Orientador: Simone Biagio Chiacchio / Coorientador: Maria Lucia Gomes Lourenço / Banca: Wilson Roberto Fernandes / Banca: Roberto Calderon Gonçalves / Resumo: A avaliação clínica dos recém-nascidos, bem como a definição da conduta terapêutica adotada, representam expressivos desafios ao Médico Veterinário. O objetivo deste estudo foi descrever os padrões de vitalidade e bioquímica neonatal em equinos da raça Paint Horse nascidos em eutocia nas primeiras 48 horas de vida. Foram avaliados 20 neonatos, ao nascimento e 10 minutos após o parto pelo escore de Apgar modificado. As avaliações laboratoriais (hemogasometria, eletrólitos, lactato, glicemia e cortisol) e eletrocardiográficas foram realizadas imediatamente após o parto (M0) e as quatro (M1), oito (M2), 12 (M3), 16 (M4), 20 (M5), 24 (M6), 36 (M7) e 48 horas (M8) após o nascimento. No escore de Apgar, observou-se diferença estatística entre os momentos analisados (p< 0,001), sendo a média ao nascimento, 7,80 ± 0,89 e 10 minutos após, 8,35 ± 0,99. Durante as 48 horas pós-parto, a temperatura corporal apresentou elevação progressiva. Os parâmetros laboratoriais como o lactato, sódio, potássio, glicose, ânion gap e cortisol alteraram-se significativamente nos momentos analisados. Não foram encontradas diferenças estatísticas entre as variáveis hemogasométricas. No traçado eletrocardiográfico, notou-se diminuição progressiva da duração do intervalo QT e da amplitude e duração da onda T. Em conclusão, potros neonatos apresentaram alterações eletrolíticas, bioquímicas e eletrocardiográficas significativas durante as primeiras 48 horas de vida, sendo os parâmetros propostos adequados para a avaliação da vitalidade neonatal. A ocorrência comum de anormalidades clínicas e laboratoriais em potros recém-nascidos aparentemente saudáveis sublinha a necessidade da realização de exames clínicos regulares e valores laboratoriais de referência, em diferentes idades. Os dados encontrados subsidiam os aspectos fundamentais sobre a fisiologia neonatal e a variabilidade dos parâmetros clínicos, em potros em ... / Abstract: Clinical evaluations of newborns, as well as defining the therapeutic decision, represent significant challenges to the veterinarian. The aim of this study was to describe the patterns of neonatal vitality and biochemistry in horses breed Paint Horse eutocia born in the first 48 hours of life. 20 neonates at birth and were evaluated 10 minutes after delivery with Apgar modified. Laboratory (blood gas, electrolytes, lactate, glucose and cortisol) and electrocardiographic evaluations were performed immediately after birth (M0) and four (M1), eight (M2), 12 (M3), 16 (M4), 20 (M5 ), 24 (M6) 36 (M7) and 48 hours (M8) after birth. At Apgar score, there was statistical difference between the analyzed time points (p <0.001), with an average at birth, 7.80 ± 0.89, and 10 minutes, 8.35 ± 0.99. During the 48 hours postpartum, body temperature showed a progressive increase. Laboratory parameters such as lactate, sodium, potassium, glucose, anion gap and cortisol changed significantly in the time points analyzed. No statistical differences were found between blood gas parameters. In the electrocardiogram, there was progressive decrease in QT interval duration and the amplitude and duration of the T wave In conclusion, neonatal foals showed significant electrolyte, biochemical and electrocardiographic changes during the first 48 hours of life, with the appropriate parameters for proposed assessment of neonatal vitality. The common occurrence of clinical and laboratory abnormalities in apparently healthy newborn foals emphasizes the need to conduct regular clinical examinations and laboratory reference values at different ages. The data found subsidize the fundamental aspects of neonatal physiology and the variability of the clinical parameters in foals eutocia and serve as a basis for clinical decision making in cases of dystocia / Mestre

Orientador: Cristina Maria Garcia de Lima Parada / Banca: Maria Antonieta de Barros Leite Carvalhaes / Banca: Maria Luiza Gonzales Riesco Bellini / Resumo: Evidências recentes têm indicado diferenças relevantes entre os nascidos de termo, quando se consideram as cinco semanas que compõem esse período. Assim, foi proposta a divisão do termo em três categorias: termo precoce ("early term"), entre 37 semanas e 38 semanas e 6 dias; termo completo ("full term"), entre 39 semanas e 40 semanas e 6 dias e termo tardio ("late term"), entre 41 semanas e 41 semanas e 6 dias. Considerando-se a importância desta questão para a prática clínica propôs-se a realização do presente estudo, que teve por objetivo geral analisar as condições de nascimento e comparar desfechos neonatais de recém-nascidos de termo nascidos em maternidade de médio porte do interior paulista nos anos de 2011 e 2012. Trata-se de estudo epidemiológico transversal, de caráter analítico, que utilizou dados secundários de 2455 nascimentos. Dados sociodemográficos e obstétricos foram obtidos para caracterização das mães. Entre as variáveis dependentes foram incluídas: estatura, peso, perímetro cefálico e o Índice Ponderal de Röhrer. Variáveis indicativas de sua condição no período neonatal, como índice de Apgar, intercorrências, necessidade de reanimação ou transferência para serviços de maior complexidade e condições no momento da alta também foram obtidas. Foram utilizadas duas estratégias de análise: na primeira, a variável independente, idade gestacional, foi tratada de forma estratificada (37-38/39-41 semanas completas) e, na segunda, de forma contínua. Na análise estatística, a comparação das características maternas foi realizada a partir do teste Qui quadrado. A comparação entre recém-nascidos dos dois estratos gestacionais em relação às variáveis dependentes foi realizada pelos testes Mann-Whitney ou Qui-quadrado. A chance de ocorrência dos desfechos em função da idade gestacional foi obtida por regressão logística múltipla ... / Abstract: Recent evidences have indicated relevant differences between babies who are born at term, that is, when it is considered the five weeks that make up this period. Thus, the division of the term was proposed to fit into three categories: early term, between 37 weeks and 38 weeks and 6 days; full term, between 39 weeks and 40 weeks and 6 days and late term, between 41 weeks and 41 weeks and 6 days. Considering the importance of this issue for the clinical practice, we intended to accomplish the present study, which aimed to analyze the conditions of birth and compare the neonatal outcomes of newborns at term in midsized maternities, in the countryside of the state of São Paulo - Brazil, from 2011 and 2012. This regards across-sectional epidemiological study, which has an analytical approach, and used secondary data of 2455 births. Socio-demographic and obstetrical data were obtained, in order to characterize the mothers. Among the dependent variables we included: height, weight, head circumference and the Röhrer's Ponderal Index. Significant variables of the babies' condition in the neonatal period, such as Apgar's index, complications, need for resuscitation or transfer to more complex services and their conditions, when babies are discharged, were also obtained. Two strategies of analysis were used: in the first, the independent variable, gestational age, was handled in a stratified way (37-38\/39-41 full weeks) and in the second, continuously. In statistical analysis, the comparison of maternal characteristics was performed from the Chi-square test. The comparison between newborns of both gestational strata in relation to the dependent variables was conducted by Mann-Whitney or the Chi-square tests. The chance of occurrence of outcomes according to the gestational age was obtained by multiple logistic regression, correcting the effect of the demographic variables, gestational history and current pregnancy. In all the analyses, ... / Mestre

Resumo: O objetivo do trabalho foi avaliar a eficácia de protocolos terapêuticos na abordagem clínica e laboratorial de cordeiros prematuros para estimular a atividade respiratória. Constituíram-se quatro grupos: grupo I (n=6): cordeiros sem tratamento; grupo II (n=9): cordeiros cujas mães receberam dexametasona pré-parto; grupo III (n=6): cordeiros tratados com surfactante; e grupo IV (n=6): cordeiros cujas mães receberam dexametasona pré-parto e tratados com surfactante. Foi realizada avaliação física, termográfica, radiográfica e espirométrica dos animais após o nascimento (M0), aos 15 minutos (M1/4), à uma (M1), às seis (M6), às 12 (M12), às 24 (M24) e às 48 horas de vida (M48). Amostras sanguíneas foram colhidas para realização de hemogasometria, hemograma, perfil funcional hepático e renal, glicemia, lactatemia e determinação sérica de cortisol e insulina. Após o nascimento até o M48, os cordeiros apresentaram pH baixos, associados à alta pCO2 e elevação de HCO3. Houve diminuição na contagem de He, VG, VCM e Hb nas primeiras 48 horas. A concentração sérica de creatinina diminuíu até o M48. Ocorreu aumento do lactato até o M1, seguido por diminuição até o M48. Os cordeiros prematuros apresentaram baixa vitalidade e comprometimento na função pulmonar. A utilização do surfactante deve ser realizada em conjunto com a administração de dexametasona materna pré-parto. As variações no hemograma e no perfil bioquímico são fisiológicas. A termografia pode ser utilizada para análise e monitoramento da temperatura corporal. / Abstract:The objective was to evaluate the efficacy of different therapeutic protocols in clinical and laboratory approach of premature lambs to stimulate respiratory activity. Four groups were formed: group I (n=6) included lambs without treatment; group II (n=9) included lambs born to mothers that were treated with dexamethasone antepartum; group III (n=6) included lambs treated with surfactant; and group IV (n=6) included lambs treated with surfactant and born to mothers that were treated with dexamethasone antepartum. Physical, thermal, radiographic and spirometric evaluation were performed after birth (T0), 15 minutes later (T15), one hour (T1), six hours (T6), 12 hours (T12), 24 hours (T24) and 48 hours after birth (T48). Blood samples were taken at the same time to perform blood gas analysis, liver and renal profile, blood glucose, blood lactate and serum concentration of insulin and cortisol. After birth to T48, all the lambs showed low pH values, which were associated with high pCO2 values and HCO3 . There was a decrease in RBC, HCT, MCV and HGB in the first 48 hours. Creatinine serum concentrations was decreased to the T48 . There was an increase of lactate to the T1, with a reduction to the T48. Premature lambs showed low vitality and impaired pulmonary function. The use of surfactant should be performed in combination with maternal antepartum dexamethasone administration. Changes in blood count and biochemical profile are physiological variations. Thermal imaging can be used for analysis and monitoring of temperatures. / Orientador:Luiz Cláudio Nogueira Mendes / Banca:Flávia de Almeida Lucas / Banca:Alexandre Secorun Borges / Banca:Guilherme de Paula Nogueira / Banca: Fernando José Benesi / Doutor

D.L. A 790-2008

Dissertation (Ph.D.)--University of South Florida, 2008. / Title from PDF of title page. Document formatted into pages; contains 154 pages. Includes vita. Includes bibliographical references.

Thesis (Ph.D.)--RAND Graduate School, 2007. / Includes bibliographical references.

MCur / Department of Advanced Nursing Science / See the attached abstract below

La Communauté française décide en concertation avec la Région bruxelloise et la Région wallonne, de financer un Centre d’Epidémiologie Périnatale (CEpiP). Les Communautés et Régions chargent le CEpiP de les assister dans la vérification, le remplissage et la correction des certificats concernant les naissances à partir du 1er janvier 2008. Le CEpiP est également chargé d’encoder les certificats bruxellois, les certificats wallons étant toujours encodés par un sous-traitant.<p>Un problème souvent rencontré dans l’analyse des certificats de naissance est la présence de données manquantes. Des informations manquaient sur 64.0% des certificats bruxellois de janvier 2008 (situation de base). Le renforcement de l’enregistrement par le CEpiP durant l’année 2008 est lié à une diminution des informations manquantes sur les certificats initiaux (à la sortie des maternités et services d’état civil) après la première et la deuxième année d’enregistrement :20,8% et 19,5% des naissances en décembre 2008 et 2009 respectivement. Le taux résiduel de données manquantes après correction grâce aux listes envoyées aux maternités et services d’Etat civil est faible. En particulier, la nationalité d’origine des parents était souvent manquante, jusqu’à 35% à Bruxelles (données non publiées), et ce taux est passé à 2.6% en 2008 et 0.1% en 2009. Certaines données manquantes ne sont pas distribuées de façon équivalente selon la nationalité de la mère, même après correction. Les mères d’origine sub-saharienne ont les taux de remplissage les moins élevés. Enfin, le taux de mort-nés a augmenté par rapport aux données de 2007, au profit des mort-nés avant l’âge de 28 semaines, et suggère une amélioration de l’enregistrement suite au renforcement de l’information.<p>Les données concernant l’indice de masse corporelle des patientes sont donc relevées depuis 2009 pour l’ensemble des mères qui accouchent en Belgique. L’obésité maternelle et l’immigration sont en augmentation en Belgique, et ont été rarement étudiées au travers d’études de population sur les certificats de naissance. Des études ont pourtant montré que ces mères étaient à risque de complications périnatales, comme la césarienne ou la mortalité périnatale. L’obésité et l’immigration ont en commun le fait qu’elles recouvrent des réalités médicales, sociales et relationnelles face au personnel soignant, qui les mettent à risque de complications périnatales.<p>Des différences en termes de complications obstétricales et néonatales entre populations immigrantes et autochtones ont été observées en Belgique et dans d’autres pays, mais elles sont encore mal comprises. <p>Dans un premier travail d’analyse, nous avons évalué les taux de mortalité périnatale chez les mères immigrantes, en fonction du fait qu’elles étaient naturalisées ou non.<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères immigrantes (8.6‰) que non-immigrantes (6.4‰).<p>Le taux de mortalité périnatale est globalement plus élevé chez les mères non naturalisées (10.3‰) que chez les mères naturalisées (6.1‰).<p>Le taux de mortalité périnatale varie selon l’origine des mères, mais dans chaque sous-groupe étudié, les mères non naturalisées ont un taux plus élevé de mortalité périnatale.<p><p>Des études ont successivement montré davantage, ou moins de césariennes chez les mères immigrantes. Peu de facteurs confondants étaient généralement pris en compte. Dans un second travail d’analyse, nous avons comparé les taux de césarienne dans plusieurs sous-groupes de nationalités.<p>Les taux de césarienne varient selon les sous-groupes de nationalités. Les mères originaires d’Afrique sub-saharienne ont un odds ratio ajusté pour la césarienne de 2.06 (1.62-2.63) en comparaison aux mères belges. L’odds ratio ajusté n’est plus statistiquement significatif après introduction des variables anthropométriques dans le modèle multivariable pour les mères d’Europe de l’Est, et après introduction des interventions médicales pour les mères du Maghreb.<p><p>Peu d’études ont analysé la relation entre l’obésité maternelle et les complications néonatales, et la plupart de ces études n’ont pas ajusté leurs résultats pour plusieurs variables confondantes. Nous avons eu pour but dans un troisième travail d’analyse d’étudier la relation entre l’obésité maternelle et les paramètres néonatals, en tenant compte du type de travail (induit ou spontané) et du type d’accouchement (césarienne ou voie basse). Les enfants de mères obèses ont un excès de 38% d’admission en centre néonatal après ajustement pour toutes les caractéristiques du modèle multivariable (intervalle de confiance à 95% :1.22-1.56) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 45% (1.21-1.73) et 34% (1.10-1.63) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 18% (0.86-1.63) et non statistiquement significatif.<p>Les enfants de mères obèses ont un excès de 31% de taux d’Apgar à 1 minute inférieur à 7, après ajustement pour toutes les caractéristiques du modèle mutivariable (1.15-1.49) ;les enfants de mères obèses en travail spontané et induit ont également un excès de risque de 26% (1.04-1.52) et 38% (1.12-1.69) respectivement, alors qu’après une césarienne programmée l’excès de risque est de 50% (0.96-2.36) et non statistiquement significatif.<p><p>In 2008, a Centre for Perinatal Epidemiology was created inter alia to assist the Health Departments of Brussels-Capital City Region and the French Community to check birth certificates. A problem repeatedly reported in birth certificate data is the presence of missing data. The purpose of this study is to assess the changes brought by the Centre in terms of completeness of data registration for the entire population and according to immigration status. Reinforcement of data collection was associated with a decrease of missing information. The residual missing data rate was very low. Education level and employment status were missing more often in immigrant mothers compared to Belgian natives both in 2008 and 2009. Mothers from Sub-Saharan Africa had the highest missing rate of socio-economic data. The stillbirth rate increased from 4.6‰ in 2007 to 8.2‰ in 2009. All twin pairs were identified, but early loss of a co-twin before 22 weeks was rarely reported.<p>Differences in neonatal mortality among immigrants have been documented in Belgium and elsewhere, and these disparities are poorly understood. Our objective was to compare perinatal mortality rates in immigrant mothers according to citizenship status. Perinatal mortality rate varied according to the origin of the mother and her naturalization status: among immigrants, non-naturalized immigrants had a higher incidence of perinatal mortality (10.3‰) than their naturalized counterparts (6.1‰). In a country with a high frequency of naturalization, and universal access to health care, naturalized immigrant mothers experience less perinatal mortality than their not naturalized counterparts. <p>Our second objective was to provide insight into the differential effect of immigration on cesarean section rates, using Robson classification. Cesarean section rates currently vary between Robson categories in immigrant subgroups. Immigrant mothers from Sub-Saharan Africa with a term, singleton infant in cephalic position, without previous cesarean section, appear to carry the highest burden.<p>If it is well known that obesity increases morbidity for both mother and fetus and is associated with a variety of adverse reproductive outcomes, few studies have assessed the relation between obesity and neonatal outcomes. This is the aim of the last study, after taking into account type of labor and delivery, as well as social, medical and hospital characteristics in a population-based analysis. Neonatal admission to intensive care and low Apgar scores were more likely to occur in infants from obese mothers, both after spontaneous and <p> / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

v anglickém jazyce The thesis deals with the care of premature newborns. The structure of the thesis is divided into several chapters, which focus on the definition of neonatology and development of the neonatal care in the Czech Republic and abroad and on the definition of premature newborn and their most common diseases. Substantial part is devoted to development of the care of premature newborn and its current status. The final part of the thesis is devoted to interviews with the nurses, who have been working in the neonatal intensive care unit for long time. The thesis is formed by description and used it in written and electronic resources. The aim of the thesis is overview of the development of care of premature newborn in the past and present. Key words: Neonatalogy, development of neonatalogy, Oxygen therapy, Kangaroo mother care, history of incubators, Virginie Apgar, UPMD history, classification of the newborn, resuscitation of the newborn, congenial defects, history of Gynaecology and Obstetric Clinic VFN, history of the Institute for the care for mother and child, newborn screening, newborn nutrition

This study aimed to identify factors affecting women’s utilisation of the prevention of mother-to-child transmission (PMTCT) of HIV, evaluate the quality of PMTCT services, describe health outcomes of mothers and infants and to identify factors that influence mother-to-child transmission (MTCT) of HIV. Structured interviews were conducted with 384 women who had utilised PMTCT services. Information was also obtained from the health records of these women and of their infants. Better educated women, who had male partners and were self-employed were more likely to use PMTCT services. Being unmarried, poor and feeling stigmatised made it difficult for women to use these services. Respondents were satisfied with PMTCT services except that clinics sometimes had no medications. The health care workers followed the Ethiopian guidelines during HIV testing and counseling but not when prescribing treatment. Although the respondents’ CD4 cell counts improved, their clinical conditions did not improve. The MTCT rate was significantly higher if infants did not receive ARVs, had APGAR scores below seven, weighed less than 2.5kg at birth, were born prematurely, and if their mothers had nipple fissures. PMTCT services could be improved if more women used these services, health care workers followed the national guidelines when prescribing ARVs, clinics had adequate supplies of medicines, all infants received ARVs, and mothers’ nipple fissures could be prevented. Antenatal care should help to avoid premature births of infants weighing less than 2.5kg and having APGAR scores below 7. Future research should compare formula feeding versus breastfeeding of infants with HIV-positive mothers / Health Studies / D. Litt. et Phil. (Health Studies)