Abstrakt Bakgrund: Sverige är idag världsledande gällande överlevnaden hos extremt underburna barn. Den högspecialiserade vården i Sverige är centraliserad till regionsjukhus vilket leder till att flertalet av dessa barn behöver transporteras från hemsjukhus till regionsjukhus för fortsatt vård. Motiv: Föräldrars känslor i samband med att deras barn behöver neonatal intensivvård är väl studerat i tidigare forskning både internationellt och nationellt. Då det finns begränsat med kunskap angående dessa föräldrars behov av stöd i samband med flytt av deras extremt underburna barn till annat sjukhus finns det möjligheter till förbättring inom området. Syfte: Syftet med studien var att belysa vilket stöd föräldrar till extremt underburna barn önskade när deras barn behövde flyttas till en annan neonatalavdelning på ett annat sjukhus.Metod: Studien genomfördes som en kvalitativ enkätstudie med öppna frågor med empirisk design. Enkäterna analyserades via en kvalitativ innehållsanalys med induktiv ansats av Elo & Kyngnäs. Föräldrarna (n=63) rekryterades via ett strategiskt urval från hela Sverige. Resultat: Resultatet delas in i två huvudkategorier; ”Föräldrars behov av förberedelser inför flytt till annat sjukhus” samt ”Föräldrars behov av emotionellt och personligt stöd”. Resultatet visar att det finns ett stort behov av stöd hos föräldrarna för att minimera de negativa upplevelser som kan uppstå då deras extremt underburna barn behöver flyttas till en annan neonatalavdelning. Föräldrarna beskriver att de önskar få information om avdelningen de flyttar till avseende rutiner och faciliteter samt när flytt förväntas ske och att denna information idag är bristfällig. Föräldrarna beskriver även att deras känslor och upplevelser behöver bli bekräftade av personalen och att behovet av en kontaktperson är stort. Konklusion: Resultatet belyser vilket stöd föräldrar efterfrågar i samband med flytt av sitt extremt underburna barn vilket skapar möjligheter för en framtida utveckling av neonatalvården. Implementering av stödjande vårdrutiner samt förbättrat samarbete mellan sjukhusen skulle öka möjligheterna för en förbättrad föräldraupplevelse och därmed minskad psykisk ohälsa. / AbstractBackground: Sweden is world-leading when it comes to survival rates among extremely preterm infants. Highly specialized care units are centralized to regional hospitals, resulting in that many extremely preterm infants need to be moved from their home hospital to a regional hospital for additional care. Motive: Parents' emotions when their extremely preterm infant requires neonatal intensive care is a well-studied area in both national and international studies. The authors therefore believe that there is a reason for further research regarding parents’ need for support in connection to the relocation of their extremely preterm infant to another hospital. Since there is limited research regarding the needs of these parents, there are opportunities for improvement in the area.Aim: The purpose of this study was to illustrate what support parents of extremely preterm infants need when their infant needs to be moved to another neonatal unit at another hospital. Methods: The study was conducted as a qualitative questionnaire study with open questions with empirical design. The questionnaires were analysed using a qualitative content analysis with an inductive approach by Elo & Kyngnäs. The parents (n=63) were recruited via a strategic selection from all over Sweden.Result: The result is divided into two main categories; “Parents’ need for preparation when moving to another hospital” and “Parents’ need for emotional and personal support”. The result shows that there is a great need for support among parents to minimize the negative experiences that can occur when their extremely preterm infant needs to be moved to another neonatal unit. The parents describe that they wish to receive more information about routines and facilities at the unit they are moving to, and then the move is expected to take place. The parents also describe that their feelings and experiences could be further confirmed by the staff and that they have a need for establishing a relation with a contact person. Conclusion: The result highlights what support parents request in relation to transportation of their extremely preterm infant, creating opportunities for further improvements in neonatal care. Implementation of supportive care routines and improved collaboration between hospitals could increase the opportunities for an improved parental experience and by that reduced mental illness.

Infant hearing screening (IHS) programs are not yet widespread in developing countries, such as South Africa. In order to ensure that the benefits of early hearing detection and intervention (EHDI) programs reach all infants, initial recommendations for the implementation of IHS programs in South Africa have been made by the Year 2002 Hearing Screening Position Statement by the Health Professions Council of South Africa. One of the platforms recommended for IHS in South Africa is the neonatal intensive care unit (NICU). South African NICU infants are at an increased risk for hearing loss, resultant of their high-risk birth histories, as well as the prevalence of context-specific environmental risk factors for hearing loss. There is currently a general scarcity of contextual data regarding the prevalence of risk indicators for hearing loss, and the prevalence of auditory impairment in the South African NICU population. The objective of this study was to describe an IHS program for NICU infants at a secondary hospital in Gauteng, South Africa. A quantitative descriptive research design was used to report on a cohort of 129 NICU infants followed up during a 29 month period. The objective of the study was achieved by describing the sample of infants in terms of the presence of specific risk indicators for hearing loss, the efficiency of the IHS program, and the incidence of auditory pathologies. Infants received their initial hearing screening as part of their medical and developmental follow-up visit at the hospital at three months of age. Routine rescreening visits were scheduled three monthly, whilst infants who failed the hearing screening were requested to return after three weeks for a follow-up. A data collection sheet was used to collect biographical information and risk indicators for hearing loss. Immittance measurements were recorded in the form of high-frequency and low-frequency tympanometry. Distortion product otoacoustic emissions (DPOAE) and automated auditory brainstem responses (AABR) were recorded, as well as diagnostic auditory brainstem responses (ABR) in cases where infants referred the screening protocol. Results revealed that environmental risk factors present in this sample included poor maternal education levels and prenatal HIV/AIDS exposure. At least 32% of mothers participating in this study did not complete high school. Prenatal HIV/AIDS exposure was present in at least 21% of the current sample of infants. The screening coverage rate fell short of the 95% benchmark set by the Joint Committee on Infant Hearing (JCIH, 2000). A 67% coverage rate was achieved with AABR screening, and an 88% coverage rate was achieved with DPOAE screening. 93% of infants had immittance screening performed on their initial visit to the IHS program. According to the Fisher’s two-sided exact test and the logistic regression procedure, high frequency tympanometry proved to be more effective than low frequency tympanometry, when assessing the middle ear functioning of infants younger than seven months when compared with DPOAE results. Normative pressure and admittance data was compiled for the use of high frequency tympanometry in NICU infants. Poor follow-up rates were recorded for both routine and non-routine visits, but are expected to improve over time. Furthermore, results indicated a high incidence of hearing impairment. Permanent congenital hearing loss was identified in 3% (n=4) of the sample. Half of these presented with sensorineural hearing loss, whilst the other half had auditory neuropathy. The incidence of auditory impairment is estimated to be 3.75% if the percentage of infants who did not return for follow-up is taken into account. A high incidence of middle ear pathology was recorded, with an incidence rate of 60.4%, including bilateral and unilateral middle ear pathology. The high prevalence of auditory impairment in South African NICU infants, and the lack of widespread IHS programs, indicates that many vulnerable infants are being the denied the benefits of early identification of and intervention for hearing loss. The implementation of widespread IHS programs in South Africa is therefore essential, in order to ensure that all South African infants receive the benefits of EHDI programs. / Dissertation (MCommunication Pathology)--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / unrestricted

Cette étude se concentre sur l'administration de sucrose pour soulager la douleur chez les nouveau-nés prématurés en unité de soins intensifs néonatals (USIN). En utilisant la Théorie du Comportement Planifié (TCP) d'Ajzen, les chercheurs ont examiné le comportement, l'intention, les attitudes, les normes subjectives et la perception de contrôle des infirmières travaillant dans une USIN d'un centre hospitalier universitaire de niveau III. Les résultats ont révélé que la majorité des infirmières ont déclaré avoir administré du sucrose aux nouveau-nés prématurés au cours des deux dernières semaines de travail en USIN, et qu'elles avaient l'intention de continuer à le faire lors des prises de sang au talon. De plus, les attitudes, les normes subjectives et la perception de contrôle des participantes étaient favorables à l'utilisation du sucrose pour soulager la douleur des prématurés. Ces résultats soulignent l'importance de sensibiliser et de former les infirmières à l'utilisation appropriée des interventions non pharmacologiques, telles que l'administration de sucrose, pour soulager la douleur chez les nouveau-nés prématurés. Ils mettent en évidence le rôle crucial des infirmières dans la gestion de la douleur chez cette population vulnérable et suggèrent des pistes d'amélioration pour une prise en charge optimale. En conclusion, cette étude met en lumière les facteurs influençant le comportement des infirmières concernant l'administration de sucrose pour soulager la douleur des prématurés en USIN. Elle souligne l'importance de considérer les variables de la TCP dans la planification des stratégies visant à améliorer les soins et à réduire la douleur chez les prématurés en USIN. / This study focuses on the administration of sucrose for pain relief in preterm infants in the neonatal intensive care unit (NICU). Using Ajzen's Theory of Planned Behavior (TPB) as a theoretical framework, the researchers examined the behavior, intention, attitudes, subjective norms, and perceived control of nurses working in a level III university hospital NICU. The results revealed that the majority of nurses reported administering sucrose to preterm infants in the past two weeks of their work in the NICU, and they had the intention to continue doing so during heel-stick procedures. Furthermore, nurses' attitudes, subjective norms, and perceived control were favorable towards the use of sucrose for pain relief in preterm infants. These findings highlight the importance of raising awareness and providing training for nurses regarding the appropriate use of non-pharmacological interventions, such as sucrose administration, for pain relief in preterm infants. They underscore the crucial role of nurses in managing pain in this vulnerable population and suggest avenues for improvement in optimizing care. In conclusion, this study sheds light on the factors influencing nurses' behavior regarding the administration of sucrose for pain relief in preterm infants in the NICU. It underscores the importance of considering the variables of the TPB in planning strategies to enhance care and reduce pain in preterm infants in the NICU.

This study examined healthcare professionals’ perceptions on feeding difficulties experienced by infants with NOWS, the involvement of SLP in care, knowledge and experience levels of professionals, and trends in education and follow up care. A 34-question survey was developed to obtain data from participants involved in the care of exposed infants using the secure webbased RedCap™ platform. Nonparametric inferential statistics and descriptive analysis were used to interpret data. Feeding difficulties in infants exposed were reported by all respondents with SLP involvement reported by 42.2%. Results found that 51.9% of respondents were confident in their ability to educate families about feeding difficult with 60% reported inadequate time to provide education. Discharge follow up was inconsistent amongst facilities. The study supports early involvement of SLPs to address feeding difficulties and improve education.

Nel presente lavoro di tesi sono riportati i risultati di un innovativo progetto di ricerca longitudinale nell'ambito della psicobiologia. I recenti progressi nel campo dell'epigenetica sono stati applicati allo studio delle conseguenze di esperienze avverse precoci sullo sviluppo socio-emozionale in bambini nati fortemente pretermine. La nascita pretermine costituisce un fattore di rischio per lo sviluppo socio-emozionale, in parte per l'esposizione ad eventi stressanti (es.: dolore neonatale) durante l'ospedalizzazione in terapia intensiva neonatale (TIN). L'epigenetica si riferisce a processi biochimici altamente sensibili alle esperienze ambientali e che alterano la funzione di trascrizione di specifici geni, senza modificare la struttura della sequenza di DNA. Il candidato ha sviluppato un razionale clinicamente rilevante per la ricerca epigenetica comportamentale della prematurità. Inoltre il progetto di ricerca ha dimostrato che il livello di esposizione a procedure dolorose si associa a esiti avversi sul piano temperamentale e della risposta allo stress a tre mesi e che tale associazione è mediata da alterazioni epigenetiche a livello del gene che codifica per il trasportatore della serotonina. Le implicazioni teoriche, cliniche ed etiche di questi risultati sono trattate nella sezione conclusiva. Il progetto di epigenetica comportamentale della prematurità fornisce una nuova prospettiva teorica ed empirica sul tema dell’interazione tra genetica ed ambiente. / In the present work, the candidate reports the results of an innovative longitudinal research project in the field of psychobiology. The recent epigenetic progresses have been applied to the study of the consequences of early adverse event exposures on the socio-emotional development of very preterm infants. Preterm birth is a major concern for socio-emotional development, partly due to the exposure to adverse stressful stimulations (i.e., skin-breaking procedures) during the Neonatal Intensive Care Unit (NICU) stay. Epigenetics refers to biochemical processes which are sensitive to environmental cues and which alter the transcriptional activity of specific genes without changing the DNA structure. The candidate has developed a clinically relevant rationale for preterm behavioral epigenetics (PBE). The research project has demonstrated that the early exposure to high levels of skin-breaking procedures during NICU stay associate with non-optimal temperamental profile and stress regulation at 3 months of age. This association was mediated by epigenetic modifications (DNA methylation) of the stress-related gene encoding for serotonin transporter. The theoretical, clinical and ethical implications of these findings are discussed further in the final section of the thesis. The PBE project provides a new framework for the issue of the interconnections between nature and nurture.

This Ph.D. dissertation processes and analyzes signals from the neonatal intensive care units (NICUs) for the study of maturity, systemic infection (sepsis) and the influence of immunization in the premature newborn. A special attention is payed to the electroencephalography and the breathing signal. The former is often contaminated by several sources of noise, thus methods based on the signals decomposition and optimal noise cancellation, adapted to the characteristics of the immature EEG, were proposed and evaluated objectively on real and simulated signals. By means of the EEG and delta burst analysis, detected automatically by a proposed classifier, infant's maturation and the effects of vaccination are studied. Concerning the second signal, breathing, non-linear and fractal methods are adapted to evaluate maturity and sepsis. A robustness study of estimation methods is also conducted, showing that the Hurst exponent, estimated on respiratory variability signals, is a good detector of infection.

Ce mémoire de thèse porte sur le traitement et l'analyse des signaux issus des unités de soins intensifs néonatales (USIN) pour l'étude de la maturité, de l'infection généralisée et de l'influence de l'immunisation chez le nouveau-né prématuré. Une attention particulière est portée sur l'électroencéphalographie et le signal de respiration. Pour le premier, ce signal est souvent bruité en USIN et des méthodes de décomposition du signal et d'annulation optimale du bruit, adaptées aux particularités des EEG immatures, ont été proposées et évaluées objectivement sur signaux réels et simulés. L'analyse de l'EEG et des bouffées delta, repérées automatiquement par un classificateur proposé, ont permis d'étudier la maturation et les effets de la vaccination. Pour la seconde modalité, la respiration, des méthodes non-linéaires et fractales sont retenues et adaptées pour évaluer la maturité et l'infection généralisée. Une étude de robustesse des méthodes d'estimation est menée et on montre que l'exposant de Hurst, estimé sur des signaux de variabilité respiratoire, est un bon détecteur de l'infection. / This Ph.D. dissertation processes and analyzes signals from the neonatal intensive care units (NICUs) for the study of maturity, systemic infection (sepsis) and the influence of immunization in the premature newborn. A special attention is payed to the electroencephalography and the breathing signal. The former is often contaminated by several sources of noise, thus methods based on the signals decomposition and optimal noise cancellation, adapted to the characteristics of the immature EEG, were proposed and evaluated objectively on real and simulated signals. By means of the EEG and delta burst analysis, detected automatically by a proposed classifier, infant's maturation and the effects of vaccination are studied. Concerning the second signal, breathing, non-linear and fractal methods are adapted to evaluate maturity and sepsis. A robustness study of estimation methods is also conducted, showing that the Hurst exponent, estimated on respiratory variability signals, is a good detector of infection.

No description available.

Les nouveau-nés prématurés sont soumis à de nombreuses procédures douloureuses lors de leur hospitalisation à l’unité néonatale, où la plus fréquente est le prélèvement sanguin au talon. La douleur répétée et non traitée entraîne des conséquences à long terme pour les nouveau-nés prématurés. L’utilisation des interventions de soulagement de la douleur, tant pharmacologiques que non pharmacologiques, est limitée chez cette population. Nous avons donc vérifié la faisabilité et l’effet d’une nouvelle intervention pour le soulagement de la douleur, soit l’odeur du lait maternel. Cette étude pilote visait à évaluer la faisabilité et l’acceptabilité d’une intervention de stimulation olfactive avec du lait maternel pour diminuer la réponse à la douleur des nouveau-nés prématurés, nés entre 28 et 34 semaines de gestation, lors d’un prélèvement sanguin au talon. L’étude pilote a été menée auprès d’un groupe de 12 nouveau-nés prématurés (présence de jumeaux), 11 mères et 20 infirmières dans une unité néonatale de niveau III, soit de soins intensifs. L’odeur du lait maternel a été combinée aux soins standards au moment du prélèvement sanguin au talon et la douleur a été mesurée à l’aide du Premature Infant Pain Profile Revised. Ensuite, les mères et les infirmières ont complété des questionnaires concernant la faisabilité et l’acceptabilité de l’intervention de stimulation olfactive. Des questionnaires auto-administrés remis aux mères (n=11) et aux infirmières (n=20) après l’intervention ont permis de confirmer la faisabilité et l’acceptabilité de l’intervention qui étaient de plus de 80% pour les mères et les infirmières. Les effets observés ont indiqué que plus la compresse imbibée de lait maternel était proche du nez du nouveau-né prématuré plus il semblait y avoir un effet sur la diminution de la réponse à la douleur lors d’un prélèvement sanguin au talon ainsi qu’un retour au calme après le prélèvement plus rapide. L’odeur du lait maternel est une intervention non pharmacologique de soulagement de la douleur qui est peu coûteuse et facilement réalisable par les mères et les infirmières. Les résultats de l’étude pilote confirment la faisabilité et l’acceptabilité de l’intervention et soutiennent la méthodologie d’un essai clinique randomisé à plus large échelle. / Preterm neonates experience many painful procedures during their hospitalisation in the Neonatal Intensive Care Unit (NICU) where heel prick is the most frequent painful intervention. Repeated and untreated pain has long term consequences for preterm neonates. The use of pharmacological and non-pharmacological pain management interventions is limited for preterm neonates. Therefore, it is essential to investigate new pain management interventions such as breast milk odor. This pilot study aimed to evaluate the feasibility and acceptability of an olfactive stimulation intervention to manage procedural pain of preterm neonates, born between 28 and 34 weeks of gestation, during heel prick. A pilot study was conducted with 12 preterm neonates, 11 mothers and 20 nurses in a level III NICU. The study group was familiarised with breast milk odor for nine hours preceding blood sampling. Breast milk odor was combined with standard care during heel prick and pain was measured by the Premature Infant Pain Profile-Revised. Self-reported questionnaires administered to mothers (n = 11) and nurses (n = 20) confirmed the feasibility and acceptability of the intervention, with a proportion of over 80% for both of these items. Observed effect indicated that the closer the compress with the breast milk odor was to the preterm neonates’ nose (n=12), the shorter time to return to baseline after the painful procedure was and the lower the pain score was on the PIPP-R. Breast milk odor is a non-pharmacological pain management intervention which is non-expensive and feasible for mothers and nurses. Findings of this pilot study guide the methodology of a randomized controlled trial.