<p>The purpose of this study was to survey the occurrence of and obstacles to team training in</p><p>neonatal life support in Swedish hospitals and, accordingly, to compare university hospitals</p><p>with other hospitals. The study included all the managers in 37 pediatric wards who</p><p>participated in telephone interviews with the aid of a questionnaire. The results showed that</p><p>81 % of the Swedish hospitals that have a paediatric ward train the staff in neonatal life</p><p>support. All of the university hospitals and 74 % of the other hospitals are running training in</p><p>some form. The methods of training varied and so did the occurrence of training. All the</p><p>managers thought it was important to train neonatal life support. No statistical significant</p><p>difference occurred between university hospitals and other hospitals concerning the methods</p><p>of training, evaluation of training or in possibilities and obstacles of training. The conclusion</p><p>is that training multidisciplinary teams in neonatal life support is going on in most of the</p><p>Swedish hospitals. The team training in neonatal life support is quite a new method in Sweden</p><p>and several hospitals have started the training this year. One third evaluate their training by</p><p>oral reports, which is twice as often as written reports. A recommendation based on the results</p><p>of this study is that certification for the professionals who are involved in neonatal life support</p><p>should be considered.</p>

The purpose of this study was to survey the occurrence of and obstacles to team training in neonatal life support in Swedish hospitals and, accordingly, to compare university hospitals with other hospitals. The study included all the managers in 37 pediatric wards who participated in telephone interviews with the aid of a questionnaire. The results showed that 81 % of the Swedish hospitals that have a paediatric ward train the staff in neonatal life support. All of the university hospitals and 74 % of the other hospitals are running training in some form. The methods of training varied and so did the occurrence of training. All the managers thought it was important to train neonatal life support. No statistical significant difference occurred between university hospitals and other hospitals concerning the methods of training, evaluation of training or in possibilities and obstacles of training. The conclusion is that training multidisciplinary teams in neonatal life support is going on in most of the Swedish hospitals. The team training in neonatal life support is quite a new method in Sweden and several hospitals have started the training this year. One third evaluate their training by oral reports, which is twice as often as written reports. A recommendation based on the results of this study is that certification for the professionals who are involved in neonatal life support should be considered.

No description available.

No description available.

With asphyxia, newborns may suffer cardiogenic shock with myocardial dysfunction and dysregulation of vasomotor tone resulting in multiorgan dysfunction. Vasoactive medications are often administered with limited evidence directing clinicians regarding the use of high-dose monotherapy with dopamine relative to combination treatment with dopamine and a second different agent. We hypothesized that the treatment of hypoxia-reoxygenated newborn piglets with combinations of vasoactive medications would improve systemic and regional hemodynamics. Instrumented newborn piglets were subjected to hypoxia-reoxygenation with subsequent infusion of high-dose dopamine or moderate-dose dopamine and one of epinephrine, milrinone or levosimendan. Treatment with high-dose dopamine improved systemic and mesenteric perfusion. The addition of low-dose epinephrine showed some benefits regarding pulmonary hypertension and should a non-catecholamine agent be added to dopamine, milrinone is preferred to levosimendan given benefits to mesenteric perfusion. We conclude that the selection of appropriate vasoactive medical therapy should be directed by the clinical effects desired. / Experimental Surgery

La suffocation est une forme d’asphyxie dans laquelle l’oxygène ne peut atteindre le sang. Il existe divers types de suffocation dont la suffocation par confinement/ environnementale, les étouffements externe et interne, et les asphyxies traumatique/ positionnelle. La littérature scientifique sur la suffocation est relativement pauvre, étant principalement constituée de revues de cas et de quelques séries de cas limités à un contexte particulier de suffocation. Dans le contexte actuel d’une médecine basée sur les preuves, les ouvrages de médecine légale n’ont guère d’études pour appuyer leurs enseignements, tirés essentiellement de l’expérience personnelle de générations de médecins légistes. Le présent projet vise à palier ce manque de données sur la suffocation, un type de décès pourtant important en pratique médico-légale. Il s’agit d’une étude rétrospective de six ans portant sur tous les cas de suffocation non-chimique ayant été autopsiés au Laboratoire de sciences judiciaires et de médecine légale. À notre connaissance, cette étude est la première à établir le portrait systématique des morts par suffocation non-chimique en milieu médico-légal. Elle permet, entre autres, de confirmer les modes de décès usuels par catégorie de suffocation, le type de victime et les contextes courants. Généralement, les résultats concordent avec la littérature, appuyant ainsi le savoir commun des pathologistes sur la suffocation non-chimique. Toutefois, certaines dissimilitudes ont été notées quant aux modes de décès lors de l’étouffement externe. Par ailleurs, les questions reliées à la classification des asphyxies et aux définitions souvent contradictoires sont discutées. En un effort de normalisation, ce projet souligne les divergences retrouvées dans les classifications usuelles et tente d’en dégager les définitions courantes afin de proposer un modèle de classification unifié. / Suffocation is a general term that encompasses several forms of asphyxia generated by a deprivation of oxygen. It includes different subtypes such as environmental suffocation/ entrapment, choking, smothering and traumatic/ positional asphyxia. In the forensic literature, suffocation has been the object of several papers, but mainly case reports or cases series. Studies of subsets of suffocation deaths, limited to a specific scenery or category, have also been reported, such as suffocation in motor vehicle collisions. Nonetheless, there are still several areas of forensic pathology mainly based on tradition, with textbook explaining and describing common knowledge that is not supported by modern research data: suffocation makes no exception. The present project is intended to contribute to evidence-based data on non-chemical suffocation deaths. It comprises a 6-year retrospective study of all non-chemical suffocation cases in the forensic victim population of Quebec. As far as we know, this is the first paper to ever portray a systematic study of non-chemical suffocation deaths in forensic setting. In general, the results are concordant with the textbook literature, therefore supporting common knowledge related to manner of death in non-chemical suffocation. However, discrepancies have been underscored in smothering. Furthermore, the classification of asphyxia and the definitions of subtypes, such as suffocation, are far from being uniform, varying widely from one textbook to another and from one paper to the next. Unfortunately, similar research designs can lead to totally different results depending on the definitions used. Closely comparable cases are classified differently by equally competent forensic pathologists. Therefore, the present project highlights the discrepancies between textbook classifications and tries to draw mainstream definitions, in order to propose a more unified classification of asphyxial deaths.

A research report is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Sciences in Child Health Johannesburg, 2016 / Background: Leratong Hospital is a regional hospital in the West Rand of Johannesburg, South Africa. Statistics from maternity in 2008 showed high utilisation rates for delivery services at Leratong but a study on neonatal mortality was not yet done. It was therefore essential to measure and analyse the causes of new-born deaths so as to have policies to advance neonatal care. Objectives: To determine the neonatal mortality rate (NMR), the major neonatal causes of death and the occurrence of avoidable health factors. Methods: This was a prospective review of the clinical records of the 46 neonates who died within the 3 month period (15th April 2013 to the 15th July 2013). Data was obtained from neonatal admission and death registers. Information on the number oflive births was obtained from labour ward registers. Delegation books for nurses were checked to determine the number of nursing staff per shift as well as their allocation in different rooms. Neonate's age, birth weight, gender, race, place of origin, reason for admission and cause of death, were analysed. Health factors examined were access to high care services and to the neonatal ICU, number of staff on duty and the use of treatment guidelines. Questionnaires were used to collect information, and the consent to use clinical records was obtained from the mothers. Descriptive statistics were used to describe the frequencies and percentages of variables. Logistic regression of variables was applied to predict mortality. Results: The overall neonatal mortality rate at Leratong Hospital was lower than the rates found in South Africa and other studies in sub-Saharan Africa. Almost 37% of neonates died within 24 hours of admission. The three most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than sixty per cent of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low birth weight neonates. A critical staff shortage (nurse: neonate rati02.: 1:10) was the most common modifiable factor (63% of deaths). Thirty seven per cent of neonates were denied access to ICU. The significant predictors of neonatal death were being born preterm (OR: 3.1, 95% CI 1.7-6.0), extremely low birth weight (OR: 27.5,95% CI 8.2-92.6), very low birth weight (OR: 5.0, 95% CI 2.1-12.3) and birth by caesarean section (OR: 3.2, 95% CI 1.6-6.2). Conclusions: The study found the neonatal mortality rate at Leratong Hospital in 2013 to be lower than rates recorded in South Africa. Our results showed that the most common causes of neonatal mortality were similar to those in other hospitals in sub-Saharan Africa and in South Africa. A high number of neonatal deaths were avoidable by providing high care services (including NCP AP and surfactant) and adequate number of nurses trained in newborn care in the admission room, improving access to neonatal ICU, early detection of perinatal asphyxia and improved neonatal resuscitation, and the supervision of medical doctors. / AC2016

La suffocation est une forme d’asphyxie dans laquelle l’oxygène ne peut atteindre le sang. Il existe divers types de suffocation dont la suffocation par confinement/ environnementale, les étouffements externe et interne, et les asphyxies traumatique/ positionnelle. La littérature scientifique sur la suffocation est relativement pauvre, étant principalement constituée de revues de cas et de quelques séries de cas limités à un contexte particulier de suffocation. Dans le contexte actuel d’une médecine basée sur les preuves, les ouvrages de médecine légale n’ont guère d’études pour appuyer leurs enseignements, tirés essentiellement de l’expérience personnelle de générations de médecins légistes. Le présent projet vise à palier ce manque de données sur la suffocation, un type de décès pourtant important en pratique médico-légale. Il s’agit d’une étude rétrospective de six ans portant sur tous les cas de suffocation non-chimique ayant été autopsiés au Laboratoire de sciences judiciaires et de médecine légale. À notre connaissance, cette étude est la première à établir le portrait systématique des morts par suffocation non-chimique en milieu médico-légal. Elle permet, entre autres, de confirmer les modes de décès usuels par catégorie de suffocation, le type de victime et les contextes courants. Généralement, les résultats concordent avec la littérature, appuyant ainsi le savoir commun des pathologistes sur la suffocation non-chimique. Toutefois, certaines dissimilitudes ont été notées quant aux modes de décès lors de l’étouffement externe. Par ailleurs, les questions reliées à la classification des asphyxies et aux définitions souvent contradictoires sont discutées. En un effort de normalisation, ce projet souligne les divergences retrouvées dans les classifications usuelles et tente d’en dégager les définitions courantes afin de proposer un modèle de classification unifié. / Suffocation is a general term that encompasses several forms of asphyxia generated by a deprivation of oxygen. It includes different subtypes such as environmental suffocation/ entrapment, choking, smothering and traumatic/ positional asphyxia. In the forensic literature, suffocation has been the object of several papers, but mainly case reports or cases series. Studies of subsets of suffocation deaths, limited to a specific scenery or category, have also been reported, such as suffocation in motor vehicle collisions. Nonetheless, there are still several areas of forensic pathology mainly based on tradition, with textbook explaining and describing common knowledge that is not supported by modern research data: suffocation makes no exception. The present project is intended to contribute to evidence-based data on non-chemical suffocation deaths. It comprises a 6-year retrospective study of all non-chemical suffocation cases in the forensic victim population of Quebec. As far as we know, this is the first paper to ever portray a systematic study of non-chemical suffocation deaths in forensic setting. In general, the results are concordant with the textbook literature, therefore supporting common knowledge related to manner of death in non-chemical suffocation. However, discrepancies have been underscored in smothering. Furthermore, the classification of asphyxia and the definitions of subtypes, such as suffocation, are far from being uniform, varying widely from one textbook to another and from one paper to the next. Unfortunately, similar research designs can lead to totally different results depending on the definitions used. Closely comparable cases are classified differently by equally competent forensic pathologists. Therefore, the present project highlights the discrepancies between textbook classifications and tries to draw mainstream definitions, in order to propose a more unified classification of asphyxial deaths.

To investigate the relationship between birth asphyxia and neurological impairment a cohort of 184 infants with a low (≤3) one-minute Apgar score was studied. All were singletons, apparently normally formed, and born at term (≥37 weeks' gestation) in the John Radcliffe Hospital, between January 1984 and September 1985. The 181 cohort survivors were traced at the age of five years; 159 were assessed by a paediatrician on a battery of neurodevelopmental tests, and information about a further eight was obtained from other sources. Three infants in the cohort died neonatally with a diagnosis of birth asphyxia, and three had spastic quadriplegia, profound developmental delay and visual impairment. Examination of the perinatal histories of these six children, including their fetal heart rate patterns in labour and acid-base status at delivery, found convincing evidence of birth asphyxia. Only one other child in the cohort exhibited similar signs of birth asphyxia; he was unimpaired at the age of five. To assess the impact of birth asphyxia on the overall rate of cerebral palsy, all cases of cerebral palsy born to Oxford residents in the study period were identified. Of 30 cases of cerebral palsy, the three identified in the follow-up study were the only ones whose impairment could be attributed to birth asphyxia in a full-term birth. Birth asphyxia therefore accounted for 10% of all cases of cerebral palsy, a fraction that agrees with previous estimates. The frequency of cerebral palsy due to birth asphyxia was estimated as 1 in 3800 full-term livebirths. A detailed analysis of the test scores of the 159 children assessed by the paediatrician failed to show any association between their acid-base values at delivery and test scores, or between their fetal heart rate patterns in labour and test scores. These results conform with the view that birth asphyxia has an "all or nothing" effect, and that it presents as a cluster of abnormal neonatal signs, including persistent cerebral depression, severe acidaemia, neonatal encephalopathy, and multiorgan dysfunction.

Thesis (Ph.D.) - University of Queensland, 2004. / Includes bibliography.