Thesis--University of Oklahoma. / Bibliography: leaves 117-122.

Made available in DSpace on 2015-07-22T20:50:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-01-28 / Objetivo: verificar a ocorrência das alterações auditivas em recém nascidos que participaram do Programa de triagem auditiva neonatal de um Hospital Público (UNIFESP- Brasil) no período de 2005 a 2007 e verificar se os recém nascidos que falharam na triagem auditiva por comprometimento condutivo tem mais episódios de perda condutiva durante os primeiros anos de vida do que aqueles que não falharam. Métodos: 0 estudo foi dividido em duas partes. A primeira parte foi retrospectiva analisando-se 0 diagnóstico audiol6gico de 231 (de mil novecentos e noventa e seis) recém nascidos que falharam na triagem auditiva e sua associação com a idade gestacional, 0 peso ao nascimento e as principais intercorrências neonatais. Na segunda parte compararam-se os 62 recém nascidos que falharam na triagem auditiva por comprometimento condutivo com os 221 recém nascidos que passaram na triagem auditiva. Foi feito 0 acompanhamento por meio de EOAT, imitanciometria e avaliação comportamental. Foram utilizados para analise estatística 0 teste Exato de Fisher e modelos de Regressão Logística. Resultados: A incidência de alterações auditivas na população estudada foi de 11,5%, sendo 8,4% de perda condutiva, 1 % de perda neurossensorial, 2% de alteração central. As crianças que falharam na triagem por alteração condutiva tiveram mais episódios de perda condutiva (estatisticamente significante) durante 0 primeiro ano de vida que as crianças que não falharam. Conclusões: Houve maior ocorrência de perda auditiva condutiva dentre as alterações auditivas estudadas. Os neonatos que falharam na triagem auditiva neonatal no primeiro mês de vida por alteração condutiva tem maior chance de terem perda auditiva condutiva ao longo do primeiro ano de vida. / TEDE / BV UNIFESP: Teses e dissertações

O cateter central de inserção periférica (PICC) é um dispositivo cada vez mais utilizado nas Unidades de Terapia Intensiva Neonatal (UTIN). O objetivo do estudo foi caracterizar os neonatos (RN) submetidos ao procedimento de inserção do cateter PICC e descrever suas práticas de inserção, manutenção e remoção em RN. Estudo observacional com delineamento longitudinal realizado no Berçário Anexo à Maternidade do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os dados foram obtidos pela observação dos procedimentos e informações registradas nos prontuários dos neonatos submetidos ao procedimento. No estudo, incluíram-se todos os procedimentos de inserção, manutenção e remoção de cateter PICC ocorridos entre de março e setembro de 2006, em recém-nascidos internados na unidade neonatal citada. Antes do início da coleta dos dados, o projeto de pesquisa foi apreciado e aprovado pelo Comitê de Ética em Pesquisa da Instituição, campo do estudo. No período estudado, ocorreram 37 procedimentos de inserção do cateter PICC. A média da idade gestacional e o peso dos RN eram de 32,2 semanas e 1.289,2 gramas, respectivamente. A maioria, 22 (59,4%) RN, era do sexo masculino, 18 (48,7%) RN tinham menos de três dias de vida no dia do procedimento e 35 (94,6%) RN foram submetidos à inserção do cateter para infundir nutrição parenteral total. A maioria, 21 (56,8%) RN, apresentou diagnóstico de síndrome do desconforto respiratório. A administração de fármaco sedativo previamente ao procedimento ocorreu em 4 (10,8%), nenhum RN recebeu analgesia. O tipo de cateter mais utilizado foi o de poliuretano, 35 (94,6%). A média da freqüência de punções venosas foi 3,4 e em 8 (21,6%) RN foram obtidos sucesso na introdução do cateter na primeira punção venosa. As veias mais puncionadas foram as localizadas em membros superiores, a basílica foi puncionada em 29,9% dos RN e a cefálica, em 22,8% dos RN. Fragilidade vascular, transfixação venosa e obstrução do cateter foram os principais motivos de insucesso na inserção do PICC. Alteração da viscosidade sangüínea foi uma intercorrência identificada pelas enfermeiras na inserção do PICC. A prevalência de sucesso do procedimento foi de 64,9% (24 RN). Obteve-se posicionamento central da ponta do cateter em 20 (83,3%) RN e periférico em 4 (16,7%) RN. A média da extensão do cateter introduzido em MSD foi de 11,4 cm, em MSE, 13,5cm e em região cervical, 7,1 cm. Solução de clorexidina a 0,5% foi o anti-séptico mais utilizado nos curativos e a NPT foi a solução mais infundida pelo cateter. O tempo médio de permanência do cateter foi 8,9 dias, 11 (27,5%) foram removidos em decorrência de infecção do cateter, 7 (17,5%) pelo término da terapia intravenosa e 7 (17,5%) por obstrução. Dos 24 cateteres removidos, 14 (58,3%) foram enviados para cultura, dos quais, 10 (71,4%) tiveram resultado negativo. Das quatro pontas com resultado positivo, em duas (14,3%) foram identificados Estafilococos coagulase negativa / The peripherally inserted central catheter (PICC) are increasingly employed in the neonatal intensive care units. The aims of the study were to characterize the neonates who underwent PICC catheter insertion and to describe insert, upkeep and removal PICC catheter practices in neonates. Prospective cohort study carried out at Neonatal Intensive Care Unit of University of São Paulo School Medical Hospital. Data were obtained by nurse procedures performance observation and from the medical chart records of the neonates who underwent PICC catheter insertion. Data were collected from March to September, 2006 and all the neonates underwent PICC catheter insertion during this period were included in the study. The study protocol was approved by the Research Ethics Board of the Hospital where the study was carried out. Written informed consents were obtained from parents or legal guardian of all infant newborns underwent PICC catheter insertion and from certified registered nurses responsible for catheter insertion, maintenance of the line and for removal it. It was obtained data from 32 infants newborn underwent procedure of PICC catheter insertion. The gestacional age and infant weight mean were, 32.2 weeks and 1289.2 g, respectively; 22 (59.4%) neonates were male, the PICC catheter was inserted in 18 (48.7%) neonates in the first three days of life and 35 (94.6%) babies were underwent PICC insertion to provide total parenteral nutrition; 21 (56.8%) neonates had diagnosis of respiratory distress syndrome, any of them received analgesics and 4 (10,8%) newborns received sedation. The polyurethane catheter was more used, 35 (94,6%) than the silicone catheter, 2 (5,4%). The mean of venous puncture frequency was of 3.4 and the rate success obtained in the first attempt was 21,6% (8 newborn). The most accessed veins for insertion PICC lines were basilic, 29,9% and cephalic, 22,8%. Vascular fragility, venous transfixation and obstruction were the majorities causes of failure to insert the PICC line. The frequency of success on PICC line insertion was 64,9% (24 neonates). The position of tip catheter in 83,3% (20 neonates) was central (superior vena cava), others 16,7% (4 neonates) tips was peripherally. The length of catheter line mean to thread in right arm veins was 11,4 cm, in the left arm,13,5cm and in the jugular vein was 7,1 cm. It was used chlorhexidine 0.5% antiseptic solution in the majority of catheter insertion site dressing. Total parenteral nutrion was the soluction infused by the catheter line. The mean time of remaining the catheter was 8.9 days, 11(27,5%) catheters were withdrawn due to suspect of catheter infection, 7(17,5%) catheters withdrawn after end the intravenous therapy and 7 (17,5%) due to obstruction. From 24 catheters withdrawn, 14 (58,3%) tip catheters were underwent to microbyological analysis and the results were negative for 10 (71,4%) analysis, from others four tips catheter which results were positive, in two (14,3%) identified coagulase-negative staphylococci

A necessidade de usar a idade corrigida nos recém-nascidos pré-termos (RNPTs) ao avaliar o desenvolvimento motor (DM) é um assunto controverso. Para verificar a necessidade de usar a correção de idade nos primeiros seis meses de idade corrigida, 43 RNPTs foram analisados, por meio da Alberta Infant Motor Scale (AIMS), como um todo e divididos em dois grupos segundo a idade gestacional. Os resultados sugerem que há diferença estatística significativa no DM, quando se utiliza a idade cronológica. Portanto, há necessidade de corrigir a idade, para não subestimar o DM dos RNPTs, classificando-os como atrasado / The need of using the corrected age in pre-term infants (PT) to assess the motor development (MD) is a controversial issue. To verify the need of using the corrected age, during the first six months the corrected age, 43 PT were analysed according to Alberta Infant Motor Scale (AIMS), as one group and as divided into two groups according to gestational age. The results suggested that there is statistically significance in the MD, when the chronological age is used. In conclusion, there is the need of correcting the age, in order not to under-estimate the MD of PT, classifying them as delayed

Realizamos um estudo de corte transversal para investigar os fatores de risco para colonização de recém-nascidos por Klebsiella pneumoniae produtora de betalactamase de espectro estendido durante surto em unidade neonatal de risco intermediário. O surto se deveu à colonização crônica de profissional de saúde portadora de onicomicose. Cento e vinte recém-nascidos internados na unidade neonatal durante um período de três meses foram rastreados para colonização por Klebsiella pneumoniae produtora de ESBL através de cultura de swab retal, sendo detectados 27 colonizados. A análise multivariada mostrou que a colonização se associou de forma independente ao uso prévio de antimicrobianos e à ausência de aleitamento materno. Os antimicrobianos mais utilizados foram penicilina e amicacina. Uso prévio de antimicrobianos apresentou odds ratio (OR) igual a 12,3 [intervalo de 95% de confiança (IC): 3,66-41,2, P<0,001]. Aleitamento materno foi associado à redução do risco de colonização (OR: 0,22; IC95%: 0,05-0,99; P=0,049). Nove isolados recuperados no primeiro estágio do surto e 27 isolados de culturas de rastreamento foram posteriormente tipadas por eletroforese em gel de campo pulsado, revelando seis apresentações distintas (A a F). No primeiro estágio do surto ocorreram os clones A, C e E, enquanto entre os 27 isolados das culturas de rastreamento os seis clones foram identificados. O clone A também foi identificado nas mãos de técnica de enfermagem portadora de onicomicose. Pudemos concluir que uso prévio de antimicrobianos predispôs à colonização. O possível efeito do aleitamento materno como fator protetor deve ser mais bem investigado. A detecção de diferentes genótipos de K. pneumoniae sugere que a disseminação de elementos móveis portando o gene ESBL tenha se superposto à simples disseminação de um clone durante o surto / We describe a cross-sectional survey to identify risk factors for colonisation of neonates by extended-spectrum beta-lactamase producing Klebsiella pneumoniae. This occurred following exposure to a colonised healthcare worker during an outbreak in an intermediate-risk neonatal unit. In total, 120 neonates admitted consecutively during a three-month period were screened for ESBL-producing K. pneumoniae by rectal swabbing and 27 were identified as colonised. Multivariate analysis showed colonisation to be independently associated with use of antibiotics and absence of breastfeeding. Previous use of antibiotics presented an odds ratio (OR) of 12,3 [95% confidence interval (CI): 3,66-41,2, P<0,001]. The most commonly used antibiotics were penicillin and amikacin. Breastfeeding was associated with reduced risk for colonisation (OR: 0,22; 95% CI: 0,05-0,99; P=0,049). Nine isolates recovered during the first stage of the outbreak and 27 isolates from surveillance cultures were typed thereafter by pulsed-field gel electrophoresis, revealing six different profiles (A - F). Clones A, C, and E were implicated in the first stage of the outbreak, whereas among the 27 strains recovered from surveillance cultures, all six clones were identified. Clone A was also found on the hand of a nursing auxiliary with onychomycosis. We concluded that prior antimicrobial use predisposed to colonisation. The possible role of breastfeeding as a protective factor needs to be further elucidated. Detection of different genotypes of ESBL-producing K. pneumoniae suggests that dissemination of mobile genetic elements bearing the ESBL gene may have been superimposed on the simple dissemination of a clone during the outbreak

O objetivo deste estudo foi construir uma variável para representar a qualidade da assistência ao recém-nascido em estudos populacionais a partir da definição de critérios para as etapas assistenciais visando elaboração de um algoritmo para categorização de condição clínica e identificação de cuidados assistenciais mínimos ou básicos para aquela condição. Realizada revisão da literatura sobre diretrizes para atenção ao recém-nascido foram definidas condições clínicas que se diferenciam pelos procedimentos assistenciais básicos que necessitam receber e foi elaborado um tutorial para a composição da variável assistência ao recém-nascido e que permitisse a aplicação de um algoritmo. Foram criados critérios para definição de quatro etapas assistenciais e verificação da adequação/inadequação em cada uma delas, assim como o peso entre elas para composição da variável síntese. O algoritmo foi aplicado aos dados coletados em prontuários médicos em dois estudos de mortalidade neonatal precoce, um de tipo caso controle e outro uma coorte de recém-nascidos com peso < 1500 g, parte de projeto de pesquisa de mortalidade perinatal, desenvolvido na Região Sul do Município de São Paulo, referente ao período de agosto 2000 a fevereiro 2001. Na primeira etapa assistencial denominada manejo e reanimação na sala de parto encontrou-se para a coorte percentual de adequação para os óbitos e para os sobreviventes acima de 75%. No estudo caso-controle o percentual de adequação ficou próximo a 80% entre os casos e entre os controles foi de 98,7%. Na segunda etapa, denominada berçário utilizado, o percentual de adequação entre os óbitos na coorte foi de 66%. e de 78% para os sobreviventes, sendo que em 17% dos eventos não foi possível obter classificação. No estudo caso-controle, entre os casos o percentual de adequação foi de 67%, o percentual de \"sem classificação\" foi superior a 18% e cerca de 10% dos recém-nascidos morreram na sala de parto. Para os controles o percentual de adequação foi de 97%. Na terceira etapa, denominada procedimentos diagnósticos, o percentual de adequação na coorte atingiu pouco mais de 50% nos óbitos e o percentual de \"não classificados\" foi 26%, e nos sobreviventes a adequação chegou a 73% e os \"sem classificação foi de 20%. No estudo caso-controle, entre os casos , o percentual de adequação foi de 60% e 1 em 4 não puderam ser classificados e nos controles em quase 80% os procedimentos foram adequados e em menos de 15% não foi possível obter classificação. Na quarta etapa, denominada procedimentos terapêuticos, encontrou-se para a coorte percentual de adequação para os óbitos de quase 50% e em mais de 20% deles não foi possível classificar e entre os sobreviventes a adequação foi de 42% e os \"sem classificação\" somaram mais de 20%. No estudo caso-controle, entre os casos o percentual de adequação foi de 49% e os \"sem classificação\" perfizeram 23% e nos controles a adequação foi de 76% e menos de 5% ficou sem classificação. Na coorte o percentual de adequação da variável composta assistência ao recém-nascido foi de 65% para os óbitos e 81% para os sobreviventes e 16% dos eventos não puderam ser classificados. No estudo caso-controle, o percentual de adequação da variável composta entre os casos foi de 70% e 97% para os controles Não foi possível classificar 17% dos casos e 2,2% dos controles. Os resultados encontrados apontam para a viabilidade de aplicação do algoritmo em estudos epidemiológicos e plausibilidade clínica na aplicação e revelaram percentuais menores de adequação para os recém-nascidos mais graves, que têm risco de morrer mais elevado, necessitando de uma assistência diferenciada que procure atuar sobre as condições que levam a esse risco aumentado, exigindo dos serviços de saúde a presença de recursos materiais e humanos mais especializados, nem sempre disponíveis nos serviços. / The objective of this study was to develop a variable to measure the quality of newborn care in population studies, with the definition care phases, in order to develop an algorithm capable of categorizing clinical conditions and corresponding minimal or basic care needs. Literature review identified guidelines for neonatal care and the identification of essential clinical conditions and their basic care needs and a tutorial was developed with the definitions that permitted the application of an algorithm to clinical information registered in hospital records. Criteria for the definition of adequacy of care for 4 phases were created, and their corresponding weight in total adequacy of care. The algorithm was applied to data obtained from medical hospital records in two studies of early neonatal mortality, a case-control and a cohort of newborns weighing < than 1500 g, part of a research project of perinatal mortality, developed in the South Region of the City of São Paulo, with data from august 2000 to February 2001. For the initial phase of care, of management and resuscitation after birth, the proportions of adequacy of care in the cohort was > 75% for both deaths and survivors. In the case-control study the proportion of adequacy of care was near 80% for the cases and 98% for the controls. In the second phase of care, type of neonatal care unit, for the cohort the proportion of adequacy of care was 66% for deaths and 78% for the survivors, and 17% of the events could not be classified. In the case-control study, for the cases the proportion of adequacy was 67%, nearly 10% died before removal from the labor room, and 18% of the events could not be classified. For the controls the proportion of adequacy was 97%. In the third phase of care, called diagnostic procedures, the proportion of adequacy for the cohort was 50% for the deaths, with 26% of the events not classified, and for the survivors adequacy was 73% and no classification was 20%. For the case-control, the proportion of adequacy of cases was 60%, with 1 in 4 of the events not classified, and for controls adequacy was nearly 80% and 15% not classified. In the fourth phase of care, called therapeutic procedures, the proportion of adequacy for the cohort was nearly 50% for the deaths, 20% of the events not classified, and 42% for the survivors, with 20% not classified. For the case-control, in cases adequacy was 49%, not classified 23%, and in controls adequacy was 76%, and less than 5% not classified. For the composite variable adequacy of care, in the cohort, care was classified as adequate for 65% of deaths and 81% of the survivors, and 16% could not be classified. In the case-control, care was classified as adequate for 70% of the cases and 97% of the controls, and 17% and 1% respectively could not be classified. The results indicate that the algorithm is viable for use in epidemiological studies and has clinical plausibility, and revealed lower proportions of adequacy for the sicker newborns, with higher death risk, who need more specialized care, in order to be able to intervene on those conditions that lead to this higher risk, thereby demanding more human and material resources, not always available in these services.

This study was designed to discover parents' experience following a stillbirth or early infant death. The conceptualization of the research problem was based on Kleinman's (1978) cultural system model which directed the researcher to elicit directly from clients their explanatory models, or their way of viewing the experience. The specific research questions were (1) How do couples perceive and interpret their experience following stillbirth or early infant death? and (2) How do couples view the social support they have received at the time of their infant's death? Six couples, who were recruited primarily from bereavement support groups, participated in the study. Each couple had experienced a stillbirth or early infant death between four months and four years prior to the study. Data were collected from the subjects with the use of unstructured interviews, allowing the experiences to unfold as they were perceived by the participants. Four main themes that evolved from the data were (1) anticipation of parenthood and the shattering of hopes with the death or knowledge of impending death of the infant; (2) a multidimensional personal grief experience; (3) an interpersonal grief exerience influenced by the social support of health care professionals, of friends and family and of the spouse; and (4) reflection and search for meaning in the experience. The discovery of couples' perceptions of their bereavement experience and their view of the support received will assist in enhancing the ability to provide more effective nursing care to bereaved families. Implications for nursing practice, research and education are delineated. / Applied Science, Faculty of / Nursing, School of / Graduate

The purpose of this phenomenological study was to determine the meaning parents give to their family's experience when they have a child awaiting corrective heart surgery. A secondary purpose was to identify appropriate interventions for nurses who deal with families during the transition period, from initial diagnosis of congenital heart disease until admission to hospital for corrective heart surgery. A convenience sample of six couples were interviewed at various times during the identified transition period, for a total of 11 interviews. An interview guide of open-ended questions provided some loose structure for the initial interviews. Analysis of the verbatim transcriptions began concurrently with data collection and continued during the formal analytic phase with meaning units emerging from the data. The parents described four facets of the experience: diagnosis of congenital heart disease, adjusting to caring for child once home, living with a child with a chronic condition, and waiting for corrective heart surgery. Not only did parents talk about how they felt during the four facets but they also described the range of coping strategies they employed through their experience. In discussing these findings within the context of other chronic illness experiences it became evident that parents draw from a common pool of coping strategies whether the child is in a chronic or more acute phase of an illness. Most of the parents in discussing their overall impressions of the experience had not found their child's illness to be as disruptive to family life as they had first anticipated. Those families with the most symptomatic infants seemed to have a particular need for an alliance with one health care professional to support them through the transition period. Generally, parents did not spend a lot of time dwelling on the corrective surgery until close to the anticipated date for that event; instead they employed various coping strategies which allowed them to normalize their lives. Implications for nursing practice which arise from these conclusions are multiple. Overall, nurses must assess the meaning that individual families give to their experience, assist families to employ suitable coping strategies, and offer support as necessary. General implications for nursing research are in the realm of studies which will further nurses' understanding of the waiting period for corrective heart surgery both from the parents' and the siblings' perspective. / Applied Science, Faculty of / Nursing, School of / Graduate

Landau and Gleitman's experiments investigating a blind child's meaning for look, as it applied to herself, were replicated with a three year old boy who was totally blind, and had no concomitant disorders. Several commands to look were presented within informal play sessions. Responses to the look commands were compared with responses to instructions to touch, listen and taste. Experiments were video recorded for subsequent analysis. It was found that the blind child associated the haptic perceptual modality with the visual verb, in that an instruction to look at an object elicited manual exploration of the object. His meaning for look was distinct from his meanings for the other perceptual verbs. These findings were consistent with Landau and Gleitman's findings. Landau and Gleitman's interpretation, of how a blind child's mastery of visual terms bears on the word/meaning mapping problem, is critically discussed. / Medicine, Faculty of / Audiology and Speech Sciences, School of / Graduate

This study was designed to investigate the experience of having arthritic pain from the children's perspective. Previous research on how Canadian children perceive and manage arthritic pain and how it affects their daily lives is nonexistent. Therefore the purpose of this qualitative descriptive study was to explore and describe the arthritic pain experience of school age children with juvenile rheumatoid arthritis (JRA) and to understand the impact/influence of various factors on the construction of that experience. Ten children, aged 10 to 13 years, with either early (at 2 to 4 years) or late (at 7 to 11 years) onset arthritis participated in this study. Descriptive data were obtained during two open-ended in depth interviews with the children in their homes. Using content analysis, data were analyzed for themes and their elements. An analytical framework of themes and their elements was developed that reflected the children's descriptions of and explanations for arthritic pain in the context of their day to day in the context of their day to day living with arthritis, both in the past and currently. The children perceived pain to be synonymous with arthritis and the mediating factor in how they functioned. They described arthritic pain in relation to distinguishing factors: intensity, duration, and frequency. Intermittent arthritic pain was attributed to cessation of medications, arthritis "flare-ups," inactivity, and activity. A current concern for most children was pain attributed to activity because it meant limitations in activities with peers. The children identified strategies they used to manage pain and cope with pain's unpredictability. The findings of this study were discussed in relation to selected research studies that either supported or refuted the findings of this study. Implications for nursing practice and research were addressed. / Applied Science, Faculty of / Nursing, School of / Graduate