Congenital diaphragmatic hernia (CDH) is a potentially fatal condition found in neonates where embryological defects in the diaphragm negatively impact fetal maturation and growth. The defect allows contents below the diaphragm to potentially migrate into the thoracic cavity during development, which could lead to secondary complication including pulmonary hypertension and left ventricular hypoplasia. CDH tends to have a high neonate mortality rate in congruence with the severity of the condition. Several risk factors for CDH include accompanying chromosomal abnormalities and the anatomical positions of organs in the fetus. Diagnosis is typically found with an ultrasound (US) in utero. There have been several studies in order to better understand the pathology of the disease and new techniques to try and alleviate the cases prenatally, however the risks involved with these procedures may outweigh the benefits. The standard practice for neonates that qualify for postnatal treatment is the use of extracorporeal membrane oxygenation (ECMO) postnatally, to facilitate oxygenated blood to the fetus via a bio-mechanical device. Recent treatment techniques that have revolutionized care for CDH include a delayed surgical intervention in order to reduce the risk of developing a pulmonary ailment such as pulmonary hypertension and/or lung hypoplasia. Interventions with inhaled nitric oxide have also been shown to relegate a similar outcome to those with ECMO intervention. Despite the advancements in knowledge, treatment, and technology, the mortality rate for CDH still hovers around 50% on average, yet that percentage can increase or decrease depending on the severity of the condition and any genetic abnormalities associated with it. Overall, while there have been great strides in treatment and understanding of CDH, additional research is necessary in order to provide the utmost care for future generations of CDH patients.

Learning to read is essential, yet many children do not receive a diagnosis of developmental dyslexia (DD) until second or third grade. The aim of this dissertation is to identify brain and behavioral predictors of DD so that diagnosis and intervention can begin sooner. Experiment 1 examines infants with familial risk of DD longitudinally. Infants completed non-sedated diffusion-weighted imaging (DWI) between 4- and 18-months of age and cognitive-linguistic assessment at four years. Infants at- risk of DD displayed reduced fractional anisotropy (FA) and increased radial diffusivity (RD) in the left arcuate fasciculus (AF) and reduced FA and axial diffusivity (AD) of the splenium of the corpus callosum (CC) compared to peers without a familial risk. Both the left AF and CC are implicated in reading and reading-related tasks, and atypicalities have been observed in children and adults with DD. RD may reflect myelination and AD is thought to indicate pathway complexity suggesting infants at-risk of DD exhibit reduced myelination of the left AF and reduced pathway complexity of the CC at or shortly after birth. The left AF assessed in infancy predicted four-year-old vocabulary skills while the CC predicted four-year-old print knowledge. Experiment 2 explores the association between white matter microstructure of the left AF and CC and neural activity during phonological processing assessed via functional magnetic resonance imaging (fMRI). Preschoolers with and without a familial risk of DD completed DWI and an fMRI alliteration task where children indicated via button-press whether two words started with the same initial sound. Positive correlations were observed between FA of the left AF and CC and neural activity in the left medial temporal gyrus and the left lingual gyrus, two regions implicated in phonological processing. Experiment 3 examines whether white matter microstructure of the CC assessed in preschool is associated with school-age reading fluency in children with and without a familial risk of DD. Similar to children and adults with DD, preschoolers with a familial risk of DD displayed greater FA and AD of the CC compared to controls. Furthermore, AD of the CC predicted school-age reading fluency. / 2018-12-03T00:00:00Z

Wong Pui On Raymond. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 105-120). / Abstracts in English and Chinese. / Contents --- p.i / Abstract --- p.vi / Statement of originality --- p.xii / Acknowledgments --- p.xiii / List of figures and tables --- p.xiv / Abbreviations --- p.xvii / Publications --- p.xx / Text / Chapter Chapter 1: --- Introduction and Objectives --- p.1 / Chapter 1.1 --- Neonatal Sepsis --- p.2 / Chapter 1.2 --- Markers of Infection --- p.4 / Chapter 1.2-1 --- Clinical markers for sepsis --- p.4 / Chapter 1.2-2 --- Cytokines as markers of sepsis --- p.7 / Chapter 1.2-3 --- Cell surface receptors as markers of sepsis --- p.8 / Chapter 1.3 --- The immune system in response to pathogen challenge --- p.10 / Chapter 1.3-1 --- Source of cytokines --- p.11 / Chapter 1.4 --- General outline of cytokines implicated in sepsis --- p.12 / Chapter 1.4-1 --- IL-2 --- p.13 / Chapter 1.4-2 --- IL-4 --- p.15 / Chapter 1.4-3 --- IL-5 --- p.16 / Chapter 1.4-4 --- IL-6 --- p.17 / Chapter 1.4-5 --- IL-10 --- p.18 / Chapter 1.4-6 --- IFN-γ --- p.19 / Chapter 1.4-7 --- TNF-α --- p.21 / Chapter 1.5 --- General outline of cell surface receptors implicated in sepsis --- p.23 / Chapter 1.5-1 --- CDllb --- p.23 / Chapter 1.5-2 --- CD64 --- p.24 / Chapter 1.5-3 --- CD45RO --- p.25 / Chapter 1.5-4 --- CD25 --- p.26 / Chapter 1.6 --- Aims of study --- p.27 / Chapter Chapter 2: --- Materials and methods --- p.31 / Chapter 2.1 --- Patients inclusion criteria and classification --- p.32 / Chapter 2.2 --- Sample collection and sepsis screening --- p.33 / Chapter 2.3 --- Quantitation of cell surface antigens --- p.35 / Chapter 2.3-1 --- Cell acquisition and calculation --- p.37 / Chapter 2.4 --- Quantitation of plasma cytokines --- p.38 / Chapter 2.4-1 --- Cytometric Beads Array assay --- p.40 / Chapter 2.5 --- Statistical Analysis --- p.41 / Chapter Chapter 3: --- "Cell surface and plasma cytokine markers for the diagnosis of late-onset sepsis in preterm, very low birthweight (VLBW) infants" --- p.51 / Chapter 3.1 --- Results --- p.52 / Chapter 3.1-1 --- Lymphocyte markers: CD25 and CD45RO --- p.52 / Chapter 3.1-2 --- Neutrophil markers --- p.53 / Chapter 3.1-2a --- CD64 --- p.54 / Chapter 3.1-2b --- CDllb --- p.55 / Chapter 3.1-3 --- Purified CDllb --- p.56 / Chapter 3.1-4 --- Comparison of cell surface markers --- p.56 / Chapter 3.1-5 --- Interluekin 6 (IL-6) and C-Reactive Protein (CRP) --- p.57 / Chapter 3.2 --- Combined analysis of diagnostic markers --- p.58 / Chapter 3.3 --- Discussion --- p.58 / Chapter Chapter 4: --- Proinflammatory and anti-inflammatory cytokine response in preterm very low birthweight infants (VLBW) with systemic infections --- p.82 / Chapter 4.1 --- Results --- p.83 / Chapter 4.1-1 --- Correlation of cytokine levels in infected patients --- p.84 / Chapter 4.2 --- Subgroup analysis --- p.85 / Chapter 4.2-1 --- Proinflammatory and anti-inflammatory cytokine ratios --- p.85 / Chapter 4.2.2 --- The deceased case --- p.86 / Chapter 4.3 --- Discussion --- p.87 / Chapter Chapter 5: --- General Discussion and Conclusions --- p.97 / Chapter 5.1 --- General Discussion --- p.98 / Chapter 5.1-1 --- Cell surface markers --- p.98 / Chapter 5.1-2 --- Infection markers with prognostic significance --- p.100 / Chapter 5.1-3 --- Limitations of infection markers in clinical applications --- p.100 / Chapter 5.2 --- Conclusions and future development --- p.102 / Chapter 5.2-1 --- Conclusions --- p.102 / Chapter 5.2-2 --- The future development --- p.102 / References --- p.105

Background: Docosahexaenoic acid (DHA), choline and uridine-5-monophosphate (UMP) are important brain nutrients which form phosphatidylcholine, the most abundant brain membrane phospholipid. DHA, choline and UMP supplementation increases rodent brain phospholipids, synaptic components, functional brain connectivity and cognitive performance. This novel pilot study supplemented infants at risk of neurological impairment (ARNI) with a nutrient combination containing these neurotrophic compounds. Aims: 1) In a double blind randomised control trial (RCT), investigate if intake of a specific nutrient combination improves neurodevelopmental and visual outcome in infants ARNI. 2) Using novel measures of cortical visual function, investigate the effect of perinatal brain injury severity, gestational age at birth and sex upon visuocognitive development in infants at risk of neurodevelopmental impairment. Method: Recruitment was from UK neonatal units. Eligibility: ≤ 31 weeks, weight < 9th percentile; < 31 weeks with ≥ Grade II intraventricular haemorrhage (IVH) or preterm white matter injury (PWMI); 31-40 weeks with ≥ Grade II IVH or PWMI, ≥ Sarnat Grade II HIE or defined brain MRI abnormalities. Stratification was by sex, gestation and brain injury severity. Randomised infants received neurotrophic supplementation or placebo, for 2 years. Primary outcome was Bayley Scales of Infant Development III (BSID III) composite cognitive score (CCS) after 2 years. Secondary outcomes included BSID III composite language score (CLS) and BSID III composite motor score (CMS). Cortical visual measures were pattern reversal visual event related potential (PR-VERP) latency (transient and calculated), orientation reversal visual event related potentials (OR-VERP), and the Fixation Shift test (FS). Functional behavioural vision was assessed using the Atkinson Battery of Child Development for Examining Functional Vision (ABCDEFV). Local Ethics Committee approval was granted. Results: 62 neonates were recruited. After 2 years, mean CCS in the intervention group was 87.7 (SD 20.4) and 81.6 (SD 18.5) in the placebo group (mean difference = 2.28, p=0.13; -0.2, 18.2). Mean CLS in the intervention group was 91.5 (SD 20.1) and 83.2 (SD 19.6) in the placebo group (mean difference = 2.74, p=0.1; -2.4, 18.3). CMS was similar in both groups. In relation to trial visual outcome measures, more infants in the placebo group gave a statistically significant OR-VERP response than in the intervention group (p=0.03). There were no statistically significant differences between the placebo and intervention on any other trial visual outcome measure. Cohort analyses indicate that transient PR-VERP latency is prolonged in children at risk of neurodevelopmental disability compared to typically developing infants (mean difference = -23.3, p=0.015, 95% CI -42.10 - -4.54). Calculated PR-VERP latency is prolonged to an even greater extent in children at risk of neurodevelopmental disability compared to typically developing infants (mean difference -148.6, p=0.000, 95% CI -179.7- -117.43), and remains prolonged across the age range tested. Conclusions: 1) The difference in CCS and CLS between intervention and placebo groups represents a clinically significant effect size. Use of neurotrophic micronutrient supplementation in infants ARNI warrants exploration in a large multicentre RCT. 2) Calculated PR-VERP latency may be a more appropriate outcome measure of cortical visual function than transient PR-VERP latency in infants at risk of neurodevelopmental disability.

Tang, Leung Sang Nelson. / "February 2002." / Thesis (M.D.)--Chinese University of Hong Kong, 2002. / Includes bibliographical references (p. 185-206). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web.

Background: Lung clearance index (LCI), obtained by multiple breath washout testing (MBW), is a sensitive measure of lung disease in infants. It has been identified as a particularly suitable endpoint for clinical trials in cystic fibrosis (CF), but has potential applications in many other conditions. However, MBW in infants presents a number of technical challenges. Conventional MBW is based on simultaneous measurement of flow and gas. These two signals are then aligned and combined to derive expired gas volumes and measures of ventilation inhomogeneity: this process becomes increasingly vulnerable to errors in gas signal alignment at rapid respiratory rates. At present, no existing system for infant MBW meets all the criteria set out in international guidelines, and there is no simple method of assessing lung function outside research laboratories in this population. This thesis describes an alternative method of performing MBW in infants. In this method, expired gas is collected and analysed to derive functional residual capacity (FRC) and LCI. There is no need to simultaneously measure flow, and therefore no need for the complicated step of integrating flow and gas signals. Dead space is also significantly reduced by removing the flowmeter. Methods: In the first phase of testing, an existing lung model was modified to generate realistic infant breathing parameters with high accuracy. The prototype system was modified to improve accuracy and subsequently tested at FRC of 100-250mls with respiratory rates of 20-60min-1. In the second phase, testing proceeded to an in vivo pilot study of the novel method in children with cystic fibrosis and healthy controls. Practical applicability of the system was determined by the number of successful duplicate tests, and within-subject repeatability. Comparison was made with LCI measurements obtained using a respiratory mass spectrometer, currently considered the gold standard for infant LCI. Results: In a total of 103 tests performed in the lung model, overall mean error (standard deviation) of FRC measurement was -1.0(3.3)%, with 90% of tests falling within +/-5%. 13 patients were excluded from the clinical study due to being unsedated or inadequately sedated and therefore failing to tolerate the test. A total of 25 patients (7 children with CF, 18 healthy control children) were deemed to be adequately sedated at the start of the test, of these 20 patients (7 with CF) successfully underwent duplicate testing (80% success rate). Mean FRC for healthy controls was 19.5ml/kg, and mean LCI 6.45. For children with CF, mean FRC was 21.8ml/kg and mean LCI 6.98. Mean within-subject coefficient of variation for FRC was 7.18% and for LCI 5.94%. Of 4 infants assessed with both the novel method and the respiratory mass spectrometer, there was good correlation in FRC measurement (mean difference -8.1%). Comparison of LCI with the mass spectrometer was affected by technical difficulties with the test; in those patients who underwent technically adequate tests with both methods, mean difference in LCI between the two methods was 1.65%. Discussion: FRC measurement using the novel method has superior accuracy in vitro than previously described systems. Data from the pilot study suggest that this is a feasible and reproducible method of performing LCI in infants and young children, as long as they are adequately sedated. Results in both children with CF and controls fall within the expected range, and well within accuracy limits set by international guidelines. However, the system and testing protocol could be further improved to reduce the number of technically inadequate tests having to be excluded. This could provide a more accessible alternative to previously described systems for infant MBW.

Orientador: Maria Alice Faria / Banca: Dagoberto Buim Arena / Banca: Maria Aparecida B. de Camargo / Resumo: Esta pesquisa tem por objetivo o estudo do livro infanto-juvenil O boy da Via Láctea, de Regina Chamlian; a escritora usou o intertexto e se baseou em O capote do escritor russo Gogol recriando o texto adaptando-o aos nossos dias. Procuramos na primeira parte definir literatura e literatura infanto-juvenil; discutimos em seguida as nuances da literatura infantil, infanto-juvenil e a pedagogia numa tentativa de esclarecimentos sobre estes assuntos polêmicos. Nosso trabalho abordou também o conceito de leitura partindo dos métodos utilizados no Brasil para o aprendizado até o conceito de texto e sua diversidade, existente nos Parâmetros Curriculares Nacionais (PNCs). Em seguida analisamos literariamente o texto de Chamlian, O boy da Via Láctea e o conto de Gogol, O capote comparando-os, já que há uma intertextualidade declarada por parte da autora citada. A segunda parte compreendeu a recepção do texto e para isso utilizamos a transcrição de uma entrevista realizada com alunos de uma oitava série de uma escola pública de Assis, SP, no ano de 2000. / Abstract: This research aimed at the study of the infant-juvenile book: O boy da Via Láctea , by Regina Chamlian; the writer used the intertext and was based on O capote, by the Russian writer Gogol recreating the text and adapting it to the today's world. We sought in its first part to define literature and infant-juvenile literature; and after that, we discussed the nuances of infant literature, infant-juvenile literature and the pedagogy in an attempt to explain these polemic subjects. Our work also approached the concept of literature from the learning methods in use in Brazil to the concept of text and its diversity, present in the Parâmetros Curriculares Nacionais (PCNs). After that, we analyzed the text O boy da Via Láctea, by Chamlian and the short story, O capote, by Gogol comparing them as there is an intertextuality according to the first quoted author. The second part comprehended receiving of the text and for these purpose we used the transcription of an interview carried out with students of an eighth grade class in a public school in Assis - SP, in the year 2000. / Mestre

nÃo hà / As mortes desencadeadas em crianÃas menores de um ano de vida sÃo influenciadas por fatores biolÃgicos, culturais, demogrÃficos, socioeconÃmicos e assistenciais. Este trabalho teve como objetivo avaliar a evitabilidade dos Ãbitos infantis ocorridos na Secretaria Executiva Regional VI em Fortaleza-CE, em 2008 e 2009. Trata-se de um estudo do tipo ecolÃgico, descritivo e quantitativo, tendo como desfecho a ocorrÃncia do Ãbito infantil. Foram estudados 192 Ãbitos, de uma populaÃÃo de 240. As variÃveis foram agrupadas de acordo com as caracterÃsticas sociodemogrÃficas e maternas. Analisaram-se as mÃdias, medianas e IC95% de variÃveis quantitativas. Para avaliaÃÃo da evitabilidade dos Ãbitos, foram usados os critÃrios propostos pela Lista Brasileira de Mortes EvitÃveis no Sistema Ãnico de SaÃde, apÃs anÃlise pelo Comità Regional de PrevenÃÃo do Ãbito Infantil e Fetal. Em 2008,54% e 2009,52% dos Ãbitos em menores de um ano foram considerados evitÃveis pelo ComitÃ. Comprovou-se que 30% dos Ãbitos de menores de um ano ocorridos em 2008 sÃo reduzÃveis por aÃÃes adequadas de diagnÃstico e tratamento; 26% por adequada atenÃÃo à mulher na gestaÃÃo; 22% por aÃÃes adequadas de promoÃÃo à saÃde; 12% reduzÃveis por adequada atenÃÃo ao recÃm-nascido; 8% por adequada atenÃÃo à mulher no parto, e 2% reduzÃveis por aÃÃes de imunoprevenÃÃo. Dos Ãbitos evitÃveis em 2009, 44% foram classificados como reduzÃveis por adequada atenÃÃo à mulher na gestaÃÃo; 33% por aÃÃes adequadas de diagnÃstico e tratamento; 10% por adequada atenÃÃo ao recÃm-nascido; 7% por aÃÃes adequadas de promoÃÃo à saÃde; e 6% reduzÃveis por adequada atenÃÃo à mulher no parto. Os resultados encontrados podem ser utilizados para o direcionamento de intervenÃÃes efetivas que visem a diminuir a mortalidade infantil, tanto no Ãmbito da Secretaria Executiva Regional VI, como nas demais secretarias do municÃpio de Fortaleza. / Deaths triggered in children less than one year of life are influenced by biological, cultural, demographic, socio-economic and assistance factors. This study describes the epidemiology profile of infant deaths that happened in the 6th Regional Executive Office in Fortaleza-CE, Brazil, in 2008 and 2009 and assesses its avoidability according to the results of the Regional Committee for the Prevention of Infant and Fetal Death (CRPOIF). This is an ecological, descriptive and quantitative study, with the outcome of the occurrence of infant death. 192 deaths were studied in a population of 240. Variables were grouped according to maternal socio-demographic characteristics. For data processing we used the Epi-Info software version 3.5.1, with analysis of means, medians of some variables and adopted the Confidence Interval of 95%. To assess the avoidability of deaths, we used the criteria proposed by the Brazilian List of Preventable Deaths in the National Health System after being reviewed by the committee. In 2008 (54%) and 2009 (52%) of deaths in children under one year of life were considered preventable by the CRPOIF based on this list, and following the classification adopted to analyze the deaths. It was concluded that 30% of deaths of children under one year old in 2008 are avoidable by appropriate actions of diagnosis and treatment, 26% by appropriate care to women in pregnancy, 22% by appropriate actions for health promotion, 12% are avoidable by appropriate care to newborns, 8% by appropriate care to women during childbirth, and 2% reduced through actions of vaccine prevention. From the avoidable deaths in 2009, 44% were reduced through appropriate care to women in pregnancy, 33% by appropriate actions for diagnosis and treatment, 10% by appropriate care to newborns, 7% by appropriate actions to health promotion and 6% reduced through appropriate care to women in childbirth. These results can be used to address effective interventions that aim to reduce infant mortality, both within the 6th Regional Executive Office, as in the other offices of this city.

This study was designed to determine the contributions of mothers and fathers to infant social development. Nine 1 0-month-olds , 12 fourteen-month- olds, and 12 eighteen-month-olds were observed with their mothers and fathers in a laboratory situation. Parent-infant interactions were videotaped during three different episodes: Mother-infant dyad, father-infant dyad, and mother- father-infant triad. Findings revealed different interaction patterns as a result of the ages of infants and the interaction situation. Older infants and their parents engaged in more verbal behavior (responsive talk, social speech, and story reading) than younger infants and their parents. It was found that parents and infants interacted with each other more when observed in dyads than in triads. However , it is argued that situation may not be a significant factor, if the duration of interactions, is controlled for. There were no significant differences between mothers and fathers in the amount of interaction they engaged in with their infants . Likewise, there were few gender differences across age groups in parent-infant interaction. The data are discussed with respect to the importance of early interaction patterns and the need to control for interaction time when examining "second-order" effects.

Notre recherche s’intéresse au vécu du bébé dans la dyade lorsque la mère a vécu un événement traumatique et que lui ne l’a pas vécu. Pour ce faire, nous explorons l’impact du trauma maternel sur le contre-transfert d’un groupe de thérapeutes. Cette recherche qualitative est réalisée à partir d’entretiens collectifs. Des entretiens de recherche filmés mère-bébé ont été diffusé à huit focus groupes d’en moyenne cinq thérapeutes. Nous avons adopté une double méthode d’analyse du matériel : une analyse phénoménologique interprétative (Smith,2009) et une analyse psychanalytique de la dynamique groupale. Les résultats de notre étude mettent en avant la présence de manifestations contre-transférentielles intenses, s’exprimant à travers des réactions corporelles, sensorielles, verbales et affectives. L’exposition aux éléments irreprésentables du trauma, crée, une tension au sein du groupe, entraînant un repli sur des systèmes interactifs connus, et perturbe le recours aux outils de pensée habituels. L’enveloppe groupale et la fonction contenante sont particulièrement mobilisées et impactées par le récit des événements traumatiques. A travers les éprouvés sensoriels et les mécanismes d’empathie métaphorisante (Lebovici, 1998), les thérapeutes ont mis en lumière un sentiment de détresse originelle chez les bébés et des vécus d’abandon chez les plus grands. La dimension groupale favorise, cependant, le déploiement de mécanismes de défenses spécifiques permettant une relance des processus de pensée et de transformation. Cette recherche met en lumière les potentialités créatives d’un dispositif composé d’une équipe interprétante, dans la prise en charge de ces dyades, imposant la reconnaissance et l’analyse des éléments contretransférentiels et intertransférentiels. / Our qualitative research is part of a larger one which objective is to shed light on the infant’s experience in the context of his/her relationship to his/her traumatized mother. The mother’s trauma must have had occurred without the infant’s presence. Our section explores the impact of mother’s trauma on the countertransference reactions within focus groups of therapists. Eight groups composed each of four to five participants are shown a videotaped research interview of a traumatized mother and her infant. The data collected is analyzed upon the principles of two methods : the interpretative phenomenological analysis (Smith, 2009) for the narrative discourse and the psychoanalytic analysis for the groups’ dynamics. Participants’expressed intense countertransference reactions : physical, sensory, cognitive and affective reactions. Exposure to the unrepresentable traumatic elements induces high tension in the group. The latter consequently withdraw into known interactional patterns as its thinking capacity seemed corroded by the toxicity of the traumatic elements.The “group envelope” and its holding function are eminently activated and impacted by the narrative of the traumatic events.Through the sensorial receptivity and the “metaphorizing empathy” (Lebovici, 1998) process,the participants’ reactions depict the original helplessness and the experience of abandonment experienced by new borns and infants. Moreover, the group dimension fosters the deployment of specific defensive mechanisms and restores the thinking and transforming processes. Our results reveal the pertinence and creativity of group settings in the treatment of mother-infant dyads stuck in the realm of trauma transmission. A group setting offers several interpretative capacities through the identification and analysis of countertransference and inter-transferencemechanisms.