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MMed (Paediatrics), Faculty of Health Sciences, University of the Witwatersrand / The aim of regionalisation of neonatal services is to offer a basic level of care to the majority of the obstetric/neonatal population who are at low risk, with smaller numbers of more specialised hospitals offering higher levels of care to the fewer, higher-risk patients. On review of relevant literature there has long been a shortage of neonatal intensive care unit (NICU) beds in the South African public sector. This study was an audit within a referral system in the public sector. The aim was to identify the need for NICU beds, establish whether the need was being met, ascertain which patients required referral and which were accepted, and delineate factors that influenced the outcome of acceptance versus refusal. Subjects and Methods Data collection took place between 30 October and 11 December 2006. Seven health facilities in southern Gauteng were included as study sites. These included 2 primary healthcare clinics, 3 district, 1 regional hospital and the tertiary referral facility, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). The study included all neonates requiring transfer to a NICU, for any reason, during the study period. Data collection relied upon completion of information sheets by doctors requesting or accepting transfer of ill neonates at each of the hospitals involved. The primary outcome was acceptance or refusal at CMJAH NICU. Secondary outcome was survival or death within the study period. Results Forty-seven external requests for NICU beds were recorded at CMJAH and another 22 requests came for births within CMJAH. Only 13 (28%) of external requests were accepted. All internal requests were accommodated. Most requests came from level 2 (district or regional) hospitals, many outside the designated referral system, mainly for infants with respiratory distress. Infants older than 24 hours of age (OR 0.16; 95% CI 0.04-0.65), those with congenital abnormalities, and those requiring surgery (OR 0.11; CI 0.23-0.57) were significantly more likely to be accepted. Greater numbers of staff on duty at CMJAH also correlated with the probability of acceptance into NICU. Conclusion Relatively few external requests were accepted. CMJAH provides sub-specialist services including paediatric surgery and therefore should accept patients requiring such management. However, there was a high number of patients refused admission for ‘simple’ neonatal respiratory conditions. Level 2 hospitals should be able to manage these. Furthermore, hospitals are not following strict referral protocols. The findings are indicative of the continued shortage of neonatal intensive care beds, poor adherence to referral guidelines, and a general failure of regionalisation within the sector under consideration.

Mischlingskinder, also referred to as brown babies were the illegitimate children of African American occupation soldiers in post-World War II Germany. The complexities of their existence are often discussed in the context of national identity, racial identity and diplomacy. Their existence in Germany presented social struggles for the children as well as their mothers as a post Nazi German began towards society of racial acceptance. A few cases, through the cooperation of both the US and German government, some of the children were eligible for adoptions by African American families in America through the Brown Baby Adoption Plan. A thematic analysis was performed on 20 archived newspaper articles to uncover the different themes in which the children are discussed. My question is whether these themes connect to a lager theoretical concept of the “priceless child”. The results uncovered themes in which the brown babies were discussed which included their treatment in Germany, neglect, adoption and arrival in adoptive homes. The narratives of the children change over time in relation to the specific themes.

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MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009. / As the medical world advances, there is an ever increasing survival rate of children that are born prematurely and of a low birth weight. For this reason more and more research is being done to investigate the consequences of being born pre-term and underweight. Research has shown that children who are born prematurely may show signs of developmental delay later on in life (Johnson, 2007). Motor development has been shown to be more affected by prematurity than any other causative factor of prematurity (Goyen and Lui, 2002). The main aim of the study was to establish the differences in global development between pre-term and full-term infants at eighteen months. The Bayley Scales of Infant Development II (BSID II) were used to determine performance in both the pre-term and the full-term group. These results were statistically analysed in greater detail in the mental and the motor section. The Mental and Psychomotor Developmental Indices (MDI and PDI) of the BSID II were used to determine the extent of the mental and motor delays in this sample. The Household Economic and Social Status Index (HESSI) was used in order to ascertain if the socioeconomic status of a family had any bearing on the development of the child in both the mental and the motor categories. This was statistically analysed. The socio-economic factors assessed in this study did not show any statistical significance but did confirm that these children come from similar backgrounds. The results of this study showed that there is a delay in the pre-term group when compared with the full-term group. The mean MDI for the full-term group was 105.25, this is compared with the pre-term group of 81.9, which is statistically significant (p<0.001). The PDI for the full-term group showed a mean score of 109.6. The mean score for the pre-term group was 86.8. This also showed a statistical significance (p<0.001). The pre-term infants in this study showed a significant delay both in the mental and the motor domains. The cognitive delays may be linked to an under-developed corpus callosum due to the premature birth. The motor delays may be caused due to a decreased motor control and developmental dyspraxia. Infants that are born prematurely are at a higher risk to suffer from developmental delays in the cognitive, language and the motor developmental domains. This study confirms what has been found in previous studies showing cognitive development to be the developmental domain most affected by prematurity. The results of this study are important as they support policy change to ensure that these children are followed-up to allow the at-risk children to reach their full potential.

MS(Med), Child Health: Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand / Background: ELBW preterm infants are at extremely high risk for adverse neurodevelopmental (ND) outcome. Systemic hypotension is an important peri-natal risk factor in neurodevelopmental outcome. Numerous other risk factors exist for adverse neurodevelopmental outcome. Aim: To assess whether early mean systemic blood pressure and other risk factors contribute to poor ND outcome in ELBW preterm infants managed at Panorama Medi-Clinic. Methods: A retrospective, analytical study using data obtained from 2003 to 2008. Data from the Vermont Oxford Network database of which Panorama Medi-Clinic is a member was used to select a cohort of inborn, surviving infants weighing ≤ 1000g or ≤ 30 weeks gestational age. Early mean systemic BP records were obtained from nursing records. ND data was obtained from the neurodevelopmental clinic or routine follow up clinics notes. Infants with major defects at birth were excluded. The cohort was classified according to their general developmental quotient and whether or not they had signs of cerebral palsy into a normal or abnormal neurodevelopmental group. All patients remained completely anonymous and ethical clearance was obtained from the ethics committee at Panorama Medi- Clinic. P a g e | VII Results: 82 infants were eligible. 78 were entered the study. 4 were lost to follow up. Average birth weight was 782.1g ± 148.23. Average gestational age was 27.06w ± 1.32. Normal neurodevelopmental outcome was found in 64(82%). An abnormal neurodevelopmental outcome was found in 14(18%). No statistically significant difference was found by logistical regression when mean systemic blood was compared between normal and abnormal neurodevelopmental groups. If a cut off BP of <30 mm Hg, or inotropic agents were administered, no statistical difference was found between the normal and abnormal groups. Severe grades of IVH, ROP, post-natal steroids, and chronic lung disease, and gastro-intestinal perforation, were identified as risk factor of adverse outcome

This study investigates a single retrospective case of psychoanalytic infant observation. Two principal aims emerged from the evolving investigation. The first concerned the methodology involved in examining observational data using psychoanalytic methods, the second being the exploration of what can be learned from the systematic study of a single recorded case of infant observation using Grounded Theory. The focus for the study concerned the infant’s first year and considered the structuring of the infant’s psychic life, which takes place in the initial relationship(s). From the phenomenological description of behaviours in the observed context, combined with the emotional field described in the observation reports,emotional meaning was inferred. The systematic use of line-by-line coding, abductive reasoning and the formation of categories led to discussion of the following detail:The first month of life; Exploration of the period when mother was traumatically absent, followed by her return; Selected observations that reveal parent/infant recovery. Several conclusions are reached regarding the observed infant. The first concerns the identification of synchronous rhythms or patterns in the mother/infant relationship where they were found to form a backdrop to aesthetic reciprocity. Rupture in aesthetic attunement was instrumental in activating a cascade of early proto-defensive organisation into later development. This took the form of oral preoccupation; namely regurgitation, rumination and choking. Whilst this defensive organisation may be specific to the observed infant, the study draws attention to developmental processes that may be relevant to infants in general. There is evidence to support how babies are more integrated than first thought by Bick (1968) and are ‘open’ to triangular relating in the first weeks. Proto-defensive structures may be evidenced from the start of post-natal life. This study makes a contribution to the body of knowledge concerning rumination in infancy.