Thesis (MPH.) -- University of Limpopo, 2018 / Background: Pregnant women expect a normal pregnancy, a normal delivery and a healthy baby. Unfortunately, premature birth is a common occurrence; ithas some complications and causes death in developing countries. Mothers feel disappointed for not carrying their pregnancies to term and worry about the survival of their babies. Admission into neonatal intensive care unit increases chances of baby survival but has emotional impact on mothers, thus the need to explore their experiences. Objective: To explore the lived experiences of mothers regarding their first exposure to their premature babies admitted in neonatal intensive care unit. Methods: A qualitative and exploratory study using semi-structured interviews with purposively selected mothers was conducted. Interviews were conducted in English using an interview guide, audio recorded and continued until data saturation was reached, thus 8 mothers participated in the study. Field notes were collected. Voice recordings were transcribed verbatim and analysed thematically. An independent coder confirmed the findings. Results: Mothers experienced stress and anxiety, and felt neglected by health care workers. They felt the focus was on the baby alone and the mothers’ needs ignored, though others were happy that they were welcomed. Conclusions: Therefore, parents need support when their premature babies are admitted in neonatal an intensive care unit. Continuous update on conditions of their babies is also necessary. / AMREF Health Africa, and Limpopo Department of Health

Thesis (Ph.D.)--University of Western Australia, 2008.

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Respiratory distress syndrome is the major cause of mortality in premature babies. Increasing numbers of neonates are now surviving the disease due to advances in techniques used in neonatal intensive care units. Mechanical ventilation is an essential part of the treatment for respiratory distress syndrome and is an area in which improvements and modifications are constantly being made. In the early 1980's a new infant ventilator was introduced involving ventilation by a distal jet. As yet, the mechanisms by which the distal jet ventilator enhances gas exchange are unknown. Original experiments are carried out to record the attenuation and speeds of the pressure wave produced by the distal jet ventilator. The observed changes in wave shape and the high wave speed imply that the ventilator produces waves operating within an acoustic regime. An understanding of the gas exchange mechanisms active in shock assisted ventilation is initiated by a comprehensive investigation of the transport properties of acoustic waves. The advection and diffusion that result from a linear concentration gradient in an acoustic flow are analysed, from the Eulerian and Lagrangian viewpoints. The Eulerian investigation shows that the total flux of tracer through a given pipe can be optimized by choosing the frequency appropriately. The Lagrangian transport is increased as both frequency and radius increase. For all values of parameters, Lagrangian streaming is observed, with a steady net flow in the pipe core away from the tube entrance and an opposing net flow near the tube walls.

4 pp. / Before they may even know they are pregnant; women’s bodies and their level of folate play a critical role in preventing certain birth defects, specifically neural tube defects (NTDs). NTDs are birth defects in the brain, spinal cord, or spine. Considered ‘one of the most important public health discoveries of this century’ is that daily supplemental folic acid taken before becoming pregnant significantly reduces the risk of NTDs (1). In 1998, the United States made sweeping efforts that fortified cereal grains with folic acid to ensure all Americans consume adequate amounts of this vitamin. So what exactly is folate? What are the functions of this vitamin? What foods have high levels of folate and what is the recommended daily intake? This article will answer these questions and will go on to explain folic acid fortification and the impact fortification has had on the incidence of NTDs in Arizona.

Os conhecimentos produzidos acerca das interações de bebês em contextos coletivos têm priorizado suas interações com os adultos. Em contextos de acolhimento institucional de crianças em situação de vulnerabilidade, isso se repete, o estudo de bebês nesse contexto estando imerso em invisibilidade. Entendendo que o ser humano é relação, tal característica estando presente mesmo no bebê, hipótese do trabalho é de que suas interações ali poderiam ser mais efetivadas com outras crianças acolhidas já que, nesse contexto, funcionárias são orientadas a não se apegar aos bebês e/ou dispensam pouca presença pela sobrecarga de trabalho. Assim, o objetivo foi investigar as ocorrências de práticas de cuidado na interação de crianças e bebês em situação de acolhimento institucional. A pesquisa teve fundamentação na perspectiva da Rede de Significações, de referencial histórico-cultural. O estudo foi realizado em instituição de acolhimento do interior do Mato Grosso do Sul, de onde se selecionou dois bebês focais Caio e Ana (de sete e dez meses) -, sem parentesco entre eles. Além deles, foram participantes as crianças também acolhidas naquele período e a própria pesquisadora. Foram realizadas 47 videogravações, de trinta minutos cada, por seis meses, sendo três meses com cada bebê focal. Também foram realizadas entrevistas semiestruturadas com funcionários da instituição e, ainda, construiu-se diário de campo. A noção de cuidado foi baseada nos conceitos de Heidegger - Cuidado por Ocupação (baseado em tarefas) e Cuidado por Preocupação (baseado no Ser Com). O cuidado por preocupação teve tonalidades diversas: Atenção, como ir em direção ao bebê, quando o percebia sozinho; Solicitude, como ir em direção ao bebê, em decorrência de expressividades diversas; e, Preocupação/tensão, ir em direção ao bebê, para protegê-lo/ socorrê-lo em situações de perigo. À análise, verificou-se muitas interações das crianças, a maioria concentrada em brincadeiras. Com relação às práticas de cuidado, verificou-se grande ocorrência nas interações das crianças com os bebês e mesmo na interação de bebês, envolvendo as três tonalidades acima. Os cuidados eram, em grande parte, de interações recíprocas, diádicas e comumente viabilizadas por crianças mais velhas (multietárias). Os parceiros que ofertaram cuidados diferenciados eram os mais afetivos e buscados pelos bebês. Embora os cuidados fossem mais ofertados por meninas, este estudo demonstrou que meninos também cuidaram dos bebês. No caso de Ana, as interações não envolviam crianças com grau de parentesco, diferentemente do caso de Caio, que foi bastante cuidado pela irmã. Discute-se a importância do estabelecimento de relações naquele contexto, particularmente nos grupos de irmãos, de forma que possam preservar identidade familiar e manutenção dos vínculos afetivos. As interações permeadas por trocas afetivas foram vistas, como tendo indícios de empatia pelas crianças, mesmo as bem novas, sendo uma questão conceitual a ser explorada em futuros estudos. Pontua-se que tais interações e práticas de cuidados não devem substituir os cuidados dos adultos. A mediação pelo adulto é fundamental e deve ser implementada, inclusive considerando a questão da organização das crianças e sua localização dentro do ambiente de acolhimento / Interactions of babies with adults in collective contexts have been prioritized by most research literature. In institutional care of vulnerable babies, researches are immersed in invisibility. The relationship that features the human being is present even in the baby. Our work hypothesis is that babies interactions could be great effective when occur with children. In that context, employees are oriented not to attach to the babies and pay little attention due to work overload. The objective was to investigate the occurrences of care actions within the interaction of children and babies in an institutional host situation. The research was based on the Network of Meanings, historical, and cultural perspectives. The study was carried out in a care institution in the interior of Mato Grosso do Sul, from which two focal babies - Caio and Ana (seven and ten months old) - were selected, without any relationship between them. In addition, children who were also welcomed in the care institution and the researcher herself participated. For six months, thirty minutes of each 47 video were recorded, three months with each of two focal babies. Also, semi-structured interviews were conducted with employees of the institution, and a kind of logbook was also written to better understanding institutional dynamics. The notion of care was based on the Heidegger concepts - Care for Occupation (based on tasks) and Care for Concern (based on Being With). Care for worry had several tones: Attention, Solicitude, Worry, that is how heading towards the baby, when it was alone or crying, and protect or help it in dangerous situations. At the analysis, many interactions of the children were verified, most concentrated in jokes. With regard to the care practices, there was a great occurrence in the interactions of the children with the babies and even in the babies interaction involving the three shades above. Care was largely of reciprocal interactions, dyadic and commonly made feasible by older children (multistage). Partners who offered differentiated care were the most affectionate and sought after by baby. Although the care was more offered by girls, this study showed that boys also care. In Ana\'s case, interactions did not involve children with a degree of kinship, unlike the case of Caio, who was taken care of by her sister. It is discussed the importance of establishing relationships in that context, particularly in sibling groups, so that they can preserve family identity and maintain affective bonds. Interactions permeated by affective exchanges were seen as having signs of empathy for children, even the new ones, being a conceptual issue to be explored in future studies. It is pointed out that such interactions and caring practices should not replace the care of adults. Mediation by the adult is fundamental and should be implemented, including considering the issue of the organization of children and their location within the care environment

No caso de um nascimento prematuro, uma vez que a gravidez é interrompida, o recém-nascido não corresponde ao bebê idealizado na gravidez e na maioria das vezes, não tem condições físicas de viver fora do útero sem ajuda da tecnologia médica. Os pais experimentam situações estressantes, o que afeta suas percepções e habilidades para interagir com a criança, dificultando o estabelecimento de um apego íntimo. Assim, é necessário que a mãe e a família tenham no hospital um ambiente acolhedor para poder receber e proteger seu bebê, amenizando os efeitos desta interrupção. Este estudo tem por objetivo compreender os significados atribuídos ao nascimento e internação de um bebê pré-termo e de muito baixo peso na perspectiva dos pais. Foram entrevistados cinco pais e cinco mães de bebês pré-termo de muito baixo peso que coabitavam o mesmo teto e que tinham, no momento das entrevistas realizadas, seus bebês internados. Foram realizadas duas entrevistas semi-dirigidas com cada um dos pais; uma logo após o nascimento e outra após um mês de internação. As entrevistas foram audiogravadas e transcritas na íntegra. Foram selecionadas as entrevistas de um casal para aprofundar a análise através do estudo de caso. O trabalho teve um enfoque qualitativo a partir do referencial psicanalítico de D. Winnicott. Na análise do caso foram abordados aspectos das condições emocionais da mãe e do pai em relação ao nascimento de uma bebê prematura, a relação que cada cuidador estabeleceu com a equipe do hospital, as fantasias em relação aos futuros cuidados à bebê e as vivências desenvolvidas como esposa e mãe; marido e pai. No presente estudo são apresentadas dificuldades dos pais que vão além do luto por estarem diante de seu filho que nasceu prematuro. Os pais são envolvidos por uma situação de muita ansiedade que faz brotar antigas feridas internas de suas histórias, além de outras nuances que só podem ser entendidas e vivenciadas se os profissionais estiverem abertos emocionalmente ao cuidado dos familiares para acolhê-los de forma integral. Destaca-se assim, a necessidade de se despir de olhares técnicos voltados para a racionalidade científica que não levam em conta a singularidade e a subjetividade presente em cada caso. Trata-se de um olhar mais atento às questões emocionais das relações pais-bebês, para que não se faça do atendimento uma escuta estereotipada baseada em conhecimento pré-estabelecidos que não permitem a fertilidade do contato com o novo e o desconhecido que surge a cada dia em um hospital. Acredita-se que este estudo possa em alguma medida estimular aqueles que pretendem repensar e desenvolver novos sentidos nas práticas do cuidado em saúde. / In the case of a premature birth, once the pregnancy is interrupted, the newly born does not correspond to the idealized baby during the pregnancy and, most of times, does not have physical conditions of living outside the womb without medical help. The parents experiment stressing situations, which affects their perceptions and skills to interact with the child, hindering the establishment of an intimate attachment. Therefore, it is necessary that the mother and the family have in the hospital a welcoming environment to be able to receive and protect their baby, softening the effects of this interruption. This study has by objective to comprehend the meanings assigned to birth and hospitalization of a preterm and very low birth weight baby on the perspective of the parents. It were interviewed five fathers and five mothers of preterm and very low birth weight babies, which cohabited the same roof and had, in the moment of the interviews, their babies hospitalized at a Neonatal Intensive Care Unit (NICU). It were conducted two semi-directed interviews with each parent; one right after the birth and the other one after a month of hospitalization. The interviews were audio recorded and transcribed in full. It were selected the interviews of a couple to deepen the analysis trough the study of case. The work had a qualitative approach from the psychoanalytical reference of D. Winnicott. In the analysis of the case were approached aspects of the mother\'s and the father\'s emotional conditions towards the the birth of a premature child, the relationship each caregiver had established with the hospital staff , the fantasies towards the future cares to the baby and the experiences developed as wife and mother; husband and father. In this study are presented parent\'s difficulties that go beyond the mourning by facing their child that was born premature. The parents are involved in a situation with lots of anxiety that brings back old internal wounds from their own histories, beyond other nuances that can only be understood and lived if the professionals were emotionally opened to family caring, to welcome them integrally. Stands out so the need of undress technical views directed to scientific rationality that does not consider the singularity and the subjectivity of each case. It is about a look more opened to the emotional issues of the parent-babies relationships, so as not to make the treatment a stereotyped hearing based on pre-established knowledge that does not permit the fertility of the contact with the new and the unknown that is brought each day at a Neonatal Intensive Care Unit. It is believed that this study may, somehow, stimulate those who intend to rethink and develop new meanings in health care practices.

Abstract Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, establish content validity of the tool kit among clinical experts, and make recommendations about the use of the tool kit in the neonatal intensive care unit. Polit, Beck, and Owen’s framework was used to establish content validity. Neonatal intensive care nurses who were considered “experts” using Benner’s novice-to-expert theory (n = 7 reviewed the tools which were quantitatively computed and yielded an Item Content Validity Index value range of 0.86 to 1.00, and a Scale Content Validity Index of 0.97, reflecting that the content met the objectives of the toolbox. Positive social change can be realized through use of the tool kit in the neonatal intensive care unit to educate mothers in the care of their preterm babies, thus improving both maternal and infant outcomes.

No caso de um nascimento prematuro, uma vez que a gravidez é interrompida, o recém-nascido não corresponde ao bebê idealizado na gravidez e na maioria das vezes, não tem condições físicas de viver fora do útero sem ajuda da tecnologia médica. Os pais experimentam situações estressantes, o que afeta suas percepções e habilidades para interagir com a criança, dificultando o estabelecimento de um apego íntimo. Assim, é necessário que a mãe e a família tenham no hospital um ambiente acolhedor para poder receber e proteger seu bebê, amenizando os efeitos desta interrupção. Este estudo tem por objetivo compreender os significados atribuídos ao nascimento e internação de um bebê pré-termo e de muito baixo peso na perspectiva dos pais. Foram entrevistados cinco pais e cinco mães de bebês pré-termo de muito baixo peso que coabitavam o mesmo teto e que tinham, no momento das entrevistas realizadas, seus bebês internados. Foram realizadas duas entrevistas semi-dirigidas com cada um dos pais; uma logo após o nascimento e outra após um mês de internação. As entrevistas foram audiogravadas e transcritas na íntegra. Foram selecionadas as entrevistas de um casal para aprofundar a análise através do estudo de caso. O trabalho teve um enfoque qualitativo a partir do referencial psicanalítico de D. Winnicott. Na análise do caso foram abordados aspectos das condições emocionais da mãe e do pai em relação ao nascimento de uma bebê prematura, a relação que cada cuidador estabeleceu com a equipe do hospital, as fantasias em relação aos futuros cuidados à bebê e as vivências desenvolvidas como esposa e mãe; marido e pai. No presente estudo são apresentadas dificuldades dos pais que vão além do luto por estarem diante de seu filho que nasceu prematuro. Os pais são envolvidos por uma situação de muita ansiedade que faz brotar antigas feridas internas de suas histórias, além de outras nuances que só podem ser entendidas e vivenciadas se os profissionais estiverem abertos emocionalmente ao cuidado dos familiares para acolhê-los de forma integral. Destaca-se assim, a necessidade de se despir de olhares técnicos voltados para a racionalidade científica que não levam em conta a singularidade e a subjetividade presente em cada caso. Trata-se de um olhar mais atento às questões emocionais das relações pais-bebês, para que não se faça do atendimento uma escuta estereotipada baseada em conhecimento pré-estabelecidos que não permitem a fertilidade do contato com o novo e o desconhecido que surge a cada dia em um hospital. Acredita-se que este estudo possa em alguma medida estimular aqueles que pretendem repensar e desenvolver novos sentidos nas práticas do cuidado em saúde. / In the case of a premature birth, once the pregnancy is interrupted, the newly born does not correspond to the idealized baby during the pregnancy and, most of times, does not have physical conditions of living outside the womb without medical help. The parents experiment stressing situations, which affects their perceptions and skills to interact with the child, hindering the establishment of an intimate attachment. Therefore, it is necessary that the mother and the family have in the hospital a welcoming environment to be able to receive and protect their baby, softening the effects of this interruption. This study has by objective to comprehend the meanings assigned to birth and hospitalization of a preterm and very low birth weight baby on the perspective of the parents. It were interviewed five fathers and five mothers of preterm and very low birth weight babies, which cohabited the same roof and had, in the moment of the interviews, their babies hospitalized at a Neonatal Intensive Care Unit (NICU). It were conducted two semi-directed interviews with each parent; one right after the birth and the other one after a month of hospitalization. The interviews were audio recorded and transcribed in full. It were selected the interviews of a couple to deepen the analysis trough the study of case. The work had a qualitative approach from the psychoanalytical reference of D. Winnicott. In the analysis of the case were approached aspects of the mother\'s and the father\'s emotional conditions towards the the birth of a premature child, the relationship each caregiver had established with the hospital staff , the fantasies towards the future cares to the baby and the experiences developed as wife and mother; husband and father. In this study are presented parent\'s difficulties that go beyond the mourning by facing their child that was born premature. The parents are involved in a situation with lots of anxiety that brings back old internal wounds from their own histories, beyond other nuances that can only be understood and lived if the professionals were emotionally opened to family caring, to welcome them integrally. Stands out so the need of undress technical views directed to scientific rationality that does not consider the singularity and the subjectivity of each case. It is about a look more opened to the emotional issues of the parent-babies relationships, so as not to make the treatment a stereotyped hearing based on pre-established knowledge that does not permit the fertility of the contact with the new and the unknown that is brought each day at a Neonatal Intensive Care Unit. It is believed that this study may, somehow, stimulate those who intend to rethink and develop new meanings in health care practices.

Bakgrund: Spinning Babies beskrivs som ett verktyg för att främja normal fysiologisk förlossning genom smärtlindring, avslappning och positioner som främjar optimal passage av barnet genom förlossningskanalen. Syfte: Att belysa barnmorskors erfarenheter av att tillämpa Spinning Babies vid förlossning. Metod: Studien genomfördes med en kvalitativ design. Datainsamlingen genomfördes genom tre fokusgruppsintervjuer med totalt 12 barnmorskor. Datamaterialet analyserades med kvalitativ innehållsanalys. Resultat: Resultatet presenteras i tre huvudkategorier med underkategorier: Ett verktyg för att främja det normala, Tillfredsställelse med att utöva och utvecklas i sin barnmorskekonst, Ett nytt perspektiv på födandet. Barnmorskornas erfarenhet är att Spinning Babies ger förutsättningar för att främja normal förlossning, att utövandet upplevs som stimulerande samt att tillämpningen av Spinning Babies ger upphov till ny förståelse. Slutsats: Barnmorskors förutsättningar att främja normal förlossning kan underlättas om de har konkreta verktyg. Spinning Babies kan användas för att förbättra förlossningsutfall och bidra till en positiv förlossningsupplevelse. När barnmorskor arbetar tillsammans för att stödja den födande kvinnan och partnern upplevs förlossningsarbetet även mer stimulerande. / Background: Spinning Babies is described as a tool to promote physiological birth process through pain relief, relaxation and positioning for optimal passage of the baby through the birth canal. Aim: To describe midwives experiences of applying Spinning Babies during childbirth. Method: The study was conducted with a qualitative design with three focus group interviews. 12 midwives participated. The data was systematically analysed with qualitative content analysis. Result: The result was presented in three main categories with subcategories: A tool for promoting the normal, Satisfaction with exercising and developing in one's midwifery art, A new perspective on childbirth. The midwives' experience that Spinning Babies provide conditions for promoting normal childbirth. The practice is viewed as stimulating and generates a new understanding of child birth. Conclusion: Midwives' ability to promote normal childbirth can be facilitated if they have concrete tools. Spinning Babies can be used to improve childbirth outcomes and contribute to a positive childbirth experience. When midwives work together to support the woman giving birth and her partner, their work is also experienced as more stimulating.