Syftet med denna litteraturstudie var att beskriva vilken aktuell vetenskap som lett till rekommendationen av att administrera sockerlösning till nyfödda barn i smärtlindrande syfte, i samband med hälstick/venpunktion. Litteraturstudien var av kvantitativ, deskriptiv art. Data analyserades med hjälp av Forsberg och Wengströms granskningsmall för randomiserade kontrollerade studier. De studier som granskades i denna uppsats visade genomgående att sockerlösningen har betydelse för smärtlindringen hos det nyfödda barnet som genomgått någon form av procedursmärta. Vad gäller styrkan på sockerlösningarna kunde konstateras att högre styrka gav bättre effekt. Utöver sockerlösningen vidtogs i studierna även andra omvårdnadsmässiga strategier för att reducera stress och smärta. Det är viktigt ur ett sjuksköterskeperspektiv att tänka på att till exempel hålla barnet varmt och bara klä av den extremitet som ska stickas i. Det anses att ett tryggt, lugnt och mätt barn visar mindre smärtreaktioner än ett hungrigt och irriterat. Författarna till denna litteraturstudie anser att man inte bara ska förlita sig på som i det här fallet sockerlösningen i smärtlindringssyfte utan se helheten då planering och eftertanke också är viktiga bitar vid provtagningar av spädbarn. Sockerlösningen skall ses som ett bra komplement i smärtlindringssyfte.

The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.

Infants with life-terminating conditions (ILTCs) are those whose conditions prevent them from living more than two years. When these infants have difficulty assimilating food and fluids orally, doctors can provide nutrition and hydration through artificial means. While artificial nutrition and hydration (ANH) can provide benefits, it can also result in complications leading to pain and/or distress in addition to that which an ILTC may already be experiencing from one or more underlying conditions. Many medical experts maintain that withholding or withdrawing ANH can help a patient’s body produce its own analgesics. I consider four categories of ILTCs: 1) infants who receive prognoses of two weeks or less; 2) infants who will live longer than two weeks but no more than two years and who are not suffering or in distress; 3) infants who are not dying, but are in distress from the use of ANH; and 4) infants who are not dying, but are in distress from their conditions and/or ANH. I argue that in addition to providing natural analgesics, withholding or withdrawing ANH is a form of comfort care that prevents the occurrence of further complications requiring additional medical treatments and keeps ILTCs content. Under certain circumstances, the withholding or withdrawing of ANH should be obligatory. As it stands, the whole of Catholic teaching on ANH is inconsistent. Operating from the sanctity-of-life ethic, the Church teaches that ANH is an ordinary, therefore obligatory, form of care. But this position contradicts the view that any form of care presenting a grave burden to a patient and/or his family is extraordinary and therefore optional. In addition, by making ANH obligatory, the Catholic Church causes families to undergo heroic suffering (i.e., enduring more than what can be expected or asked of anyone), which the Church says is not required of everyone. I argue that rethinking the Catholic position on ANH will enable the Church to offer practical moral guidance for families to comfort ILTCs, help ILTCs and their families avoid heroic suffering, and provide spiritual care families of ILTCs need, all while still respecting the sanctity of life of every person.

Bei einer MRT in Sedierung steht der potentielle Wärmeverlust über die Körperoberfläche einem Temperaturanstieg durch die Absorption von Energie aus dem Hochfrequenzfeld der Sendespule gegenüber. Bei Schädel-MRT-Untersuchungen in bereits vorliegenden Studien (1,5T, 3T) konnte mittels Ohrtemperaturmessung vor und nach der MRT ein Temperaturanstieg von 0,5 ° C bei Säuglingen und Kleinkindern gemessen werden. In der vorliegenden Arbeit sollte untersucht werden, ob bei 3T-MRT-Untersuchungen unterschiedlicher Körperregionen und Dauer in Propofol-Sedierung bei Säuglingen und Kleinkindern eine Zu- oder Abnahme der Körpertemperatur stattfi ndet und ob eine kontinuierliche Temperaturüberwachung auf der Haut eine verlässliche Messmethode ist. In der klinischen Observationsstudie wurden 50 Kinder im Alter bis zu 6 Jahren eingeschlossen und eine 3T-MRT in Propofol-Sedierung durchgeführt (ASA 1 und 2). Erstmalig erfolgte die Temperaturüberwachung kontinuierlich axillär mit einem Fiber TEMPTM Reusable Fiber-optic Surface Temperature Sensor (Invivo, Orlando/Florida, USA). Zur Kontrolle wurde die Ohrtemperatur vor und nach der MRT mit einem Infrarotthermometer First Temp Genius (Covidien Deutschland GmbH) gemessen und vegetative Reaktionen dokumentiert. Es zeigte sich ein mit der Literatur vergleichbarer signi fikanter mittlerer Temperaturanstieg auf der Haut von 36,4 ± 0,5 °C auf 36,9 ± 0,5 ° C auch bei unterschiedlichen Untersuchungszeiten und -regionen. Die nachgewiesene Erwärmung ist bei gesunden Kindern nur von geringer klinischer Relevanz. Es sind bei einer 3T-MRT-Untersuchung weder eine verstärkte Wärmezufuhr noch eine Kühlung notwendig, um Säuglinge und Kleinkinder normotherm zu halten. Ist bei speziellen Indikationen eine kontinuierliche Temperaturüberwachung notwendig, liefert ein faseroptischer Temperatursensor korrekte Daten. / In case of MRI in infants and children during propofol sedation the potential loss of body temperature confronts the temperature increase due to the absorption of energy from the high-frequency field of the transmitter coil. Therefore the physician must be aware of both effects when caring for sedated children. Objective of the present study is the effect of 3T-MRI of different body regions and scan duration on body temperature measured continuously in propofol sedated infants and children, which was not performed previously. 50 children in the age up to 6 years have been included in the observational study carried out between October 2008 and March 2009 at the Department of Pediatric Radiology, University of Leipzig. They underwent an elective 3T-MRI while sedated with propofol. The temperature monitoring has been carried out continuously axillary with a new fiber-optic sensor. For control, the tympanic temperature has been measured prior and after the MRI-examination with an infrared thermometer. A significant (p<0,05) medial temperature increase from 36,4 ± 0,5 °C to 36,9 ± 0,5 °C was evident measured axillarly with the fiber-optic sensor. Heart rate and oxygen saturation were stable throughout the MRI scan. In healthy children, the measured increase of temperature during 3T-MRI is only of minor clinical relevance. If a continuous temperature monitoring is necessary in cases with special indications e.g. critical ill children, a fiber-optical temperature sensor generates reliable data.

Thesis (D.P.H.)--University of Hawaii at Manoa, 1994. / Includes bibliographical references (leaves 119-129). / Microfiche. / x, 129 leaves, bound 29 cm

"Improved survival rates for premature infants have resulted in extended hospital stays in neonatal nurseries with consequent challenges for mothers assuming a parental role. Additionally, maternal medical complications associated with surgical birth, and a need to locate themselves in unfamiliar clinical environments, exacerbate women's experiences and transition to a maternal role competes with other roles at this time. For women living in rural and regional areas, who experience premature birth, there is additional hardship due to isolation, distance and limited support services. There has been little research on women's experiences with infants in special care nurseries in regional Australia."--(leaf ii). / Master of Nursing

Adequate nutrition is fundamental to optimal physical and cognitive growth in the second year of life. Toddlers, however, are particularly vulnerable to poor nutrition due to their high nutrient needs in relation to their body size and energy intakes. Nutrient-dense diets are therefore essential during this period. However, no practical quantitative food-based dietary guidelines directed at this age group are available to help caregivers choose nutrient-rich foods for their toddler. Such guidelines are needed not only to ensure adequate intakes of all nutrients during the period of dietary transition from infant to family foods, but also to emphasise intakes of nutrients for which toddlers are at particular risk of deficiency. Biochemical evidence suggests that iron nutrition requires special attention in New Zealand toddlers. The overall aim of this thesis was to design and assess the efficacy of practical food-based strategies for toddlers to ensure optimal nutritional status of 12-24 month old New Zealand children, with a specific focus on iron nutrition. To achieve these overall aims, the research was carried out in three stages. In the first stage, secondary data analysis of food intake data for New Zealand toddlers identified the foods commonly consumed by New Zealand toddlers, the serving sizes and frequency of consumption of these foods, and the nutrients that New Zealand toddlers are at risk of consuming in suboptimal amounts. The food intake data were obtained from 3-day weighed food intakes that had been collected on non-consecutive days in an earlier community-based cross-sectional survey of 188 randomly selected non-breastfeeding 12-24 month old urban South Island New Zealand children. In addition to describing the food consumption patterns of New Zealand toddlers, the secondary data analysis also identified that nearly 40% of New Zealand toddlers were at risk of suboptimal iron intakes. The results of these analyses were used in the second stage of the thesis to develop three food-based strategies. To do this a 4-phase approach based on linear and goal programming was used to design and hypothetically evaluate three sets of food-based strategies for 12-24 month old non-breastfeeding New Zealand children, and to identify the key problem nutrients for each set of strategies. The three sets of strategies were based on: (1) all foods consumed by toddlers including iron-fortified infant and toddler foods, (2) family foods only, or (3) family foods that are not fortified with iron. The mathematical modelling confirmed that iron was the key problem nutrient in the diets of New Zealand toddlers. The analysis showed that only food-based strategies that included a recommendation for the replacement of non-fortified cow�s milk with an iron-fortified toddler milk (500 mL), i.e. strategy set 1, achieved the Australian-New Zealand Recommended Dietary Intakes for all nutrients, including iron. In fact, inclusion of a recommendation for a substantially increased consumption of flesh foods was identified as the only possible alternative to the iron-fortified toddler milk recommendation for improving iron nutrition in New Zealand toddlers. Although the set of strategies including this flesh food recommendation did not provide as much total iron as those including the iron-fortified toddler milk recommendation, the bioavailability of the iron is likely to be greater because flesh foods provide highly bioavailable haem iron (red meat being a particularly rich source) and have an enhancing effect on the absorption of non-haem iron. The two key recommendations for achieving New Zealand toddlers� iron needs were, therefore, a recommendation to consume an iron-fortified toddler milk and a recommendation to consume substantial amounts of red meat. In the third stage, the efficacy of an increased intake of red meat or the use of an iron-fortified milk for improving biochemical iron status in healthy non-anaemic 12-20 month old New Zealand children was investigated in a 20-week partial double-blind randomised placebo-controlled intervention trial. The study also examined the effect of these two interventions on dietary iron intakes and growth, and investigated the association between the amount of meat consumed and biochemical iron parameters. Participants (n=225) were assigned to one of three groups: Meat Group (n=90), Fortified Milk Group (n=45), or Placebo Group (n=90). Children in the Meat Group were encouraged to consume two red meat dishes per day (~ 2.6 mg of iron). In the Fortified Milk Group and Placebo Group, the children�s regular milk was replaced with iron-fortified cow�s milk (1.5 mg of iron per 100 g of prepared milk), or non-fortified cow�s milk (< 0.1 mg of iron per 100 g of prepared milk), respectively. Geometric mean dietary iron intakes (95% CI) increased from 4.7 (4.1, 5.3) to 5.3 (4.7, 6.0) mg per day in the Meat Group (P=0.007), and from 4.3 (3.7, 5.0) to 10.4 (9.0, 12.2) mg per day in the Fortified Milk Group (P<0.001). These increased iron intakes differed significantly from the Placebo Group (both P<0.001), which declined from 5.1 (4.5, 5.7) to 4.6 (4.1, 5.2) mg per day during the intervention (P=0.047). Over 20 weeks, adjusted geometric mean serum ferritin concentration increased by 44% (95% CI: 14%, 82%) in the Fortified Milk Group (P=0.002), tended to decrease in the Placebo Group (14% decrease (95% CI: -27%, 1%; P=0.063)), and did not significantly change in the Meat Group (10% increase (95% CI: -7%, 30%; P=0.241)). However, because iron status declined in the Placebo Group, both groups fared significantly better than the Placebo Group: serum ferritin concentration at 20 weeks was 68% (95% CI: 27%, 124%; P<0.001) greater in the Fortified Milk Group than in the Placebo Group, and 29% (95% CI: 2%, 63%; P=0.033) greater in the Meat Group than in the Placebo Group. There were no intervention effects on haemoglobin or serum transferrin receptor concentration. The cross-sectional analysis showed that a daily intake of 1 g of red meat was associated with 0.65% (95% CI: 0.18%, 1.11%; P=0.007) higher serum ferritin concentration. No adverse effects of the interventions on the toddlers� growth were detected. In conclusion, this thesis shows that food-based strategies can be designed that, if adhered to, should ensure adequate iron status in New Zealand toddlers. Although both the iron-fortified milk recommendation and the increased red meat recommendation are likely to prevent the decline in body iron stores that can occur during the second year of life, only consumption of iron-fortified milk can successfully increase iron stores. Therefore, food-based strategies for New Zealand toddlers will need to include a recommendation that encourages the consumption of foods developed specifically for toddlers that are fortified with iron.

"Improved survival rates for premature infants have resulted in extended hospital stays in neonatal nurseries with consequent challenges for mothers assuming a parental role. Additionally, maternal medical complications associated with surgical birth, and a need to locate themselves in unfamiliar clinical environments, exacerbate women's experiences and transition to a maternal role competes with other roles at this time. For women living in rural and regional areas, who experience premature birth, there is additional hardship due to isolation, distance and limited support services. There has been little research on women's experiences with infants in special care nurseries in regional Australia."--(leaf ii). / Master of Nursing

Introduction The last national micronutrient survey of Iran showed that, in spite of a national supplementation program, the prevalence of anaemia, and zinc deficiency were 37.8% and 20% among 15-23 months old infants, respectively. Data show that more than 60% of infants do not consume supplements regular. Moreover, the current supplementation program does not provide a zinc supplement. Home fortification has been promoted as an alternative approach, where families are able to add micronutrients to home-made food for infants. The majority of efficacy trials of multiple micronutrient containing ‘Sprinkles’ powder and crushable ‘Foodlets’ tablets have been conducted in areas where maize-based complementary food is common. The potential effects of home fortification supplement in Iran are uncertain as the staple food is different (wheat and rice vs. maize in other trials) and acceptability of the Sprinkles and Foodlets is unknown. This thesis aim to assess efficacy, adherence, and acceptability of Sprinkles and Foodlets as compared with current supplement (Drops) on micronutrient status (iron, zinc, vitamin A and vitamin D) and growth in Iranian infants aged 6-18 month. Methods A total of 405 infants were recruited from Hashtgerd, 80 km west of Tehran, Iran; 43 were excluded due to not meeting the inclusion criteria. The infants were randomly assigned to receive daily supplementation of Sprinkles (n=120), Foodlets (n=121) or Drops (n=121) for four months. Sprinkles and Foodlets contain iron, zinc, vitamin A, vitamin D, folate, and multiple B vitamins similar except that levels of iron are higher in the Sprinkles group. Drops do not contain zinc, vitamin B12, or folate. The persons responsible for the laboratory test and data entry were blinded to randomization. Haemoglobin, serum ferritin, serum retinol, serum zinc, 25(OH)D concentration and anthropometric measures were assessed at baseline and four months. At each monthly phase of the follow-up, adherence to supplements and side-effects related to supplements were reported by mothers. Six focus group discussions assessed mother’s perceptions about the supplements. Within group change in means over 4 months intervention was examined by Student’s paired t-test. The within group changes in proportions were assessed using McNemar’s test. Change across the three treatment groups were compared using analysis of covariance. Ethical clearance was obtained from the ethics committee of both the University of Queensland in Australia and the Ministry of Health in Iran. Results Of the total 362 infants included in the study, 313 (86%) had complete anthropometric and haemoglobin data, and 301 infants (83%) also had both initial and final serum samples. There were no significant differences between the three groups for baseline data. Baseline data showed approximately one fourth of anaemic children had iron deficiency anaemia and 38% of infants were zinc deficient. The children had a relatively good baseline status for vitamin A, vitamin D and growth. After four months intervention mean haemoglobin increased significantly in the three groups. Serum ferritin concentration increased in the Drops group (p<0.001) and Sprinkles group (p<0.05). A significant improvement was seen in zinc status for the Sprinkles and Foodlets but not the Drops group. Mean percentage of adherence to Sprinkles, Foodlets, and Drops (total amount of supplement used divided by total amount expected to be used) was (90.4±17.25), (80.7±25.01), and (88.5±16.85) respectively. Vomiting was higher in the Foodlets compared to other groups (p<0.001). Staining of the teeth was higher in Drops than the other groups (P<0.001). Most mothers in the Sprinkles group (97.3%) preferred this supplement over current supplement whereas 87.2% of mothers in the Foodlet group preferred Foodlets over the current supplement. In the focus group discussions, mothers stated that the new supplements were more acceptable and easier to use compared to current supplement. However, they had some issues about the new supplements; for example, lack of appropriate food to add the Sprinkles or Foodlets. Conclusion The combination of multivitamins plus iron and zinc when added to wheat or rice-based complementary foods improved iron and zinc status. Combining iron and zinc in Sprinkles and Foodlets did not show negative effects on iron or zinc status. No differences were seen in efficacy of the Sprinkles and Foodlets on outcomes except a little higher improvement of iron status in Sprinkles and a slight higher weight gain of infants in the Foodlets group. According to this efficacy trial and formative study, Sprinkles had a higher acceptability in the study population and there are factors to encourage its use (easy to use, tasteless, containing all required vitamins and minerals, shape, easy to transfer, and stimulates appetite). The trial identified trade-offs in combining multiple micronutrients into a single delivery mechanism, with no benefit from addition of vitamins A and D on nutritional status in this sample of infants. We might consider different acceptability to Sprinkles in some regions by different cultural practices but in summary Sprinkles is likely to be the best option as an alternative choice to the current supplementation (Drops).

Assignment (MMed)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.