotropin-‐releasing hormone (CRH) neurons in the paraventricular nucleus of the hypothalamus (PVN) via binding to presynaptic cannabinoid receptors (CB1R). We previously found that altering the composition of dietary fat in the maternal diet during gestation and lactation modified the metabolic and hormonal profiles of the developing pups, including levels of eCBs. During the first two weeks of life, rat pups exhibit significant CRH and adrenocorticotropic hormone (ACTH) responses to stress although the adrenal GC output remains reduced. At the same time, pups also display increased sensitivity to GC feedback, but it is unclear whether eCBs play a role in mediating fast GC feedback in neonatal life. The present studies, using anoxia (3min) as a stressor and measuring ACTH and corticosterone (CORT) responses to stress, aimed at evaluating 1) the effect of maternal diet on neonatal stress responses; 2) the role of eCBs in regulating neonatal stress responses using pharmacological blockade of the CB1R with AM251; and 3) the effect of circulating GCs on the AM251 effect and the stress response using a pretreatment of either metyrapone (MET, a steroidogenic 11beta-‐hydroxylase blocker) or methylprednisolone (PRED, a synthetic GC). Our results demonstrate that maintaining mothers on a diet high in saturated fat (HF20%, HF30%) increased maternal and pup weight gain, and that supplementing a maternal diet high in polyunsaturated fats from fish oil (HFF) with extra calories in the form of sucrose induces maternal weight gain that is not translated to the offspring. Furthermore, we observed differences in CORT responses to stress that suggest direct stimulation of adrenal steroidogenesis as a result of increased polyunsaturated fats in the HFF diet. MET blunted the CORT and amplified the ACTH responses to stress, and PRED suppressed stress-‐induced ACTH secretion. Treatment with AM251, a CB1R antagonist, before stress onset tended to increase overall ACTH (except in MET pups) and CORT secretion, and also delayed the return to baseline ACTH. Taken together, our results lend further evidence to the influence of maternal diet on offspring hormonal and metabolic development and suggest that the eCB effect on ACTH secretion in neonates is most evident when there is a dynamic fluctuation of CORT concentrations.La composition des membranes neuronales et la teneur en acides gras des phospholipides qui les composent est influencée fortement par la quantité et la qualité des matières grasses présentes dans l'alimentation. En outre, l'apport de gras dans l'alimentation peut également modifier de nombreuses fonctions neuronales et neuroendocriniennes par des changements dans la production et fonction des neurotransmetteurs et neuropeptides, en particulier ceux impliqués dans les réponses au stress. Les'acides gras dérivés tels que les endocannabinoïdes (eCBs) sont d'importantes molécules de signalisation qui interviennent, en partie, dans le rétrocontrôle négatif des glucocorticoïdes (GC) sur l'activite des neurones exprimant le corticotropin-releasing hormone (CRH) dans le noyau paraventriculaire de l' hypothalamus. Ces neurones sont les principaux effecteurs de la réponse neuroendocrinienne au stress et sont sensibles aux GC via des actions génomique et non génomiques. L'action non génomique des GC est mediee par l'intermédiaire des eCBs qui se lient aux recepteurs cannabinoïdes (CB1R) présynaptiques. Nous avons constaté précédemment que les changements de gras au niveau de la diète maternelle pendant la gestation et la lactation modifient les profils métaboliques et hormonaux des jeunes ratons y compris les niveaux des eCBs dans l'hypothalamus et l'hippocampe. Au cours de cette étude, nous avons voulu savoir si les modifications des eCB par la diète maternelle pouvaient avoir un rôle significatif sur la rétroaction des GC sur le CRH et les hormones du stress des ratons. Dans un premier temps, nous avons examiné le rôle des eCBs dans la réponse au stress de l'anoxie (3min) chez les jeunes rats (jour 8) en utilisant un pré-traitement avec un antagoniste des CB1R, le AM251, avant l'exposition au stress. Dans un deuxième temps, nous avons determiné si les taux de GC circulants pouvaient influencer la manière dont les eCBs régulent la réponse au stress chez les ratons. Pour ce faire nous avons utilisé deux pré-traitements différents, soit un traitement avec la metyrapone (MET), qui produit une surrenalectomie pharmacologique et empêche la sécrétion de GC suite au stress, et un traitement avec la methylprednisolone (PRED), un glucocorticoïde synthétique qui supprime l'axe neuroendocrinien du stress et diminue les taux d'ACTH et de corticosterone stimules. Nos résultats démontrent que le poids des mères recevant une diète riche en graisses saturées (HF20%, HF30%) est augmenté de même que celui de ses petits compare aux mères contrôles. Les mères sur diète riche en gras polyinsaturés (HFF) et recevant un supplément calorique de sucrose augmentent leur poids corporel mais ne transmettent pas les calories a leurs petits. La diète maternelle HFF produit une augmentation des taux de corticosterone (CORT) ce qui suggère une stimulation directe de la stéroïdogenèse surrénalienne par les acides gras polyinsaturés dans l'alimentation de la mère. Le pre-traitement des ratons avec AM251 a tendance à augmenter les taux d'ACTH plasmatique dans les conditions basales et après le stress de l'anoxie. Cependant, le retour aux taux de base après stress a été retarde par le blockage des recepteurs aux eCBs. Lorsque les ratons reçoivent de la MET, les taux d'ACTH sont élevés et le traitement avec AM251 n'affecte plus le retour à la normale après le stress. Ceci suggère que la contribution des eCBs au rétrocontrôle des GC requiert des fluctuations circulantes de CORT. Par contre, le prétraitement avec PRED diminue la secretion d'ACTH globale mais maintient l'effet de AM251 sur la sécrétion d'ACTH. En conclusion, nos résultats montrent que les eCBs sont importants pour leur action synergique avec les GC afin de terminer les réponses neuroendocriniennes au stress chez les ratons nouveau-nés. L'influence de la quantité et qualité de gras de la diète maternelle influence également la réponse au stress des ratons, tout en influençant les taux cérébraux de eCBs.
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Prince, Kim Didi. "A comparison of standard C-reactive protein laboratory measurement to point of care C-reactive protein test in a neonatal intensive care unit setting." Master's thesis, University of Cape Town, 2016. http://hdl.handle.net/11427/22823.
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Background: Laboratory biomarkers are important adjuncts to clinical data in diagnosing neonatal sepsis. Available diagnostic tests often provide results 6 to 48 hours later. A bedside C-reactive protein (CRP) test may be able to exclude or diagnose sepsis within minutes. Objectives: The objectives were to validate the Alere AfinionTM point of care test (POCT) CRP in a tertiary neonatal unit against the gold standard CRP assay in use by the National Health Laboratory service and to determine the difference in time to obtaining a result between the two systems. Methods: A prospective observational study was conducted between February 2015 and June 2015. Neonates who were clinically indicated to undergo CRP testing were simultaneously tested using the POCT and laboratory assays. The sensitivities, specificities and predictive values for the POCT, with the laboratory test as the reference test were determined. The time to results between the two tests was compared. Results: There were 139 measured CRP sample pairs from patients with suspected or proven neonatal sepsis. Using 10 mg/L as the cutoff value for both CRP tests, the sensitivity, specificity, positive predictive value and negative predictive value were 97.4%, 99%, 97.4% and 99% respectively. The area under the receiver operating characteristic curve was 0.99 (p<0.001). The time to point of care result was 4 minutes. Laboratory results were registered at a mean of 4.7 hours but only checked after a mean of 6.8 hours. Conclusions: The POCT CRP and laboratory CRP test have excellent correlation in neonates and may be a useful, quick, reliable method to rationalise antibiotic usage, reduce costs and allow for earlier patient discharge.
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Neal, Sarah Elizabeth. "Neonatal mortality in developing countries : an analysis of trends and determinants." Thesis, University of Southampton, 2009. https://eprints.soton.ac.uk/72371/.
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There is limited understanding of how both trends and determinants of neonatal mortality vary from post-neonatal mortality, and more specifically how health care variables are associated with deaths in the first month of life. In particular the association between care at delivery and neonatal mortality is difficult to determine: in developing countries many women only seek skilled care once complications arise, making poor outcomes more probable. It is therefore inappropriate to directly compare outcomes from those who did and did not receive care at delivery due to this heterogeneity between the groups. This three-paper PHD thesis attempts to address some of these issues. Chapter 1 provides an overview of what is known about the determinants of neonatal and child mortality, before developing a conceptual framework for the analysis of neonatal and post-neonatal deaths. Chapter 2 (paper 1) provides a comprehensive analysis of the quality of Demographic & Household Surveys (DHS) data, before describing how trends in neonatal mortality differ from post-neonatal mortality over the short- and medium- term. It then examines how the associations between gross domestic product and neonatal, post-neonatal and early childhood mortality at national level differ using both cross-sectional and longitudinal data. Chapter 3 (paper 2) uses DHS data from Bangladesh to carry out bivariate and multivariate analysis to determine how the determinants of neonatal mortality vary from those of postneonatal mortality. It also tries to identify groups of women who are at ‘high’ or ‘low’ risk from institutional deliveries and compares rates of neonatal mortality. The risk categories are based on socio-economic, maternal health and health care utilisation factors that influence whether or not they are likely to have planned their delivery care or sought hospital care only in the event of complications. Chapter 4 (paper 3) furthers this work using Indian DHS data by examining how the association between health care determinants and neonatal mortality differ by asset quintile, mother’s education and state-level access to professional attendant at delivery. In this chapter I also use instrumental variable methodology to overcome the problem of endogeneity between delivery care variables and neonatal mortality. This technique enables me to examine the association between professional assistance at delivery while adjusting for the heterogeneity between women who do and do not seek such care. Chapter 5 concludes with a summary of key findings, as well as outlining areas for further research in this area.
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Trippenbach, Teresa Aniela. "Small hearts - grand matters. The ethics of neonatal treatment with unknown long-term outcome : the case of hypoplastic left heart syndrone." Thesis, McGill University, 2001. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=29405.
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Ethical decisions about medical care of infants is based on the by proxy evaluation of the infants' best interests. Since parents and physicians may have different points of reference, conflicts may arise during the decision-making process. The decision about the infant's well being becomes even more complex when high risk treatment with an uncertain long-term outcome is considered. Surgical palliation of hypoplastic left heart syndrome (HLHS) is an example of such a treatment. I use this example in my discussion on the relevant ethical issues and possible roots of conflicts between the decision-makers.I argue that as long as long-term survival rates are variable, and the survivors' quality of life remains uncertain, palliative surgery for HLHS should not be obligatory. Rather, the parents should be informed not only about the existing treatments but also about the non-treatment option, and what each option may imply for the infant, parents and the family.
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Glass, Laurie. "Preterm Infant Incubator Humidity Levels: A Systematic Review." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7650.
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Numerous scholars have reported that inconsistent incubator humidity in the neonatal intensive care unit (NICU) requires attention. Evidence synthesis was needed to assist the identification of optimal incubator humidity levels and duration to decrease transepidermal water loss (TEWL) and the potential for infection. The purpose of this doctoral project was to appraise and synthesize the evidence of preterm outcomes related to incubator humidity. The practice-focused question addressed what patient outcomes were impacted by incubator humidity level and duration in premature infants < 32 0/7 weeks cared for in the NICU. The foundation of this project was the Joanna Briggs Institute method for systematic reviews. Mefford’s theory of health promotion for the preterm infant was used to address the wholeness of the preterm infant’s body system. Evidence was classified using the Johns Hopkins evidence-based practice levels and quality of evidence. The search was conducted in 8 databases, and citation searching was used to identify 340 articles, 12 of which met the inclusion criteria. The evidence demonstrates that the practice of incubator humidity is warranted; however, it does not come without risks. Microbial growth was increased in high levels of incubator humidity. Unnecessary TEWL was prevented by lowering high levels of incubator humidity after the 1st week, improving skin barrier formation. Incubator humidity of 60%–70% in the 1st week was effective in preventing TEWL in infants born ≥ 26 weeks; however, future research is needed for infants < 26 weeks. When optimal levels and duration of incubator humidity are achieved, positive social change will occur from the improved outcomes of the smallest neonatal patients.
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Ojodun, Olumide. "The prevalence of hypertensive complications of pregnancy in Dora Nginza Hospital, Port Elizabeth, Eastern Cape." Thesis, Stellenbosch : Stellenbosch University, 2010. http://hdl.handle.net/10019.1/20451.
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Research report (MMed) -- Stellenbosch University, 2010.Bibliography
ENGLISH ABSTRACT: BACKGROUND: Hypertension and its complications is responsible for a significant proportion of maternal and neonatal morbidity and mortality worldwide. In Dora Nginza Hospital, clinical experience has shown that hypertension and its complications are common but despite this assumption, the overall prevalence of complications, social and demographic characteristics and various forms of presentations of hypertension in pregnancy is still largely unknown. OBJECTIVES: To determine the prevalence of complications, risk factors, social and demographic characteristics of hypertensive complications of pregnancy in Dora Nginza Hospital. STUDY DESIGN: The study is a retrospective descriptive study performed on medical records. The study was carried out by looking at records of patients admitted with hypertension in pregnancy over a 2 year period (2007-2008). MS Excel was used to capture the data and STATISTICA version 9 was used for data analysis. SETTING: Dora Nginza hospital, Port Elizabeth Hospitals Complex. MAIN OUTCOME MEASURES: The incidence, risk factors, maternal complications, perinatal outcome. RESULTS: A total of 22,711 deliveries were recorded in Dora Nginza hospital over the two year period (2007-2008). 1520 cases were complicated by hypertension giving an incidence of hypertension as 6.69% (66.9 per 1000 deliveries). The incidence of pre eclampsia is 35.40% and chronic hypertension 2.80%. Maternal complications occurred in 40.29% of the hypertensive women. Maternal deaths occurred in 0.79% (790 per 100000 deliveries) accounting for 38.71% of the total maternal deaths in the facility. Poor neonatal outcome was recorded in 5.90% of these women. The 2.30% stillbirths represent 3.30% of all fetal deaths in the facility for the study period. Prominent risk factors are age, race, low socioeconomic status, smoking and BMI CONCLUSION: Hypertensive disorders of pregnancy in Dora Nginza hospital is common and is an important cause of maternal and perinatal morbidity and mortality. Improved socioeconomic status, quality obstetric services which include early booking, proper antenatal care, early referral and proper documentation can minimise the effect of hypertension on pregnancy.
AFRIKAANSE OPSOMMING: geen opsomming
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Karl, Bethany C. "The Importance of Child Life Within the Neonatal Intensive Care Unit (NICU)." Ohio University / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1428577797.
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Nathan, Lisa. "Noise levels in a neonatal intensive care unit in the Cape Metropole." Thesis, Stellenbosch : University of Stellenbosch, 2007. http://hdl.handle.net/10019.1/2339.
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Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007.Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.
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Praskach, Ana. "Nature, daylight and sound : a sensible environment for the families, staff and patients of neonatal intensive care units." [Tampa, Fla] : University of South Florida, 2009. http://purl.fcla.edu/usf/dc/et/SFE0003153.
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Mörelius, Evalotte. "Stress in infants and parents : Studies of salivary cortisol, behaviour and psychometric measures." Doctoral thesis, Linköpings universitet, Pediatrik, 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-7294.
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The life of a preterm infant admitted to a neonatal intensive care unit may be stressful from the moment of birth. Ever since Hans Selye’s initial characterisation of the biological stress response, cortisol has been frequently measured as an indicator of stress responsivity. However, research of the stress response and cortisol in infants, especially those who are preterm and/or ill, has been scarce basically because of methodological issues. The first aim with this thesis was to investigate the acute stress response, as measured by salivary cortisol and behaviour, for preterm infants, healthy infants, and infants at high psychosocial risk in response to certain defined handling procedures. The second aim was to investigate the stress response, as measured by salivary cortisol and psychometric measures, for parents present during the handling procedure of their infants. The intention was to perform all investigations in an as naturally occurring situation as possible, which means that the studied procedures would have been performed irrespectively of the research. The present thesis includes six original articles. The results of the first study demonstrate that it is feasible to collect sufficient amounts of saliva and to analyse salivary cortisol in neonates using the presented method of collection and analysis. The second study shows that preterm infants, usually cared for in incubators, show no signs of discomfort and have variable cortisol responses during skin-to-skin care with their mothers. The mothers, however, experience stress and low control before their first skin-to-skin care with their preterm infant and do not relax completely until after the session. In the third study we found that preterm infants have higher baseline salivary cortisol as compared to healthy full-term infants. Moreover, preterm infants have higher and sustained pain response during a nappy change as compared to healthy full-term infants. The results of the fourth study shows that infants younger than three months, living in psychosocial high-risk families, have increased cortisol responses during a nappy change, performed by the mother. However, support with the aim of improving mother-infant interaction, dampens the stress response. The results of the fifth study show that oral sweet-tasting solution in combination with a pacifier dampen the levels of the stress hormone cortisol in three months old infants during routine immunisation. Moreover, parents experience more self-rated emotional stress before immunisation if it is their first child who is being immunised. The sixth paper shows that the material used for saliva collection (cotton buds with wooden or plastic sticks) is of importance when saliva is collected but for practical reasons not centrifuged within 24 hours prior to cortisol analyse. The present thesis shows that it is practically feasible to collect saliva and to analyse the stress hormone cortisol in infants. The interpretation of infants’ and parents’ salivary cortisol responses to different handling procedures are discussed in relation to shortand long-term consequences, neonatal intensive care, preterm birth, attachment, mood, and pain.
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Gaddy, Joshua L., and Joshua L. Gaddy. "The Effects of Developmental Nicotine Exposure on Hypoglossal Motoneuron Primary Dendrite and Soma Development in the Neonatal Rat." Thesis, The University of Arizona, 2016. http://hdl.handle.net/10150/621005.
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Nicotine from smoking or from other products containing nicotine has adverse effects on the fetus during pregnancy, such as respiratory problems. Our laboratory has previously shown that exposure to nicotine during development (DNE) alters hypoglossal motor neuron (XII MN) function, including decreased excitatory synaptic input, desensitized nicotinic acetylcholine receptors, increased input resistance, and differences in the precision and reliability of spike timing in XIIMNs. Evidence of DNE effects on XIIMN function prompted us to test the hypothesis that DNE will affect the development of primary dendrites and the soma. Brainstem slices were collected from neonates and motoneurons were filled with neurobiotin via whole-cell patch clamp. Filled cells were visualized with heavy metal intensified-3,3'-Diaminobenzidine (DAB) reaction. DAB-stained cells were analyzed using Neurolucida hardware and software. On average, the maximum soma diameter of more rostral XIIMNs was larger than that in more caudal cells. Also, caudal XIIMNs had more primary nodes than rostral XIIMNs, and there was a significant treatment effect on minimum soma diameter (Control, 13.76 ± 0.71 µm; DNE, 18.09 ± 1.22 µm). The results from this study uncovered potential effects of nicotine on XIIMNs found in rostral and caudal regions of the hypoglossal nucleus.
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Wallin, Lars. "Knowledge Utilisation in Swedish Neonatal Nursing : Studies on Guideline Implementation, Change Processes and Contextual Factors." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis : Univ.-bibl. [distributör], 2003. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-3426.
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Raynor, Desiree. "Visitor Hand-washing Compliance According to Policies and Procedures at a Regional Neonatal Intensive Care Unit." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/honors/124.
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Hospital-acquired infections cost hospitals approximately $30.5 billion per year and also result in longer hospital stays, chronic conditions, and even death with associated malpractice costs. According to the Centers for Disease Control and Prevention, hand hygiene is a simple, effective way to prevent illness and infection. The purpose of this research was to determine if visitors to a neonatal intensive care unit (NICU) in a regional medical center comply with hand-washing policies and procedures. If NICU visitors wash their hands properly, they can prevent potentially fatal infections from spreading to patients, healthcare workers, and unaffected family members. Hand-washing compliance has been previously studied in NICU staff and other healthcare workers, but not solely visitors. The researcher observed more than 120 visitors as they entered the NICU to determine the number who washed their hands for the required three minutes. Based on the findings, NICU staff and administration will be encouraged to provide more effective education, post informative signs, and install equipment to encourage visitors to use proper hand-washing techniques. Effective hand-washing should result in lower infection rates among NICU patients and lower health care costs.
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Gust, Linda. "Building capability : impact of low and high-fidelity manikins on neonatal resuscitation simulation." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Health Sciences, 2010, 2010. http://hdl.handle.net/10133/1288.
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Purpose: Does manikin fidelity affect learning outcomes in neonatal resuscitation simulation? Description: This experimental design accessed and randomly assigned health care professionals (HCP) (N=60), who completed Neonatal Resuscitation Program (NRP) recertification in a simulation lab. The experimental group used a high-fidelity manikin. The control group recertified using a low-fidelity manikin. Dependant variables included learning outcomes of confidence, skill performance, and knowledge. These were measured using the newly developed Neonatal Resuscitation Confidence Tool (NRCT), Megacode Assessment, and NRP written exam. Both groups underwent the same simulated resuscitation scenario. Outcome: A significant increase in confidence with simulation was found (p<.001). HCPs using the high-fidelity simulator did not have a significant increased level of confidence, knowledge or skill performance compared to using the low-fidelity simulator. However, there was a significant increase in confidence with repeated NRP courses (p=.003). Implications: The use of simulation for NRP is important to increase capability with increased practice intervals.ix, 109 leaves : ill. ; 29 cm. --
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Garðarsdóttir, Ólöf. "Saving the child : regional, cultural and social aspects of the infant mortality decline in Iceland, 1770-1920." Doctoral thesis, Umeå universitet, Demografiska databasen, 2002. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-56811.
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The dissertation deals with the infant mortality decline in Iceland during the 19th and early 20th Century. It shows that despite its low degree of urbanization, pre-transitional Iceland displayed higher infant mortality rates than most other European countries. Levels are only comparable with a few areas in Europe, all of whom were known for a tradition of artificial feeding of newborns. In the Icelandic case, infants were either not breastfed at all or were weaned at a very young age. Another characteristic of infant mortality in Iceland were huge fluctuations during epidemics. Because of the isolation of the country, several diseases that had become endemie in other societies, such as measles, became dangerous epidemics in Iceland and affected all age groups. After 1850 the effects of epidemics declined and 20 years later there was a steep decline in infant mortality. By the beginning of the 20th Century infant mortality in Iceland was lower than in most other societies. Although epidemics often had important temporary consequences upon infant mortality level in pretransitional Iceland, being breastfed or not was without doubt the most important determinant of infant survival. There were huge differences in infant mortality levels between areas where breastfeeding was common and those where newborns were artificially fed. Towards the turn of the 20th Century significant changes occurred. Even though there were still differences in infant mortality between those babies who were breastfed and those who were not, infant survival had improved greatly and survival chances of Icelandic newborns that were fed artificially became in an international perspective relatively good. Midwives played a central role in the infant mortality decline in Iceland. Growing secularization during the second part of the 19th Century improved educational opportunities for women and also changed the content of education. Improved educational opportunities were reflected in changes in the education of midwives. At the same time there was growth in the publication of books that directly dealt with the issue of infant health. The increase in the number of educated midwives was a factor of central importance. The interaction between midwives and a literate population was most likely the key to infant survival in the Nordic countries. This study shows that that the custom to breastfeed spread earlier in areas with higher literacy. Not only is it plausible that the interest in changing prevailing traditions was directly related to literaey levels of individuai mothers, it is also shown that midwives had the best education in areas where literacy rates were high. On the other hand, the remarkable improvements in infant survival obtained towards the end of the 19th Century were scarcely linked to changes in the economic structure. Those factors only started to play an important role in the 20th Century. In its initial stages, changes in infant feeding and improvements in personal hygiene were more importantdigitalisering@umu
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Bailey, Beth A., David Wood, Nathaniel Justice, and Darshan Shah. "Smoking During Pregnancy as a Risk Factor for Development and Severity of Neonatal Abstinence Syndrome Severity Among Newborns Prenatally Exposed to Opioids." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7666.
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Bales, Mary. "Knowledge of the Effects of Alcohol on Fetal Development Among Women of Childbearing Age." Digital Commons @ East Tennessee State University, 2011. https://dc.etsu.edu/honors/22.
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While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development.
The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.
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Nieder-Heitmann, Esther. "The impact of a sensory developmental care programme for very low birth weight preterm infants in the neonatal intensive care unit." Thesis, Stellenbosch : University of Stellenbosch, 2010. http://hdl.handle.net/10019.1/3180.
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Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010.AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word.
ENGLISH ABSTRACT: BACKGROUND Premature infants of very low birth weight are known to be inclined to developmental, medical, behavioural and various learning deficiencies by the time they reach schoolgoing age. Concerns have been raised about the effect of the neonatal intensive care unit environment on the sensory development of the premature infant and how this could contribute to these deficiencies. Various approaches claim to address this problem, of which kangaroo mother care and developmental care have in the literature been singled out as particularly promising. However, at the commencement of this study no empirical studies had been reported in the literature to confirm any of the claims of these approaches. Therefore, a need existed for an empirically researched programme that could be practically applied in the neonatal intensive care unit with a view to reducing environmental stressors regarding the sensory systems of the premature infant. AIM The aim of this study was to determine the influence of a Sensory Developmental Care Programme, which incorporated a specific kangaroo mother care protocol, on the sensory development of the very low birth weight premature infant, up to the age of 18 months (corrected age). METHODOLOGY A randomised controlled study was conducted. The study sample consisted of 89 very low birth weight premature infants, admitted during a 24-month period to the neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants were recruited by means of certain criteria and then randomly assigned to one of two groups: 1) the intervention group was cared for according to the Sensory Developmental Care Programme for ten recorded days; and 2) the control group that received the standard care of the unit, also for ten days. The intervention group consisted of 45 infants of whom 22 completed the study, while the control group consisted of 44 infants of whom 20 completed the study. Both study groups were followed up at six, 12 and 18 months (corrected age) when the Test of Sensory Functions in Infants was used to do a sensory developmental assessment. At 18 months (corrected age) a Griffiths Developmental Scale assessment was also conducted to determine function in other areas of development. Test results were analysed using repeated measures of ANOVA, and the Bonferoni t procedure to determine the effect that the Sensory Developmental Care Programme had on the sensory development of the infant up to 18 months (corrected age). RESULTS The results of the comparison of the performance of both groups (group effect), measured by the Test of Sensory Functions in Infants are of great importance to this study. The intervention group had a significant difference on the total score (p<0.00), as well as on the following four of the five sub-tests scores: reactivity to tactile deep pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration (p<0.00); and reactivity to vestibular stimulation (p<0.01). CONCLUSION The results of this study signify that the infants in the intervention group benefited from the Sensory Developmental Care Programme concerning their sensory functions up to the age of 18 months (corrected age). The Sensory Developmental Care Programme was demonstrated to be both practical and successful in terms of its aims. The Programme could therefore be fruitfully utilised in other neonatal intensive care units.
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Malin, Gemma. "The diagnostic/prognostic value of neonatal findings for predicting childhood and adult morbidity : systematic reviews, meta-analysis and decision analytic modelling." Thesis, University of Birmingham, 2013. http://etheses.bham.ac.uk//id/eprint/4156/.
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Events in utero have been linked with diseases throughout life, however there is a lack of consensus regarding the ability of neonatal tests to predict these outcomes. Systematic reviews and meta-analyses were performed, assessing umbilical cord pH and base excess at birth, standards of low birth weight, and the Apgar score, including a total of 218 papers and 26704980 individuals. The prognostic association and predictive accuracy of these tests for adverse outcomes, including neonatal mortality and morbidity, childhood morbidity including cerebral palsy, and adult outcomes, were determined. A decision-analytic model based analysis assessed the cost-effectiveness of varying the umbilical cord pH threshold, and treatment with neonatal hypothermia. This thesis determined that all of the tests examined had a strong association with neonatal mortality, and a significant but smaller association with neonatal morbidity and childhood cerebral palsy. In general, where the association was strong, tests had a high specificity and positive likelihood ratio for adverse outcome, but poor sensitivity and negative likelihood ratio, indicating that negative tests do not reduce the risk. The cost effectiveness analysis showed that the threshold of pH used in current practice to recommend neonatal hypothermia is more effective and less costly than a higher threshold.
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Barsman, Sarah Gutin. "Decision-Making for High-Risk Infants in the Neonatal Intensive Care Unit (NICU): Mothers' Attitudes and Experiences." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1564484781963305.
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Peng, Niang-Huei. "An exploration of the relationship between stress physiological signals and stress behaviors in preterm infants during periods of environmental stress in the intensive care unit." Diss., St. Louis, Mo. : University of Missouri--St. Louis, 2008. http://etd.umsl.edu/r2801.
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Jorild, Elina, and Kristin Staf. "Perinatala utfall hos kvinnor som genomgått könsstympning." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-411118.
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SAMMANFATTNING Bakgrund Kvinnlig könsstympning (Female Genital Mutilation, FGM) är en uråldrig tradition med starka band till kulturell och etnisk identitet. Mer än 200 miljoner kvinnor och flickor beräknas vara könsstympade och årligen riskerar cirka 3,9 miljoner ytterligare flickor att utsättas. Andelen kvinnor från länder där FGM är vanligt förekommande och som föder barn i Sverige har ökat i och med ökad invandring från dessa länder. FGM är internationellt betraktat som en kränkning av de mänskliga rättigheterna samt ett brott mot kvinnor och barns rättigheter. Syfte Att jämföra förekomsten och risken för perinatala komplikationer hos kvinnor med en diagnos av FGM med kvinnor utan denna diagnos som fött barn i Sverige mellan åren 2007 - 2017. Metod En populationsbaserad kohortstudie. Resultat Det huvudsakliga resultatet i denna studie är att barn födda av kvinnor med en FGM diagnos har en signifikant ökad risk för låg Apgar, födas lätta för tiden (SGA), drabbas av kramper, perinatal död inklusive intrauterin fosterdöd samt att födas överburna. Slutsats FGM är förknippat med ett flertal allvarliga perinatala komplikationer. Störst risk kunde ses mellan FGM och att födas lätt för tiden, födas överburen och intrauterin fosterdöd. Dessa samband var robusta oavsett vilket land kvinnan är född. Det går att dra slutsatsen att kvinnor med en FGM-diagnos och deras nyfödda barn tillhör en riskgrupp. Det är av stor vikt att arbeta preventivt för att skydda dessa kvinnor och barns hälsa.ABSTRACT Background Female Genital Mutilation (FGM) is an ancient tradition with strong ties to cultural and ethnic identity. More than 200 million women and girls are estimated to be exposed, and about 3.9 million more girls are at risk each year. The proportion of women from countries where female genital mutilation is common, and which gives birth to children in Sweden has increased with an increased immigration. Female genital mutilation is internationally considered as a violation of human rights and a violation of women's and children's rights. Aim To compare the incidence and risk of perinatal complications among women with a diagnosis of FGM with women without this diagnosis who has given birth to a child in Sweden during the years 2007 - 2017. Method A population-based cohort study. Results The main result of this study is that children born of women with an FGM-diagnosis have a significantly increased risk of low apgar scores, being born Small for Gestational Age, convulsions, perinatal death and prolonged pregnancy could be observed. Conclusion FGM is associated with a number of serious perinatal complications. The greatest risk was seen between female genital mutilation and being born Small for Gestational Age, prolonged pregnancy and intrauterine fetal death. These relationships were robust regardless of which country the woman was born. It can be concluded that women with an FGM diagnosis and their newborn children belong to a risk group. It is very important to work preventively to protect these women and children's health.
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Rydvall, Anders. "Withhold or withdraw futile treatment in intensive care : arguments supported by physicians and the general public." Doctoral thesis, Umeå universitet, Anestesiologi och intensivvård, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-128863.
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Background: Since the 60s and with increasing intensity a discussion have continued about balance between useful and useless/harmful treatment. Different attempts have been done to create sustainable criteria and recommendations to manage the situations of futile treatment near the end of life. Obviously, to be able to withhold (WH) or withdraw (WD) treatment which is no longer appropriate or even harmful and burdensome for the patient, other processes than strict medical (or physiological) assessments are necessary. Aim. To shed light on the arguments regarding to WH or WD futile treatment we performed two studies of physicians’ and the general populations’ choice and prioritized arguments in the treatment of a 72-year-old woman suffering from a large intra-cerebral bleeding with bad prognosis (Papers I and II) and a new born boy with postpartum anoxic brain damage (Papers III and IV). Methods. Postal questionnaires based on two cases presented above involving severely ill patients were used. Arguments for and against to WH or WD treatment, and providing treatment that might hasten death were presented. The respondents evaluated and prioritized arguments for and against withholding neurosurgery, withdrawing life-sustaining treatment and providing drugs to alleviate pain and distress. We also asked what would happen to physicians’ own trust if they took the action described, and what the physician estimated would happen to the general publics’ trust in health services (Paper IV). Results. Approximately 70% of the physicians and 46% of the general public responded in both surveys. The 72-year-old woman: A majority of doctors (82.3%) stated that they would withhold treatment, whereas a minority of the general public (40.2%) would do so; the arguments forwarded and considerations regarding quality of life differed significantly between the two groups. Quality-of-life aspects were stressed as an important argument by the majority of both neurosurgeons and ICU-physicians (76.8% vs. 54.0%); however, significantly more neurosurgeons regarded this argument as the most important. A minority in both groups, although more ICU-physicians, supported a patient’s previously expressed wish of not ending in a persistent vegetative state as the most important argument. As the case clinically progressed, a consensus evolved regarding the arguments for decision making. The new born child: A majority of both physicians [56 % (CI 50–62)] and the general population [53 % (CI 49–58)] supported arguments for withdrawing ventilator treatment. A large majority in both groups supported arguments for alleviating the patient’s symptoms even if the treatment hastened death, but the two groups display significantly different views on whether or not to provide drugs with the additional intention of hastening death, although the difference disappeared when we compared subgroups of those who were for or against euthanasia-like actions. Conclusions. There are indeed considerable differences in how physicians and the general public assess and reason in critical care situations, but the more hopelessly ill the patient became the more the groups' assessments tended to converge, although they prioritized different arguments. In order to avoid unnecessary dispute and miscommunication, it is important that health care providers are aware of the public's views, expectations, and preferences. Our hypothesis—physicians’ estimations of others’ opinions are influenced by their own opinions—was corroborated. This might have implications in research as well as in clinical decision-making.
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Srisuthisak, Sasamon. "Relationship Among Stress of Labor, Support, and Childbirth Experience in Postpartum Mothers." VCU Scholars Compass, 2009. http://scholarscompass.vcu.edu/etd/1916.
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Background: Due to the profound and life-changing aspects of giving birth and to each woman’s individualized birthing experience, it is important to understand the myriad of factors that contribute to a positive childbirth experience. The aims of this study were to: (1) identify factors related to a positive childbirth experience; (2) to examine relationships among women’s perceptions and personal evaluations of their childbirth experience, stress associated with labor pain, support from the nursing staff, initial contact with the baby following birth, support from partners, education, age, and obstetric history; and (3) to identify predictors of a positive childbirth experience. Method: A cross-sectional correlational study was conducted using a sample of 122 new mothers recruited over a 3-month period. Data were collected using self-report questionnaires. The three questionnaires used in this study consisted of: (a) the Questionnaire Measuring Attitude About Labor and Delivery Experience (QMAALD 29 items); (b) the Questionnaire Measuring Stress Associated with Labor Pain [SLPS (version 2)]; and (c) Personal Information Questionnaire (Demographic data). The Cronbach’s alpha coefficient for the 29 item QMAALD in this study was .82 and the Cronbach’s alpha coefficient of the SLPS (version 2) in this study was .89. The SPSS statistical software version 16.0 for Windows was used for data analysis. Results: Participants reported a low degree of stress associated with labor pain and a moderate amount of support received from the nursing staff. They reported holding and touching their baby immediately after birth. A positive childbirth experience was inversely related to stress associated with labor pain. The reduction of stress due to support received from the nursing staff was found to be positively related to a positive childbirth. Education was related to a positive childbirth experience; but not a significant predictor of a positive childbirth experience. Maternal age, initial contact with the baby following birth, number of labor and delivery experiences, duration of labor, interventions during labor, attendance at prenatal classes, and support from a partner did not relate to a positive childbirth experience. The regression analysis results indicated that the stress associated with labor pain, the reduction of stress due to the support received from the nursing staff, and attendance at prenatal classes were significant predictors of a positive childbirth experience. Conclusion: Stress associated with labor pain and the reduction of stress due to support received from the nursing staff were key factors contributing to a positive childbirth experience. Further research is needed to better understand the factors influencing women’s positive perceptions of the childbirth experience.
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Adams, Rozanne Charlene McChary. "Ontogeny of the innate immune response in healthy South African infants." Thesis, Stellenbosch : Stellenbosch University, 2012. http://hdl.handle.net/10019.1/71834.
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Thesis (MScMedSc)--Stellenbosch University, 2012.Includes bibliography
ENGLISH ABSTRACT: Infection is a major cause of morbidity and mortality in infants within the first few months of life. Susceptibility to infectious disease in this vulnerable population is more prevalent in resource-limited regions, with a higher disease burden. Due to certain deficiencies in their adaptive immune system, neonates rely predominantly on their innate immune system for protection against infection, a vital component in the early host defence against pathogens. Several studies have described differences in neonatal innate toll-like receptor-mediated responses compared to adult counterparts, though very little is known about these receptor responses within resource-limited settings. To address this issue, we assessed the longitudinal development of cytokine-specific responses of TLR4 and TLR7/8 in monocytes, myeloid dendritic cells and plasmacytoid dendritic cells in infants from a resource-limited setting, South Africa, within the first 12 months of life and compared it to adults. Contrary to previously published literature, we observed heightened production of TH-1 cytokines: we showed increased responsiveness to TLR4 and TLR7/8 stimulation in infants at two and six weeks of age, which may be due to vaccination administered at birth. Unexpectedly, the hyper-inflammatory response persisted at six months in response to the LPS (TLR4) stimulus. This increased response at six months may be attributed to decreased passive immunity through infant weaning as well as increased exposure to microbial pathogens in this setting. Maturation of most cytokine responses was reached at twelve months for the TLR4 receptor, and at six months for the TLR7/8 receptor. The first year of life represents a critical period for maturation of the immune response. Data from this study point towards an elevated response within the first six months of life. This heightened response reflects both an ability to mount a sufficient TH-1 response in infancy, but more likely, the increased exposure to microbial stimuli in the environment. Thus, we speculate that these age-specific inflammatory responses may influence the outcome of immune responses to various vaccines administered, which may result in altered responsiveness to immunisation in infancy.
AFRIKAANSE OPSOMMING: Die hoof oorsaak vir morbiditeit en mortaliteit in babas binne die eerste paar maande van hul lewe word toegeskryf aan infeksie. In hulpbron beperkte gebiede, gekenmerk deur `n groter siektelas, is daar `n verhoogde vatbaarheid vir infeksie in hierdie kwesbare populasie. As gevolg van sekere gebreke in die verworwe immuunstelsel, maak pasgebore babas hoofsaaklik staat op hul aangebore immuunstelsel vir beskerming teen infeksie, ’n belangrike komponent vir die vroeë verdediging teen patogene. Verskeie studies het al die verskille in toll-tipe reseptor (TTR) bemiddelde reaksies tussen pasgebore babas en volwassenes vergelyk, maar nie veel is bekend oor hierdie reaksies in areas waar hulpbronne beperk is nie. Om hierdie kwessie aan te spreek is die longitudinale ontwikkeling van sitokien-spesifieke reaksies van die TTR4 en TTR7/8 reseptore van monosiete, miëloïede en plasmasitoïede dendritiese selle van babas in die hulpborn beperkte land Suid-Afrika, oor die eerste 12 maande geëvalueer en dit vergelyk met volwassenes. In teenstelling met vorige literatuur, het hierdie studie ’n polarisasie tot TH-1-sitokien produksie gevind: verhoogde reaktiwiteit van die TTR4 en TTR7/8 is gevind in babas van twee en ses weke oud, wat gedeeltelik as gevolg van die inenting kan wees wat toegedien was na geboorte. Hierdie hiper-inflammatoriese reaksie teen die TTR4 stimulus (Lipopolisakkaried (LPS), het teen verwagting voortgeduur tot op ses maande en kan toegeskryf word aan die vermindering van passiewe immuniteit deur spening, sowel as die toenemende blootstelling aan mikrobiese patogene in die omgewing. Maturasie vir die meerderheid van die sitokiene reaksies, is bereik op 12 maande vir TTR4, en op ses maande vir TTR7/8. Die eerste lewensjaar is ‘n kritiese periode vir die ontwikkeling van die immuunstelsel. Data van hierdie studie dui op ‘n verhoogde reaksie binne die eerste ses maande van ‘n baba se lewe. Hierdie verhoogde reaksie dui op die vermoë om `n voldoende TH-1 reaksie te ontlok, maar meer waarskynlik, verhoogde blootstelling aan mikrobiese stimuli in die omgewing. Dus spekuleer ons dat hierdie ouderdom-spesifieke reaksies dalk die uitkoms van die immuunreaksie teen verskeie entstof toediening kan beïnvloed in babas.