Thesis (Ph. D.)--University of Texas at Austin, 2008. / Vita. Includes bibliographical references.

Background: In the United States, sudden infant death syndrome (SIDS) is the leading cause of death in children less than one year old, and the third leading case of death in infants. In 1992, the American Academy of Pediatrics (AAP) recommended to place infants supine for sleep, and the SIDS rate declined by 50%. Despite these efforts, the SIDS rate has plateaued since 2001. With the growing number of advanced practices nurses (APN) providing care to pregnant women and infants, APNs are in a position to educate new parents on preventing SIDS using the 2011 AAP safe sleep recommendations. Yet, knowledge, attitudes, and current practices of APNs regarding SIDS risk reduction are unknown in the State of Arizona. Purpose: The purpose of this Doctor of Nursing Practice (DNP) project was to assess the attitudes, knowledge, and current practices of APNs regarding risk reduction strategies. Methods: This study was a descriptive quantitative cross-sectional survey design. Target study participants included APNs that provided care to pregnant women and/or infants up to 12 months old. The study was conducted in the State of Arizona through online surveys using the Qualtrics software. The study participants' knowledge, attitudes, and current practices were assessed using an adapted validated survey tool that included multiple choice items and responses using Likert scales. Results: Twenty-three APNs completed the survey. Knowledge about SIDs was average, with a mean score of 74% correct. Although most APNs felt it was important to educate parents about SIDS, only three-quarters of APNs provided verbal education to parents, and less than half of participants provided written information to parents. To decrease the SIDS rate, it is necessary for APNs to gain more knowledge about current safe sleep recommendations.

INTRODUCTION: Prolonged sedation treatment in neonatal pediatric populations is associated with opioid and benzodiazepine tolerance, dependence, and withdrawal syndrome. Despite the clinical relevance of this problem, we have limited knowledge of the long-term repercussions. Current literature focuses on premature neonates and suggests that opioid exposure may cause neurodevelopmental sequelae. The main objective of this literature review was to investigate what infant populations are at risk of developing short-term and/or long-term consequences from prolonged infantile sedation exposure. PUBLISHED STUDIES: A literature review was conducted on previous studies that focused primarily on the effects of opioids and benzodiazepines on infants and how it may affect the future development in these children. Studies show that short-term consequences include increased heart rate, increased respiratory rate, increased blood pressure, intracranial pressure fluctuations, and risk of further complications such as intraventriculat hemorrhage (IVH), periventricular leukomalacia (PVL), or even death. Long-term repercussions incluse the possibility of decreased brain volume, decreased head circumference and body weight, intelligence deficits, and social and behavioral issues. DISCUSSION: Standard pain and sedation management involves the use of opioids and benzodiazepines. Treatment duration and medication dosage depend on severity of the patient’s illness. Since prolonged sedation administration is often associated with tolerance and dependence, future research (such as long-term follow up of these infants at later neurological milestones) is necessary to determine possible short-term and long-term neurological and behavioural sequelae for infants exposed to prolonged treatment with opioids and benzodiazepines. Standardized pain and sedation management guidelines may also increase the effectiveness of treatment and drug administration.

Thesis (M.S.)--Boston University

Sudden infant death syndrome (SIDS) is the devastating condition in which an infant suddenly and unexplainably passes away over the course of sleeping. This is an unfortunate situation that many new parents dread every night as they lay their newborns to rest. SIDS is the leading cause of death in infants aged from one month to one year, and the medical world still does not fully understand what causes it. However, the triple-risk theory is a new model that sets out to explain the pathology of this syndrome through the combination of genetic vulnerabilities, a critical time period, and external stressors. This thesis summarizes the current research in the realm of the central nervous system (specifically the cerebellum and brainstem) as a means of evaluating the validity of this new model. The analyzed literature concentrated on a few important topics, such as proven risk factors, evidence of homeostatic abnormalities, and significant associations with the occurrence of SIDS. It was found that there was central nervous system dysfunction on most levels, including: damaged Purkinje cells in the cerebellum, malformations of the human choroid plexus, decreased neuropeptide signaling (both orexin and brain-derived neurotrophic factors), malformations of the amino acid neurotransmitters (both excitatory glutamate and inhibitory GABA), and finally significant reductions in the receptor density and activity of the serotonin system. These irregularities were associated, in most studies, with either the prone sleeping position or known maternal nicotine use during pregnancy. In conclusion, the triple-risk model is currently the most accurate description of SIDS, given its reasonable three criteria and present-day research. This is because the studies, and real-life victims, were all concentrated within the critical time period of transition from intra-uterine to extra-uterine life, satisfying the first element of timing. The list of central nervous system dysfunctions found in SIDS cases was compelling enough to fulfill the second factor of inherent vulnerability. Finally, the associations between low oxygen rebreathing and the prone sleep position, or over-heating and tight swaddling displayed a strong relationship with the occurrence of SIDS and satisfied the third and final event, which was the induction of an exogenous stressor. These three factors of the triple-risk model allow for the variations in victim pathology, but still offers a compelling and coherent understanding of the sudden infant death syndrome.

Orientador: Olga Maria Piazentin Rolim Rodrigues / Banca: Verônica Aparecida Pereira / Banca: Ligia Ebener Melchiori / Resumo: A literatura aponta que uma interação satisfatória entre mãe e filho pode ser considerada um preditor do bom desenvolvimento infantil, pois, pode atenuar os efeitos dos fatores de risco. A chegada de um bebê que apresente algum tipo de deficiência, pode se configurar em um momento de tensão para essa mãe, pois requer adaptações e apresenta desafios ainda mais intensos. Dentre as inúmeras condições que podem afetar a infância, a Síndrome de Down (SD) destaca-se por provocar alterações globais no desenvolvimento e ter uma alta incidência na população mundial e nacional. O presente trabalho objetivou descrever, comparar e correlacionar os comportamentos interativos e não-interativos infantis e maternos, considerando os grupos de mães e bebê com e sem SD, com base em grandes categorias e subcategorias comportamentais. Participaram do estudo, 50 díades mãe-bebê com idade entre quatro e seis meses, divididas em dois grupos: 25 mães e seus bebês com SD e 25 mães e seus bebês sem SD. Foi utilizado um Instrumento para Coleta de Informações Sociodemográficas (ICIS) elaborado para este estudo e para análise da interação mãe-bebê foi utilizado o Sistema de Codificação da Interação Mãe-Criança Revisado (CITMI-R), versão brasileira, adaptado de Alvarenga e Cerezzo (2013). O instrumento prevê categorias gerais, referentes aos comportamentos infantis (interativos: Aproximação Social Positiva, Negativa e Neutra e, nãointerativos: Jogo, Regulação, Choro ou Protesto, Apatia e Movimentos de Prot... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The literature indicates that a satisfactory interaction between mother and child can be considered a predictor of child development and may attenuate the risk factors. The arrival of a baby that presents some type of disability, can be configured in a moment of tension for this mother, because it requires adaptations and presents even more intense challenges. Among the many conditions that can affect childhood, Down Syndrome (DS) stands out because it causes global changes in development and presents a high incidence in the world and national population. The present work aimed to describe, compare and correlate the interactive and noninteractive infant and maternal behaviors, considering the groups of mothers and babies with and without SD, based on behavioral categories and subcategories. Participated in the study, 50 mothers and their infants between four and six months of age, divided into two groups: 25 mothers and their babies with SD and 25 mothers and their babies without SD. An Instrument for Collecting Sociodemographic Information (ICIS), prepared for this study was used and for the analysis of the interaction, Early Mother-Child Interaction Coding System (CITMI-R), Brazilian version, adapted from Alvarenga and Cerezzo (2013). The instrument provides for general categories related to children's behaviors (interactive: Positive Social Approach, Negative and Neutral and noninteractive: Game, Regulation, Cry or Protest, Apathy and Protest Movements) and, referring to maternal behavior (interactive: Sensitive Positive, Negative and Neutral and non-interactive: Protective and non-responsive). The results showed that although the group of mothers of infants without SD had higher behavioral variability, the groups did not show marked qualitative differences in the behaviors analyzed. Regarding children's behaviors, although differences were observed... (Complete abstract electronic access below) / Mestre

This research explores the concept of descendant insurance and its efficiency as a calculated estimate of a country's fertility rates based on the infant or child mortality rates of the same country. A database of 191 countries was used to evaluate the concept by nation. The results suggest that descendant insurance plays a significant roll in decreasing total fertility rates. Prediction strength for many countries can be increased greatly by incorporating time lags into the model. Adding a lag component produced strong results for predicting fertility rates in countries where many previous studies have failed to find significant fertility trends. The results of the analysis provide further evidence for the argument that preventing infant and child deaths is a driving factor for decreasing fertility rates.

Infants acculturate to their soundscape over the first year of life (e.g., Hannon & Trehub, 2005a; Werker & Tees, 1984). This perceptual tuning of early auditory skills requires integrating across experiences that repeat and vary in content and are distributed in time. Music is part of this soundscape, yet little is known about the real-world musical input available to infants as they begin learning sounds, melodies, rhythms, and words. In this dissertation, we collected and analyzed a first-of-its-kind corpus of music identified in day-long audio recordings of 6- to 12-month-old infants and their caregivers in their natural, at-home environments. We characterized the structure of this input in terms of key distributional and temporal properties that shape learning in many domains (e.g., Oakes & Spalding, 1997; Roy et al., 2015; Vlach et al., 2008; Weisleder & Fernald, 2013). This everyday sensory input serves as the data available for infants to aggregate in order to build knowledge about music. We discovered that infants encountered nearly an hour of cumulative music per day distributed across multiple instances. Infants encountered many different tunes and voices in their daily music. Within this diverse range, infants encountered consistency, such that some tunes and voices were more available than others in infants’ everyday musical input. The proportion of music produced by live voices varied widely across infants. As infants progressed in time through their days, they encountered many music instances close together in time as well as some music instances separated by much longer lulls. This bursty temporal pattern also characterized how infants encountered instances of their top tune and their top voice – the specific tune and specific voice that occurred for the longest cumulative duration in each infant’s day. Finally, infants encountered many pairs of consecutive music bouts with repeated content – the same unique tune or the same unique voice. Taken together, we discovered that infants’ everyday musical input was more consistent than random in both content and time across infants’ days at home. These findings have potential to inform theory and future research examining how the nature of early music experience shapes infants’ early learning.

Made available in DSpace on 2016-08-29T14:10:16Z (GMT). No. of bitstreams: 1 tese_3971_.pdf: 1541004 bytes, checksum: cfe150b01f1498528604628248ec2636 (MD5) Previous issue date: 2011-08-26 / O presente estudo teve por objetivo investigar a relação entre o jogo simbólico coletivo e o desenvolvimento da linguagem em crianças de educação infantil em uma perspectiva piagetiana. Participaram desta pesquisa quatro crianças, entre 5 e 6 anos de idade, provenientes de uma Escola de Educação Infantil do Município de Vitória. A coleta de dados foi realizada em seis encontros com o grupo, com intervalo de, aproximadamente, quinze dias entre eles. Em cada situação as crianças foram convidadas a brincar de faz-de-conta em um espaço, que simula uma casa (oficina de jogo simbólico), durante 20 minutos. Os encontros foram filmados em áudio e vídeo e, posteriormente, transcritos e analisados com base nas classificações de Piaget (1990), para o jogo simbólico e para a linguagem (1973). A análise e interpretação dos dados receberam um tratamento qualitativo. A pesquisa procurou analisar o processo evolutivo de cada criança no jogo simbólico e na linguagem e a possível relação entre os dois. Os resultados obtidos nos permitiram verificar que houve uma estrita relação entre os aspectos evolutivos do jogo simbólico e da linguagem em todos os participantes, sendo que houve predominância de ações próprias da Fase II do jogo simbólico e de falas do Estágio II de conversação. A partir desses resultados, observamos que a oportunidade de se envolver no jogo simbólico coletivo, em um espaço que estimule a representação, pode desenvolver nas crianças a linguagem socializada. Assim sendo, este trabalho contribui para demonstrar a importância da preservação do espaço lúdico e simbólico nas escolas de educação infantil.

A controlling maternal feeding style can have negative consequences for child weight and eating style (Ventura & Birch, 2008). Mothers who breastfeed during the first year exert lower levels of control over child feeding (Farrow & Blissett, 2008). Explanations for this relationship speculate that experience of breastfeeding reduces control as breastfeeding requires an infant-led approach (Taveras et al. 2004) or alternatively that maternal attitudes predict both initiation of breastfeeding and later maternal control (Farrow & Blissett, 2006a). The nature of this relationship is explored in this thesis. Mothers reported their intended and actual feeding style during milk feeds when pregnant and at six months postpartum using a modified version of the Child Feeding Questionnaire (Birch, Fisher, Grimm-Thomas, Markey, Sawyer, & Johnson. 2001). Maternal use of control in the form of scheduling and encouraging milk feeds was evident. A high level of control was associated with a shorter breastfeeding duration (p < 0.001). Control beliefs were present prenatally with intended breastfeeding duration inversely associated with intended control. Furthermore, attitudes towards the infant-led nature of breastfeeding were associated with both breastfeeding duration and control. Breastfed infants need to be fed to infant demand and amount consumed is immeasurable whilst formula feeding is open to maternal manipulation. A belief that breastfeeding was inconvenient was associated with scheduling feeds whilst concerns over milk intake and low confidence were associated with encouraging feeds. Whilst scheduling feeds was a stable behaviour predictive from prenatal intention, encouraging feeds was fluid and related to maternal experience. Concerns about infant size or feeding difficulties increased use of encouraging feeds. Maternal desire for control may therefore drive breastfeeding duration, explaining the association between breastfeeding and later feeding style. The findings have important implications for breastfeeding duration, early programming of appetite and bodyweight and later maternal feeding style.