Neonatal pain management has received increasing attention over the past four decades, along with the technological advances made in neonatal care which have increased the survival of neonatal patients. Empirical evidence confirms and acknowledges that the life-saving or life supporting procedures neonates are subjected to, during their admission into neonatal intensive care or high care facilities, are often painful. Research into the effects of neonatal pain emphasises the professional, ethical and moral, obligations by neonatal staff to manage neonatal pain effectively, in order to obtain positive patient outcomes both in the short and long term. This study used a non-experimental, prospective quantitative survey to investigate the knowledge, attitudes and beliefs of nurses and doctors concerning neonatal pain and its management. To answer the research question posed fully a third objective was included to explore current practice on this topic. The entire population (N=150) of neonatal staff working in neonatal wards of two tertiary hospitals in Gauteng, were invited to participate in the study. The data was collected using self administration of the Infant Pain Questionnaire. The response rate of this study was 35.33% (n=53).Data was analysed using “STATA” 12. Descriptive findings showed that, the majority of the respondents were female, from the professional nurse category, working in neonatal intensive care units with between 0 – 5 years experience in neonatal care. A significant finding was the unavailability of a pain management guideline in the neonatal units as reported on by 64% of the respondents. Despite this pain neonatal pain is recognised and treated. The main concern raised by this is the accuracy of assessment and adequacy of pain management interventions. The neonatal staff acknowledges and empathise with neonates’ pain experience. Results from comparative analysis using a Fischer’s exact test, showed a statistically significant (p<0.05) association between procedural pain ratings and the beliefs held by the participants about the increased frequency of pharmacological intervention implementation on five clinical procedures. This positive attitude towards neonatal pain management is important in ensuring consistent and adequate implementation of guidelines, hence adequate treatment of neonatal pain. A review of the pain management interventions used in the study setting showed preference for pharmacological pain management interventions for moderate to severe pain. This requires collaboration between the nurse and doctor. This finding was found to be consistent with international pain management standards. The nurses in the study also reported inadequate implementation of non-pharmacological interventions. This method of intervention use can be enhanced with empirical evidence. The small sample size and composition of respondents are noteworthy limitations, along with the exclusion of record review as part of this study. The main recommendation is to increase research neonatal pain management utilising existing structures in the practice, education and international resources.

This research report is submitted in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg November 2014 / Background. Babies born before arrival to hospital (BBBAs) constitute a high-risk newborn population. The literature demonstrates that BBBAs have increased perinatal mortality and morbidity. Objectives. To describe the maternal and neonatal characteristics of BBBAs presenting to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, and assess whether they have increased morbidity and mortality compared with inborn babies. Methods. This was a matched case-controlled retrospective record review of newborns presenting to the neonatal unit of CMJAH between 1 January 2011 and 31 January 2013. BBBAs were matched 1:1 with the next consecutive inborn on birth-weight category and gender. Results. A total of 356 neonates were analysed. BBBAs had higher mortality than inborn controls within the first 24 hours of hospital presentation (7.9% v. 3.9%; p=0.05). Mothers of BBBAs were more likely to be unbooked (58.4% v. 10.7%; p<0.001) and of higher parity (p=0.0008). HIV prevalence was similar amongst cases and controls (24% v. 28.7%), however there were significantly more unknown HIV status in mothers of BBBA’s (49.6% v. 32%; p=0.01). Cases had a higher prevalence of early sepsis (22.9% v. 3.6%; p=0.03) and birth asphyxia (14.5% v. 0.8%; p<0.001) than controls. Overall, more deaths occurred in the very-lowbirth- weight (VLBW) (24% v. 10%; p=0.06) and low-birth-weight (LBW) (7.46% v. 0%; p=0.02) BBBA’s compared to controls. Conclusion. We demonstrated higher mortality in the immediate postnatal period and in the VLBW and LBW categories compared with hospital-delivered neonates. Once admitted, there was no difference in mortality, length of stay or number of ICU admissions between cases and controls. Mothers who delivered out of hospital were more likely to be multiparous and unbooked and to have unknown HIV, RPR and Rh results. Neonatal resuscitation, transport and immediate care on arrival at the hospital should be prioritised in the management of BBBAs.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Paediatrics Johannesburg, 2014. / Background: To describe the relative frequency and distribution of neonatal tumours; to determine the age at presentation to the oncology unit and to determine the extent of the delay in referral. To describe any associated syndromes in individual malignancies. Material and methods: A retrospective case series was performed covering 24 years. Demographics, means of diagnosis, treatment and outcome details were reviewed. Results: There were a total of 2626 patients that presented to the oncology department with suspected malignancies. Out of that, 2308 patients were diagnosed with a malignancy and 318 patients had benign tumours. Over the 24 year period 117 tumours were diagnosed in neonates (4,4%). Due to incomplete data 29 patients were excluded. Of the remaining patients, 61 were diagnosed with benign tumours and 27 with malignant tumours. The male to female ratio was 1: 1,5. The mean age at presentation was 16 days. The mean age at diagnosis was 36 days. Histology and radiology were diagnostic in 40,9% and 19,3% respectively. A combination of histology and radiology was used to make a diagnosis in 21,6% of patients, 11,4% of diagnoses were based on clinical examination and 6,8% on biochemistry and haematology. Malignant soft tissue tumours were the most common malignancy (25,9%) followed by renal tumours (18,5%), leukaemia (14,8%), neuroblastomas (11,1%) and retinoblastomas (11,1%). Teratomas (45,9%) and benign vascular tumours (44,3%) were the most common benign tumours. Chemotherapy was used to treat 22 neonates, while 50 underwent surgical removal of the tumour. Half (51,9%) of the patients diagnosed with a malignant tumour died, while 11,1% of patients were iv lost to follow up. Just under 10% (8,2%) of the patients diagnosed with a benign tumour died, while 44,3% of patients were lost to follow up. The overall mortality amongst patients diagnosed with benign or malignant tumours was 21,6%. Conclusion: There is a much higher incidence of benign tumours diagnosed in neonates (69,3%) compared to older children (12,1%). Only 1,2% of all childhood malignancies in our unit occurred in the neonatal period, which is slightly lower than the reported 2%. Two of the major issues that need to be addressed in the future management of neonatal tumours are prompt referral for prompt diagnoses and better follow up.

Thesis (doctoral)--Freie Universität Berlin, 1979.

Thesis (doctoral)--Universität Hamburg, 1979.

Thesis (Ph. D.)--University of Minnesota, 1924. / Cover title. eContent provider-neutral record in process. Description based on print version record.

Neonatal sepsis remains a global health problem due to its significant contribution to morbidity and mortality. The blood culture is the most reliable method for detection of bacterial infections. However, the sensitivity of the latter method is low and using it as a gold standard in diagnosis of bacteremia is fraught with difficulties. Neutrophil CD64 levels are upregulated in response to inflammation and tissue injury. We quantitated neutrophil CD64 by flow cytometry in neonates with signs and symptoms suggestive of sepsis/infection within the 1st four weeks of life in a prospective observational study conducted at 3 hospitals in Johannesburg. Patients were classified into categories of infection namely definite, probable and possible according to signs and symptoms of infection and blood tests including blood culture results. Of 76 neonates, there was 1 infant with definite infection, 5 infants with probable, 30 infants with possible and 32 infants with no infection. The PMN CD64 at cut off of 1.8 had a high negative predictive value in ruling out definite (100%) or probable + definite infection (95.2%). We recommend the inclusion of PMN CD64 index into the diagnostic algorithm for neonatal sepsis, as it has a high negative predictive value and can be used to rule out infection. As the positive predictive value of the test was low in confirming infection, PMN CD64 should be used as a screening rather than confirmatory test.

Aim The aim was to determine the epidemiology of invasive fungal infections at Chris Hani Baragwanath Hospital. The specific objectives were to determine the 1) risk factors, 2) clinical presentation, 3) laboratory abnormalities, 4) organisms and their susceptibilities and 6) outcome in neonates with positive blood or CSF fungal cultures at Chris Hani Baragwanath Hospital. Methods This was a retrospective record review of patients who had positive blood or CSF cultures. Patients were identified by a computerized microbiological surveillance database. The data was collected over a three-year period from January 2002 to December 2004. Patient hospital files were reviewed for clinical signs, full blood count (FBC), C-reactive protein (CRP) and outcomes. Fungal culture results were reviewed for susceptibilities. To identify risk factors a convenient cohort was compared to the patients with fungal sepsis. The data was analysed using a Statistica software package. Results There were 150 patients with fungal sepsis among admissions over this 3 yearperiod giving an incidence of 1.3 per 100 admissions. Thirty-nine records were not found thus 111 patient records were reviewed. The median birthweight was 1280g and the gestational age 30 weeks. The median age of onset was 16 days and 6.3% had early onset fungal sepsis. There were 61 males. Twenty-eight percent of patients were born to HIV positive mothers. Candida parapsilosis was the commonest (56%) organism isolated followed by C. albicans (43%). All the C. albicans isolates and 93% of the C. parapsilosis isolates were susceptible to amphotericin B. Fluconazole susceptibilities were reported as, 96% for C. albicans, and 60% of the C. parapsilosis as being susceptible. Central venous catheters (CVCs) (p=<0.001), the use of TPN (p=<0.001) and third generation cephalosporins were identified as risk factors associated with fungal sepsis. The all-cause mortality and Candida–related mortality were 30% and 23% respectively. The non-survivors had lower platelet counts (p=0.007) than the survivors. Patients with Gram-negative sepsis had lower platelet counts than the fungal group (p=<0.001) on the repeat laboratory parameters. Conclusion The incidence is 1.3 per 100 admissions. Risk factors associated with fungal sepsis are very low birthweight and gestational age, the use of TPN, CVCs and third generation cephalosporins. Candida parapsilosis is the common organism causing fungal sepsis in neonates. Candida albicans was associated with a higher mortality. Thrombocytopenia is not organism specific to fungal sepsis.

dissertation submitted to the Faculty of Health Sciences for the degree of Masters in Medicine in the University of the Witwatersrand, Johannesburg. August ,2013 / South Africa is one of the countries in which neonatal mortality has either remained the same or decreased marginally over the past 20 years (1). Resource constraints result in early discharge of well newborns and curtailment of follow up home visits by nurses. This potentially high-risk group of infants may contribute to these neonatal deaths post hospital discharge. In addition, once a neonate has been home, they are no longer admitted to the neonatal unit but to the general paediatric wards that may lack specialized neonatal care. Numerous programs, algorithms, education drives and protocols have been devised in an attempt to improve the quality of healthcare offered to the newborn. These have led to a perceptible decline in the neonatal mortality and morbidity rates respectively. The neonatal mortality and morbidity rates remain unacceptably high however, particularly in resource poor settings. Aim: The aim was to determine the profile and outcome of neonates admitted to the general paediatric wards at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Methodology: Audit of all newborns (<28days) admitted to the general wards from 1 January 2011 to 30 April 2011. Patients transferred from other tertiary hospitals were excluded. Patients with incomplete records were also excluded Results: There were a total of 73 neonates admitted with a mean weight of 3.2kg (SD 0.65). The median age for 0-7 days was 4 days and for 8-28 days was 17 days. The majority of neonates 41/73 (56.2%) were male and 21/73 (28.8%) were HIV exposed. In the HIV exposed group only 16/21 (76%) were on HIV prophylaxis. Although antenatal care (ANC) was received by 76.7% of mothers, this is lower than ANC received by the general population. Lack of ANC could possibly be a risk factor for admission of neonates. Possible risk factors for serious illness included 8 (11%) were ex premature infants and 11 (15.1%) had a low birth weight (<2.5 kg). Individual indicators for severity of illness by World Health Organization (WHO) Integrated Management of Childhood and Neonate Illness (IMCNI) were used. The most frequent indicators were tachypnoea (RR>60) 34 (46.6%), jaundice 30 (41.1%) and only 1 (1%) presented with convulsions. Respiratory distress was very sensitive (100%) and relatively specific (76%) for detecting bronchopneumonia (BRPN) with a LR of 3.98. The other clinical indicators were neither specific nor sensitive in detecting serious illness. Most 45 (61%) were referred from the local clinic. The commonest diagnoses were bronchopneumonia (BRPN) 20 (27.4%), neonatal sepsis (NNS) 22 (30.1%) and jaundice 22 (30.1%). Two patients died (2.7%). Their diagnoses were NNS and BRPN Conclusions: There are a significant number of newborns admitted to the general paediatric wards, although the mortality rate in this group was low. IMCNI guidelines remain the most sensitive indicator of the need for admission, and “routine” blood investigations are often non-contributory Community based care and education programmes as well as targeted neonatal care in hospitals for this group is warranted.

Thesis (doctoral)--Uppsala University, 1983. / Includes bibliographical references (p. 21-25).