Det föds drygt 110.000 barn i Sverige varje år och nästan 10% behöver neonatalvård på grund av för tidig födsel eller sjukdom. I denna situation befinner sig föräldrarna i en värld fylld med oro och ovisshet över sitt barns överlevnad och utveckling, vilket kan skapa en kris hos föräldrarna. För att sjuksköterskan i omvårdnaden ska kunna bemöta föräldrar på ett adekvat sätt då deras barn är beroende av sjukhusvård, bör behovet av stöd belysas, vilket var syftet med denna litteraturstudie. Fyra kategorier speglar resultatet för att beskriva olika behov av stöd; Stöd i främmande miljö, Stöd genom att skapa närhet, Stöd genom information och Stöd genom kommunikation och delaktighet. Sjuksköterskans uppmuntran och stöd har betydelse för föräldrars delaktighet i omvårdnaden av deras barn och       därigenom få möjlighet att hantera situationen. För att sjuksköterskan skall kunna förmedla kunskap som är väl beprövad och grundad på vetenskap behövs fortbildning och stöd från ledning och organisation. / About 110.000 children is born in Sweden every year. Almost 10% of the children is in need of neonatal care  because of premature birth or illness. In that situation parents find themselves in a world fild with anxiety and uncertainty about their childs wellbeing and possibility to survive, which can get the parents into a crise. For the nurse to respond to parents in an adequate manner when their child is depended on hospital care, the need for support should be highlighted, which is the aim of this literature review. Four categories reflect the result to describe the various needs of support; Support in an alien world, Support by creating closeness, Support by  information and Support by communication and participation. The nurse’s encouragement and support is important for parent’s participation in the care of their child and gives them a possibility to handle the situation. To be able to give knowledge, that is well proven and based on science, the nurse needs to get further  education and support from management and organization.

Introduction: The past decade has seen a significant shift in the demographics of childbearing in the United States. The average age of women at first birth has steadily increased over the last four decades, with the birth rate for women aged 40-44 more than doubling from 1990 to 2012. The aim of this study was to evaluate the risk of adverse pregnancy outcomes with increasing maternal age and paternal age using national health statistics data. Methods: The study population included 3 495 710 live births among women 15-54+ years of age from the 2012 Natality dataset. Outcomes were modeled for both maternal and paternal 5-year age groups using logistic regression analysis to calculate adjusted and unadjusted odds ratios (AORs, ORs) with 95% confidence intervals. Analysis was performed to examine the association between maternal and paternal age across seven different adverse outcomes, including low birthweight, low Apgar score, early term pregnancies, abnormal newborn conditions and presence of congenital anomalies. Results: The risks for most outcomes paralleled with advanced maternal age and paternal age. Logistic regression models demonstrated that maternal age groups 40-44, 45-49 and 50-54+ were at highest risk for an adverse pregnancy outcome compared to the 30-34 year old reference group. Abnormal newborn conditions including assisted ventilation, NICU admission and use of antibiotics were significant for all age groups 40 and older. Low Apgar score, low birthweight and early term pregnancies were significantly higher among mothers as well as fathers with advanced age. Conclusions: These findings suggest that advanced maternal age is a risk factor for a variety of adverse pregnancy outcomes. Women aged 35-39 have a similar risk of an adverse outcome as their younger counterparts. This suggests that perhaps we should begin assessing high-risk pregnancies as starting at an older age versus the de facto standard of 35.

Darbo tikslas - atskleisti slaugytojų patirtis, dirbant Naujagimių reanimacijos ir intensyviosios terapijos skyriuje. Kokybinio tyrimo klausimas. Kokios yra slaugytojų patirtys, dirbant Naujagimių reanimacijos ir intensyviosios terapijos skyriuje? Tyrimo metodika. Tyrimas atliektas taikant kokybinį fenomenologinį tyrimo metodą. Tyrimo duomenys buvo renkami nuo 2012 metų birželio iki 2012 metų gruodžio mėnesio, Kauno perinatologijos centro Naujagimių reanimacijos ir intensyviosios terapijos skyriuje (NRITS). Tyrime dalyvavo dešimt informantų – slaugytojų, dirbančių NRITS. Informantai buvo pasirinkti tikslinės atrankos būdu. Tyrimo duomenys rinkti individualaus atviro interviu metodu. Kiekvieno interviu trukmė buvo nuo 40 iki 90 min. Visi interviu, tyrimo dalyvėms sutikus, buvo įrašomi į diktofoną. Visi į diktofoną įrašyti interviu buvo iššifruoti t.y. paversti tekstu. Toliau tekste išskirti reikšminiai kodai - kurie buvo sujungti į potemes ir potemės sujungtos į temas. Duomenų analizė buvo atliekama taikant tyrimo duomenų tranguliaciją ir tyrėjų tranguliaciją. Tai leido užtikrinti duomenų patikimumą ir validumą. Įžvalgos. Slaugytojos savo profesiniame darbe NRITS susiduria su stipriais emociniais, vidiniais išgyvenimais ir keliamais klausimais, į kuriuos neturi atsakymų nei tėvams, nei pačios sau. Vienas iš sunkiausių emocinių išgyvenimų yra slaugomo naujagimio mirtis. Slaugytojoms trūksta žinių apie tai, kaip reikia elgtis su mirštančio naujagimio tėvais, todėl nežinodami... [toliau žr. visą tekstą] / Aim of the research: To detect nurses experiences in Neonatal Intensive Care Unit. Qualitative research question. What are nurses’ experiences in Neonatal Intensive Care Unit? Methods of the research. The research was conducted using a qualitative phenomenological method. The data were collected from June 2012 to December 2012, in Kaunas Perinatal Center at Neonatal Intensive Care Unit (NICU). The research involved ten informants - nurses working at NICU. The informants were selected by purposive sampling. Individual open interview method was used for data collection. Each interview lasted from 40 to 90 minutes. All interviews were tipe recorded and transcribed verbatim. While analyzing interviews, researchers noted their interpretations and associations. The identified codes were merged into subthemes and general themes were identified. Data analysis was performed using the data trangulation and researchers‘trangulation. It ensured validity and credibility of this study. Insights. Nurses in their professional work at Neonental Intensive Care Unit face with strong emotional, internal feelings and questions to which they do not have answers. They have answers neither for parents nor for themselves. One of the most difficult emotional experiences is the death of the newborn. Nurses' lack of knowledge about how to deal with the parents at the moment of the death newborn and because of that they do not know what is right, the survey participants think of themselves how they would... [to full text]

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.

This research project investigates the long-term consequences of perinatal exposure to high-fat (HF) on the mesocorticolimbic dopamine (DA) system. Adult offspring of mothers fed a HF diet (30% fat, compared to 5% in control mothers (C)) during the last week of gestation and throughout lactation displayed decreased locomotion in response to an acute amphetamine challenge and decreased behavioral sensitization to repeated amphetamine compared to C animals. These behavioral effects were accompanied by small increases in tyrosine hydroxylase expression in the ventral tegmental area and significant increases in DA and DOPAC content in the NAc, suggesting an elevated DA tone in this target field. In the NAc, there were no significant changes in D1, D2 receptors or DA transporter (DAT) levels between diet groups. The behavioural and biochemical data were collected in adulthood, long after the termination of the diet suggesting that a HF perinatal diet is inducing permanent changes within the DA system and might contribute to the development of metabolic disturbances.

Syftet med denna litteraturstudie var att beskriva vilken aktuell vetenskap som lett till rekommendationen av att administrera sockerlösning till nyfödda barn i smärtlindrande syfte, i samband med hälstick/venpunktion. Litteraturstudien var av kvantitativ, deskriptiv art. Data analyserades med hjälp av Forsberg och Wengströms granskningsmall för randomiserade kontrollerade studier. De studier som granskades i denna uppsats visade genomgående att sockerlösningen har betydelse för smärtlindringen hos det nyfödda barnet som genomgått någon form av procedursmärta. Vad gäller styrkan på sockerlösningarna kunde konstateras att högre styrka gav bättre effekt. Utöver sockerlösningen vidtogs i studierna även andra omvårdnadsmässiga strategier för att reducera stress och smärta. Det är viktigt ur ett sjuksköterskeperspektiv att tänka på att till exempel hålla barnet varmt och bara klä av den extremitet som ska stickas i. Det anses att ett tryggt, lugnt och mätt barn visar mindre smärtreaktioner än ett hungrigt och irriterat. Författarna till denna litteraturstudie anser att man inte bara ska förlita sig på som i det här fallet sockerlösningen i smärtlindringssyfte utan se helheten då planering och eftertanke också är viktiga bitar vid provtagningar av spädbarn. Sockerlösningen skall ses som ett bra komplement i smärtlindringssyfte.

The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.

Thesis (D.P.H.)--University of Hawaii at Manoa, 1994. / Includes bibliographical references (leaves 119-129). / Microfiche. / x, 129 leaves, bound 29 cm

The overall aim of this thesis was to investigate pregnancy and childbirth in women with intellectual disability (ID), in Sweden, the health of their newborns and midwifery care for these women. Two register studies and two descriptive studies are included. Pregnancy and birth outcomes as well as data on the newborns’ health were examined by linking data from the National Patient Register and the Medical Birth Register (I-II). The women’s experience of pregnancy and delivery was investigated with repeated interviews (III). Midwives’ knowledge of, experience of and attitudes towards pregnancy and childbirth in women with ID were evaluated with questionnaires (IV). Mothers with ID were more often teenagers, smoked more during pregnancy and had more Caesarean Sections. Their children had a higher proportion of pre-term births, were small-for-gestational-age, stillborn or died in the perinatal period. The women with ID struggled to attain motherhood and feared to lose custody of the child. The pregnancy was seen as a happy event, even though relatives did not always approve. Parent education was considered important, but not adequately adapted to their needs. The birth process was overwhelming and difficult to understand, but the child was welcomed with warm feelings, and breastfeeding was natural. Midwives stated it was different to care for women with ID and requested additional knowledge. The majority of midwives affirmed that women with ID could not manage the mother role satisfactorily, and one-third expressed that women with ID should refrain from having children. A majority of the midwives considered that the children should grow up with the parents with support from family and society, but one out of five stated that the children should grow up in foster care. Conclusion: Women with ID and their children should be considered as risk groups in pregnancy and childbirth. Professionals in maternity services need to elucidate their knowledge and skills for counselling and supporting this particular group of pregnant women in pre-, intra- and post-partum care.

In order for animals to experience pain and to suffer from it, they have to be capable of conscious perception. Recent evidence suggests that the fetus is maintained in a sleeplike unconscious state and that conscious perception therefore only occurs after birth. The timing of the onset of conscious perception depends on the maturation of underlying neurological processes and is anticipated to be species dependent. Painspecific electroencephalographic (EEG) responses of lightly anaesthetised young of three species born at different levels of neurological development were investigated. The results of the present thesis are in agreement with published data on general neurological, EEG and behavioural development. This information, in addition to the present results, has been used to estimate the approximate time of the onset of conscious perception in tammar wallaby joeys, rat pups and newborn lambs. In wallaby joeys (extremely immature at birth), the EEG remained isoelectric until about 100-120 days of in-pouch age and became continuous by about 150-160 days, with electroencephalographic and behavioural signs of conscious perception apparent by about 160-180 days. In rat pups (immature at birth), the absence of a differentiated EEG suggests that the ability for conscious perception in pups younger than 10-12 days is doubtful. The marginal EEG responses to noxious stimulation in 12-14 day-old pups and the pronounced EEG responses in pups 18-20 days suggest that rats may be capable of conscious perception from 12-14 days onwards. In lambs (mature at birth), full conscious perception is probably not apparent before 5 minutes after birth and may take up to several hours or days to become fully established. Its modulation by the residual neuroinhibitor allopregnanolone, if that occurs, would be highest over the first 12 hours after birth. Overall, the onset of conscious perception does not seem to follow an “on-off phenomenon”, but seems to develop gradually, even in species born neurologically mature. Although conscious perception, and hence pain experience, may be qualitatively different in younger animals, on the basis of the precautionary principle, when significantly invasive procedures are planned, pain relief should be provided from those postnatal ages when pain may first be perceived – i.e. from about 120 days in the tammar wallaby joey, about 10 days in the rat pup and from soon after birth in the lamb.