Thesis (MEng) -- Stellenbosch University, 2014. / ENGLISH ABSTRACT: The thermal regulation response of a neonate has to maintain temperature homeostasis, thus resisting the changes to core temperature caused by the unstable external environment. In this thesis a theoretical thermal regulation response model for human infants subject to a well-defined environment is presented. This model will aid in understanding the influences of environmental effects on core and skin temperature. The respiratory system was also included in the thermal regulation response model. A literature study was undertaken emphasising thermal regulation of neonates. The blood circulation system, skin tissue physiology and the respiratory system physiology were reviewed and helped to provide a better understanding of the thermal regulation mechanisms and how heat transfer theory can be used to analyse heat loss in neonates. The thermal heat transfer properties of skin tissue was specified and used in the development of the theoretical simulation model. The bioheat equation developed by Pennes was reviewed as well as a mathematical model developed by Fiala et al. The theoretical model was developed by applying the conservation of energy and the applicable properties to one dimensional layers to generate a set of time dependent differential equations. The set of equations was solved using an explicit numerical finite difference method, given the initial conditions. The mathematical model included heat loss through the skin, heat loss through the respiratory system, as well as the effect of environments (in incubator or in a bassinette) with different temperatures, relative humidity’s and air velocities. Clothing was also incorporated. A clinical trial was conducted to facilitate a better understanding of thermal stability in neonates. The data acquired during the clinical trial was also used to verify/validate the theoretical simulation model. The results from the simulation temperatures were compared with the average outer skin layer temperature measured during the clinical trial and an average deviation of only 0.22 °C was found, thereby proving that the simulation model gives realistic results. An experimental respiratory model was designed to simulate the respiratory system and illustrate the functioning thereof with regards to heat transfer. This was done by designing an experimental mechanical lung apparatus. The apparatus was tested and successfully imitated the respiratory system with regards to heat transfer. The results obtained from this experiment indicated that the trachea must be moistened continuously in order to condition inhaled air. The outcome of this project identified two possible applications. For the first application it can be used as a test tool for quickly evaluating the influence of different environmental conditions in the transient temperature distribution of neonates. The second application would be to enable medical professionals to monitor the influence of the thermal environment, including the temperature, relative humidity and air velocity, on the neonate’s temperature change to allow for a speedier thermal intervention strategy. / AFRIKKANSE OPSOMMING: Die hitte regulering reaksie van 'n pasgebore baba moet temperatuur homeostase handhaaf, en sodoende die veranderinge aan die kern temperatuur weerstaan wat veroorsaak word deur ‘n onstabiele eksterne omgewing. In hierdie tesis word 'n teoretiese hitte regulerings reaksie model vir menslike babas, onderhewig aan 'n goed-gedefinieerde omgewing, aangebied. Hierdie model sal help met die verstaan van die invloed wat omgewings effekte het op die kern en vel temperatuur. Die respiratoriese sisteem is ook ingesluit in die hitte regulering reaksie model. 'n Literatuurstudie is onderneem met die klem op hitte regulering van pasgebore babas. Die bloed sirkulasie sisteem, vel weefsel fisiologie en die respiratoriese sisteem fisiologie is hersien en help met beter begrip van die hitte regulering meganismes en hoe hitteoordrag teorie kan gebruik word om hitte verlies in pasgebore babas te analiseer. Die hitte-oordrag eienskappe van vel weefsel is gespesifiseer en word gebruik in die ontwikkeling van die teoretiese simulasie model. Die ‘bioheat’ vergelyking ontwikkel deur Pennes is hersien asook 'n wiskundige model wat ontwikkel is deur Fiala et al. Die teoretiese model is ontwikkel deur die toepassing van die behoud van energie tesame met die gebruik van toepaslike eienskappe en een dimensionele lae om 'n stel tyd afhanklike differensiaalvergelykings op te wek. Die stel vergelykings is opgelos met behulp van 'n eksplisiete numeriese eindige verskil metode, gegewe die aanvanklike toestande. Die wiskundige model sluit in die hitte verlies deur die vel, hitte verlies deur die respiratoriese stelsel, sowel as die effek van die omgewing (broeikas of in 'n bassinette) met verskillende temperature, relatiewe humiditeit en lug snelhede. Klere is ook in ag geneem. 'n Kliniese proef is gedoen om 'n beter begrip van termiese stabiliteit in pasgebore babas te fasiliteer. Die data wat tydens die kliniese proef verhaal is, is ook gebruik om die die teoretiese simulasie model te verifieer. Die resultate van die simulasie temperature is vergelyk met die gemiddelde buitenste vel laag temperatuur gemeet tydens die kliniese proef en 'n gemiddelde afwyking van slegs 0.22 °C is gevind, wat dus bewys dat die simulasie model realistiese resultate gee. 'n Eksperimentele respiratoriese model is ontwerp om die respiratoriese stelsel te simuleer en die funksionering daarvan te illustreer met betrekking tot hitte-oordrag. Dit is gedoen deur die ontwerp van 'n eksperimentele meganiese long apparaat. Die apparaat is getoets en slaag daarin om die respiratoriese stelsel suksesvol na te boots met betrekking tot hitteoordrag. Die resultate verkry uit hierdie eksperiment het aangedui dat die tragea kostant klam gemaak moet word om ingeasemde lug te kondisioneer. Die uitkoms van hierdie projek het twee moontlike toepassings geïdentifiseer. Die eerste is dat dit as 'n toets instrument vir die vinnige evaluering van die invloed van verskillende omgewingsfaktore in die temperatuur verspreiding van pasgebore babas gebruik kan word. Die tweede toepassing sal wees om medici in staat te stel om die invloed van die termiese omgewing te monitor, insluitend die temperatuur, relatiewe humiditeit en lug snelheid, om die neonaat se temperatuur verandering te monitor en voorsiening te maak vir 'n vinniger verwarmings intervensiestrategie.

published_or_final_version / Social Work / Master / Master of Social Work

Ample research has been found to suggest that there is no substitute, either nutritionally or emotionally, that can replace the benefits of human milk for human infants. Despite this recognition, the attitude still exists that infant formula is a reasonable alternative. The American Academy of Pediatrics (AAP), World Health Organization (WHO), and United Nation Children's Fund (UNICEF) share policy statements endorsing human milk as the optimal infant nutrition for the first 15 months. Accordingly, WHO and UNICEF launched The Baby-friendly Hospital Initiative established in 1991 to protect, promote, and support breastfeeding. Despite this unilateral support of breastfeeding, nursing and physician educational curriculums do not include lactation education, which limits the knowledge of those who provide care to the mother and newborn dyad. The purpose of this project is to promote staff lactation education and training on the infant feeding practices by encouraging breastfeeding in a hospital setting. This project includes lactation education and hands-on training for staff. A 20-hour didactic lactation education course will meet the requirements to ensure that staff training will assist in supporting patients with the early initiation of breastfeeding. Furthermore, training will include clinical competencies to evaluate the knowledge, practice patterns, and confidence of the staff. Lactation education for providers will be provided through an online course designed to improve their ability to support breastfeeding among their patients. The result of this project will assist hospital leadership to determine specific education and training for staff in increasing exclusive breastfeeding rates among their patient population.

The present study was undertaken to explore the relationship of cellular immunity to total serum ICE in an unselected sample of 278 healthy infants. Statistical analyses of infant history profiles and cellular immune and serum IgE determinations from cord blood and 10 month samples were performed using SPSSx. During the first year of life, the percent CD3, CD4, CD8, ERFC, and B-cell counts significantly increased and the CD4/CD8 ratio and responses to ConA and PW mitogens significantly decreased. Boys had lower percent CD8 cell counts and decreased responses to ConA and PW mitogens in cord blood. Cellular immune variable values were not associated with total serum ICE in any analysis. Early feeding method had no effect on 10 month serum IgE levels or cellular immune variables. Cord blood percent CD3 and CD4 cell counts were significantly decreased in infants with parental histories of asthma. In summary, (1) boys had a lower percent of suppressor T-cells and lower mitogen responses in cord blood (2) boys and girls reached similar levels for all variables by 10 months of age (3) infants with familial histories of asthma had fewer total and helper T-cells in cord blood.

One of the most effective immunological interventions for human disease prevention is the administration of anti-red blood cell (RBC) IgG, more specifically, anti-D IgG, for prevention of hemolytic disease of the fetus and newborn (HDN), a serious and potentially fatal condition caused by the maternal immune response against the Rhesus (Rh) blood group system D antigen on fetal RBC. Despite its widespread clinical use, the mechanism of the suppressive anti-RBC IgG effect is not fully understood. In a murine model of immunity to foreign RBCs, transfusion of mice with IgG-opsonized RBCs strongly attenuated the antibody response compared to transfusion of untreated RBCs. This model was used to study the anti-RBC IgG effect on the host immune response. Contrary to the predominant theories of the anti-D effect, here it is shown that IgG-mediated RBC clearance is not sufficient for the attenuation of antibody responses. IgG-opsonized RBCs internalized by the mononuclear phagocytic cells could stimulate T and B cell responses against RBC antigens. This thesis also shows that the adaptive tolerance at the T or B cell level is not the reason for the attenuation of the antibody response. Instead, IgG selectively prevented the appearance of antigen-primed RBC-specific B cells and, surprisingly, induced the host B cell response against the IgG in complex with RBCs. These results suggest that the inability of RBC-specific B cells to recognize and present RBC-specific epitopes may explain the inhibitory IgG effect.

Tyrimo tikslas: Ištirti pirmą kartą gimdžiusių moterų žinias apie žindymą. Tyrimo uždaviniai: 1. Palyginti moterų, gimdžiusių KMUK ir Kauno P. Mažylio gimdymo namuose, žinias apie žindymą. 2. Nustatyti pirmą kartą gimdžiusių moterų, informacijos apie žindymą šaltinius nėštumo metu. 3. Nustatyti pirmą kartą gimdžiusių moterų informacijos apie žindymą šaltinius po gimdymo, ligoninėje. Tyrimo metodai: Tyrimas buvo atliekamas 2009 rugpjūčio - spalio mėnesiais KMUK Akušerijos skyriuje ir Kauno P. Mažylio gimdymo namuose. Tyrime dalyvavo 146 respondentės. Naudota specialiai šitam darbui sukurta anketa. Išvados: 1. Lyginant KMUK ir Kauno P. Mažylio gimdymo namuose gimdžiusių moterų žinias apie žindymą nustatyta, kad reikšmingai didesnė dalis Kauno P. Mažylio gimdymo namuose gimdžiusių moterų, žinojo apie motinos pieno sudėtį ir reikšmingai didesnė dalis moterų gimdžiusių KMUK žinojo, jog pabrinkus krūtims, ji turėtų dažniau žindyti kūdikį (p < 0,05).Hipotezė, kad didesnė dalis moterų gimdžiusių KMUK, lyginant su Kauno P. Mažylio gimdymo namuose gimdžiusiomis, nurodo teisingus atsakymus į klausimus apie žindymą nepasitvirtino. 2. Reikšmingai didesnė dalis moterų, turinčių aukštąjį universitetinį išsimokslinimą pasirinko teisingus atsakymų variantus, kad motinos piene pakanka vandens, žindyvei pastoti yra maža tikimybė ir prieš žindymą reikia nutraukti truputį pieno, jei moters krūtys yra prisipildžiusios (p < 0,05). Hipotezė, jog pirmą kartą gimdžiusios moterys, turinčios... [toliau žr. visą tekstą] / Aim of the Study: To analyze the first-time mothers knowledge about breast-feeding. Objectives: 1. To compare the first-time mothers knowledge about breast-feeding who gave birth at Kaunas University Hospital and at Maternity Home of P. Mažylis’. 2. To identify the sources of information about breast-feeding for the first-time mothers during the period of their pregnancy. 3. To identify the sources of information about breast-feeding for the first-time mothers after childbirth at the hospital. Methods: The research was performed during the period from August till October in 2009 at the Department of Obstetrics of the Kaunas University Hospital and at Maternity Home of P. Mažylis’. 146 respondents participated in the research. A special questionnaire was used for this research. Conclusions: 1. After comparing woman knowledge’s about breast-feeding was established that significantly more women having given birth at the Maternity Home of P. Mažylis’ knew the composition of mothers milk (p<0.05), and significantly more women having given birth at Kaunas University Hospital knew that in case of breast engorgement they should breast-feed more often (p<0.05). The hypothesis that the larger part of the women who gave birth at of Kaunas University Hospital knew the right answers to the questions about breast-feeding, compared to the women who gave birth at Maternity Home of P. Mažylis’, was not confirmed. 2. A significantly more women having higher university education choose... [to full text]

La dysplasie bronchopulmonaire (DBP) constitue la principale séquelle respiratoire de la prématurité. Elle est caractérisée par des altérations du développement alvéolaire et est définie cliniquement par la persistance d'une oxygénodépendance à 36 semaines d'âge corrigé. Malgré l'amélioration constante des soins en néonatologie, la DBP reste relativement fréquente chez les prématurés de moins de 1000g, et aucun traitement préventif ou curatif véritablement efficace n'existe à l'heure actuelle. Une susceptibilité génétique à la DBP a été démontrée il y quelques années. L'identification de gènes de susceptibilité permettrait non seulement de mieux comprendre la physiopathologie de cette maladie, mais également de dégager de nouvelles pistes thérapeutiques. Les études disponibles sont basées sur une approche gène candidat, le plus souvent sur un nombre limité de sujets, et aucune d'entre elles n'a pu être répliquée dans d'autres populations. Nous avons donc décidé de réaliser une étude d'association pan-génomique à la recherche de gènes de susceptiblité à la DBP.Cette étude multicentrique a permis la constitution prospective d'une base de données cliniques et biologiques et d'une banque d'ADN de nouveau-nés prématurés de moins de 28 SA. L'étape de screening pan-génomique a été réalisée par une stratégie de DNA pooling dans deux populations ethniques différentes, et la validation par génotypage individuel dans deux populations de réplication. Les gènes sélectionnés ont ensuite été étudiés au cours du développement pulmonaire chez le rat.L'ensemble de la démarche pan-génomique a permis d'identifier un gène majeur, commun à l'ensemble des populations étudiées: SPOCK2. Notre étude a également permis d'identifier MMP16 comme gène de susceptibilité à partir des premiers résultats du DNA pooling dans la population caucasienne. L'étude de ces deux gènes au cours du développement pulmonaire chez le rat nous oriente fortement vers un rôle au cours du développement alvéolaire, avec un pic d'expression au cours de l'alvéolisation et une altération de cette expression dans le modèle hyperoxie. De plus, SPOCK2 et MMP16 appartiennent à une voie de signalisation commune, ce point renforçant fortement la crédibilité du rôle de ces gènes dans la susceptibilité à la DBP. Le rôle exact de ces gènes dans l'alvéolisation et la DBP reste à déterminer ainsi que les conséquences fonctionnelles potentielles des polymorphismes identifiés. Parallèlement, la collecte de nouveaux échantillons d'ADN chez des anciens prématurés ainsi que la collaboration avec des équipes étrangères permettra de poursuivre les études d'association dans des populations de plus en plus importantes / RationaleBronchopulmonary dysplasia is the most common chronic respiratory disease in prematureinfants. Genetic factors might contribute to bronchopulmonary dysplasia susceptibility.ObjectivesTo identify genetic variants involved in bronchopulmonary dysplasia through a genome-wideassociation study.MethodsWe prospectively evaluated 418 premature neonates (gestational age below 28 weeks), ofwhom 22% developed bronchopulmonary dysplasia. Two discovery series were created, usinga DNA pooling strategy in neonates from Caucasian and African ancestry. Polymorphismsassociated with the disease were confirmed in an independent replication population. Geneswere then explored by fine mapping and associations were replicated in an external Finnishpopulation of 213 neonates. Validated genes expression patterns were studied in rat lung,following air or hyperoxia exposure.Measurements and Main ResultsSPOCK2 gene was identified by both discovery series. The most significant polymorphism(rs1245560, p=1.66x10-7) was confirmed by individual genotyping, and in the replicationpopulation (p=0.002). Fine mapping confirmed the association of rs1245560 withbronchopulmonary dysplasia in both Caucasian and African populations with adjusted oddsratios of 2.96 (95% CI [1.37-6.40]) and 4.87 [1.88-12.63] respectively. In Caucasian neonates,rs1049269 was also associated with the disease (OR=3.21 [1.51-6.82]). These associationswere replicated in the Finnish population. In newborn rat lungs, SPOCK2 mRNA levelsmarkedly increased during the alveolar stage of lung development. After rat exposure tohyperoxia, SPOCK2 expression increased relative to air-exposed controls

Diploma thesis deals with historical formation of neonatal intensive care in the Czech Republic. Its aim is to map the evolution of intensive care, from the very beginning up to the contemporary period, and provide a concise overview of events leading to Czech Republic being one of the countries where level of neonatal care is considered to be most advanced. Theoretical nature of the thesis required a study of historical and contemporary literature, particurarly artticles and books. As an extra supplement, authentic information have been gathered from the pathfinders. In the introduction to the thesis, reason for choosing the topic is described, then current status of knowledge in this area is summarized. Following that, process of creating of the historical analysis is described. Chapter on neonatology introduces and explains terms that are crucial for comprehending the context stated in the historical part of the thesis. Chapter which maps the historical evolution itself is divided into seven sub chapters which describe course of events in the particular periods. Evolution of perinatal care abroad is also shortly described. Thesis reviews an extraordinary evolution of neonatal intensive care which has occurred in very short period of time. During this period pioneers had to overcome many hurdles,...

Os valores de glicemia considerados fisiológicos em recém-nascidos, assim como os valores considerados patológicos, levando a danos no sistema neurológico, são bastante debatidos na literatura e há pouco consenso. O objetivo deste trabalho foi analisar a glicemia de 172 recém-nascidos adequados para a idade gestacional, a termo e em aleitamento materno exclusivo, no primeiro dia de vida, através de monitor contínuo de glicemia intersticial, que registra a glicemia a cada 5 minutos. O aparelho foi retirado após 24 horas e os resultados foram analisados em programa de computador. A amostra apresentou glicemia média de 66,6 mg/dl logo após o nascimento, com redução até a sexta hora de vida, com o valor de 53,7 mg/dl. Apenas na decima quarta hora de vida, a glicemia voltou a atingir valores entre 60 e 70 mg/dl. A média da glicemia dos recém-nascidos, durante o primeiro dia de vida, foi de 60,1 mg/dl (+/- 8,3). Da amostra, 63,9% apresentou uma ou mais medidas iguais ou menores que 50 mg/dl, 16,3% apresentou uma ou mais medidas iguais ou menores que 40 mg/dl; 4,6% apresentou uma ou mais medidas iguais ou menores que 30 mg/dl e 1,2% apresentou uma ou mais medidas iguais ou menores que 20 mg/dl. Os resultados mostraram um padrão de glicemia para essa casuística, com glicemia que cai rapidamente do nascimento até a sexta hora de vida e volta a subir até a decima quinta hora, ao atingir um valor que permanece estável até o final do dia. Este estudo permitiu elaborar uma curva de evolução dos valores de glicemia intersticial, com média e dois desvios padrões acima e abaixo. A porcentagem de recém-nascidos com a glicemia igual ou abaixo de 40 mg/dl, nesse estudo, comparada a outros estudos utilizando dosagem intermitente, mostrou que a monitorização contínua é capaz de detectar maior ocorrência de valores abaixo de 40 mg/dl. Recém-nascidos com valores de glicemia igual ou abaixo de 30 mg/dl estão abaixo da curva de normalidade traçada nesse estudo e devem, posteriormente, serem estudados em estudo prospectivo. A curva de evolução dos valores de glicemia pode contribuir para o estabelecimento de padrão de valoresglicêmicos durante as primeiras 24 horas de vida em recém-nascidos nascidos a termo, adequados a idade gestacional e sem agravos no período neonatal. / The values of glycemia that are considered physiological in neonates, as well as those considered pathological (that is, leading to damages in the neurological system) are widely debated in literature, and there is little consensus. The objective of this study was to analyze the glycemia of 172 appropriate for gestational age term newborns, who were exclusively breastfed, on the first day of life, through a continuous glucose monitoring device, which calculates interstitial glycemia every 5 minutes. The device was removed after 24 hours, and the results were analyzed in a computer program. The sample had a mean glycemia of 66.6 mg/dl shortly after birth, with a reduction until 6 hours of life, reaching a value of 53.7 mg/dl. At only 14 hours of life, the blood glucose returned to values between 60 and 70 mg/dl. The mean blood glucose of the newborns during the first day of life was 60.1 mg/dl (+/- 8.3). 63.9% of the sample had one or more values of glycemia equal to or lower than 50 mg/dl, 16.3% had one or more values equal to or lower than 40 mg/dl. 4.6% had one or more values equal to or lower than 30 mg/dl and 1.2% had one or more values equal to or lower than 20 mg/dl. The results present the glycemia pattern considered physiological for this sample, with glycemia that falls rapidly from birth up to 6 hours of life and goes back up to 15 hours, reaching a value that remains stable until the end of the first day. This study allowed the development of an evolution curve of interstitial glycemia values, with mean and two standard deviations above and below it. The percentage of newborns with glycemia at or below 40mg/dl in this study, compared to other studies using intermittent dosing, showed that continuous monitoring is able to detect a higher occurrence of values below 40 mg/dl. Newborns with blood glucose values equal to or lower than 30 mg/dl are below the normality curve plotted in this study and should be further studied in a prospective study. The evolution curve of the glycemia values may contribute to the establishment of glycemic values during the first 24 hours of life in term newborns who are appropriate for gestational age and didn\'t present any conditions in the neonatal period.

A research thesis submitted for the degree of Doctor of Philosophy in Audiology in the Faculty of Humanities the University of the Witwatersrand March 2016. / Purpose: The main objective of the current study was to explore risk-based new-born hearing screening within a developing country by conducting early hearing detection in high-risk neonates within an academic hospital complex in Gauteng, South Africa. Specific objectives describing the case history factors and audio logical function in a group of high-risk determining the relationship between the case history factors and audio logical establishing the true-positive (TP) and true-negative (TN) results with different combinations of screening measures; establishing the percentage of TP and NT screening results in the total sample; and exploring the factors associated with follow-up return rate for hearing screening and diagnostic audio logical assessment. / GR2017