A clinical need exists for a blood oxygenator and pumping system for the support of neonates with respiratory deficiencies. Such systems now available for support of adults are not suitable for neonatal patients. In vitro evaluation of a new blood oxygenator and blood pumping system was performed. The data obtained suggested that this system may be applicable to neonates. In vivo studies with rabbits to further analyze the new system were done. Preliminary data from these studies indicate that the new blood oxygenator and blood pump system may be applicable to supporting neonates with respiratory deficiencies. Suggestions for future development of this system are presented. / Master of Science

Leung, Wan Lun Fiona. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2011. / Includes bibliographical references (leaves 179-204). / Abstracts in English and Chinese. / Abstract --- p.i / 中文摘要 --- p.v / Acknowledgement --- p.viii / List of Abbreviations and Symbols x --- p.vi / List of Tables --- p.xx / List of Figures --- p.xxi / Chapter CHAPTER ONE --- Introduction --- p.1 / Chapter 1.1 --- General Overview --- p.1 / Chapter 1.2 --- Necrotizing Enterocolitis (NEC) --- p.3 / Chapter 1.2.1 --- Epidemiology of NEC --- p.3 / Chapter 1.2.2 --- "Clinical Presentation, Diagnosis and Management of NEC" --- p.5 / Chapter 1.2.3 --- Pathophysiology of NEC --- p.9 / Chapter 1.2.3.1 --- Prematurity --- p.9 / Chapter 1.2.3.2 --- Bacterial Colonization --- p.12 / Chapter 1.2.3.3 --- Enteral Feeding --- p.15 / Chapter 1.2.3.4 --- Hypoxia and Ischemia --- p.16 / Chapter 1.2.3.5 --- Genetic Polymorphism --- p.17 / Chapter 1.2.3.6 --- Inflammatory Mediators --- p.20 / Chapter 1.3 --- Spontaneous Intestinal Perforation (SIP) --- p.24 / Chapter 1.3.1 --- Epidemiology of SIP --- p.24 / Chapter 1.3.2 --- "Clinical Presentation, Diagnosis and Management of SIP" --- p.26 / Chapter 1.3.3 --- Risk Factors of SIP --- p.28 / Chapter 1.3.3.1 --- Prematurity --- p.29 / Chapter 1.3.3.2 --- Use of Drugs --- p.30 / Chapter 1.4 --- Comparison between NEC and SIP --- p.32 / Chapter 1.5 --- Role of Cytokines in Pathogenesis of NEC and SIP --- p.38 / Chapter 1.6 --- Immunoregulatory Molecules of Interest in This Study --- p.46 / Chapter 1.6.1 --- Angiopoietin-2 (Ang-2) --- p.46 / Chapter 1.6.2 --- v-erb-b2 Erythroblastic Leukemia Viral Oncogene Homolog 2 (avian) (ErbB3) --- p.48 / Chapter 1.6.3 --- Type II Interleukin-1 Receptor (IL-1RII) --- p.52 / Chapter 1.6.4 --- Urokinase Plasminogen Activator Receptor (uPAR) --- p.54 / Chapter CHAPTER TWO --- Objectives --- p.57 / Chapter CHAPTER THREE --- Materials and Methodology --- p.58 / Chapter 3.1 --- Overview of the Experimental Procedures --- p.58 / Chapter 3.1.1 --- Investigation on the Profile of Circulatory Immunoregulatory Proteins in Plasma of NEC and SIP High Risk Neonates --- p.58 / Chapter 3.1.2 --- Investigation on the mRNA Expression Level of Targeted Immunoregulatory Molecules on Resected Intestinal Tissues in NEC and SIP Neonates --- p.58 / Chapter 3.1.3 --- Investigation on the mRNA and Protein Expression Levels of Targeted Immunoregulatory Molecules in Human Intestinal Cell Lines --- p.60 / Chapter 3.2 --- Reagents and Lab-wares with Their Sources --- p.61 / Chapter 3.3 --- Study Population --- p.63 / Chapter 3.4 --- Collection of Neonatal Whole Blood Samples --- p.65 / Chapter 3.5 --- Cytokine Antibody Array Analyses --- p.67 / Chapter 3.6 --- Enzyme-linked Immunosorbant Assays (ELISA) --- p.69 / Chapter 3.6.1 --- Angiopoietin-2 --- p.69 / Chapter 3.6.2 --- sErbB3 --- p.71 / Chapter 3.6.3 --- sIL-lRII --- p.72 / Chapter 3.6.4 --- suPAR --- p.74 / Chapter 3.7 --- Collection of Neonatal Resected Intestinal Tissues --- p.76 / Chapter 3.8 --- Resected Intestinal Tissue RNA Isolation --- p.78 / Chapter 3.9 --- Purity Assessment of the Purified Tissue RNA Samples --- p.80 / Chapter 3.10 --- Integrity Assessment of the Purified Tissue RNA Samples --- p.81 / Chapter 3.11 --- In vitro Stimulation of Human Enterocytes by Lipopolysaccharides (LPS) and/or Platelet Activating Factor (PAF) --- p.84 / Chapter 3.12 --- mRNA Expression Level Assessment of Selected Target Genes in Resected Intestinal Tissues and Human Intestinal Cell Lines --- p.86 / Chapter 3.12.1 --- Synthesis of First Strand cDNA --- p.86 / Chapter 3.12.2 --- Quantitative Polymerase Chain Reaction (qPCR) --- p.87 / Chapter 3.13 --- Statistical Analysis --- p.89 / Chapter CHAPTER FOUR --- Screening of Immunoregulatory Target Protein Molecules in Plasma of NEC and SIP Patients by Cytokine Array Analyses --- p.104 / Chapter 4.1 --- Results --- p.104 / Chapter 4.1.1 --- Screening of Detectable Immunoregulatory Target Molecules --- p.104 / Chapter 4.1.2 --- Selection of Target Molecules Based on the Fold Change in NEC or SIP Compared with Control Samples --- p.105 / Chapter 4.1.2.1 --- Similar Regulation of Target Molecules in Both NEC and SIP patients --- p.105 / Chapter 4.1.2.2 --- Differential regulation of Target Molecules in NEC and SIP Patients --- p.106 / Chapter 4.1.2.3 --- "Relative Normalized Expressions of Selected Circulatory Immunoregulatory Protein Molecules in NEC, SIP and Control Neonates" --- p.108 / Chapter 4.1.2.3.1 --- Anti-inflammation --- p.108 / Chapter 4.1.2.3.2 --- Pro-inflammation --- p.109 / Chapter 4.1.2.3.3 --- Cell Growth --- p.110 / Chapter 4.1.2.3.4 --- Wound Healing --- p.110 / Chapter 4.1.2.3.5 --- Angiogenesis --- p.111 / Chapter 4.1.2.3.6 --- "Anti-apoptosis, Cell Adhesion and Extracellular Matrix Organization" --- p.112 / Chapter 4.1.3 --- Further Selection of Novel Target Molecules Based on Statistical Significance and Fold Change of NEC versus SIP --- p.113 / Chapter 4.2 --- Discussion --- p.115 / Chapter CHAPTER FIVE --- Validation of Target Proteins in Plasma of NEC and SIP Patients by Enzyme-linked Immunosorbant Assay --- p.132 / Chapter 5.1 --- Results --- p.133 / Chapter 5.1.1 --- Demographic Data of the Study Group --- p.133 / Chapter 5.1.2 --- "Comparison of Plasma Levels of Target Proteins between NEC, SIP and Respective Controls" --- p.134 / Chapter 5.1.3 --- Longitudinal Study of the Pre- and Post-operative Target Proteins Levels in Plasma --- p.136 / Chapter 5.2 --- Discussion --- p.138 / Chapter CHAPTER SIX --- Investigation on mRNA Expression Levels of Target Immunoregulatory Protein Molecules in Intestinal Tissue and Intestinal Cell Lines --- p.151 / Chapter 6.1 --- Results --- p.152 / Chapter 6.1.1 --- mRNA Expression Levels of Target Molecules in the Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.152 / Chapter 6.1.2 --- mRNA Expression Levels of Target Molecules in the Macroscopically Normal and Diseased Margin of Resected Intestinal Tissues of NEC and SIP patients --- p.154 / Chapter 6.1.3 --- mRNA Expression Levels of Target Molecules in Human Intestinal Cell Lines upon LPS and PAF Challenge --- p.156 / Chapter 6.1.3.1 --- FHs-74 Int Cell Line --- p.156 / Chapter 6.1.3.2 --- Caco-2 Cell Line --- p.157 / Chapter 6.2 --- Discussion --- p.158 / Chapter CHAPTER SEVEN --- General Discussion --- p.171 / Chapter 7.1 --- Overall Findings --- p.171 / Chapter 7.2 --- Limitations of Study --- p.174 / Chapter 7.3 --- Future Investigations --- p.177 / References --- p.179

This study was undertaken to investigate the relationship between Natural Killer cells and HLA-G at the placental barrier in HIV-I infected pregnant women and to establish the significance, if any, to in utero infection. Fifty-five HIV -I infected pregnant women were recruited into the study after consent was obtained. Blood samples were collected from both mothers and babies for viral loads and CD4+ cell counts. Placental samples were obtained from pregnancies at delivery and examined by immunoperoxidase immunohistochemistry methods using monoclonal antibodies to p24 antigens and Natural Killer (CD56+) cells. HLA-G expression was quantified using real-time polymerase chain reaction. Analysis of viral loads and CD4+ cell counts were undertaken in categories. No significant association was observed between the viral load of mothers and their CD4+ cell counts. Eighteen percent of the women in this study population had 5 log viral loads with a transmission rate of 0.27(95% Cl, 0.15 - O. 39). Maternal viraemia was significantly associated with transmission of infection to babies (p = 0.047). The odds ratio indicated that for every 1 log increase in maternal viral load the babies were 3.1 times more likely to acquire the infection (Exp (B) = 3.137 (95%CI, 1.015-9.696). Furthermore, the study found that a higher number of female babies were infected than males. Although not statistically significant the odds ratio indicated that female babies were 3.1 times more likely to become infected than males (Exp (B) = 3.110 (95%CI, 0.819-11.808). We report here the results of immunohistochemistry for p24 antigens and NK (CD56+) cells and compare them to the immunological responses of both mothers and babies at birth. HIV-1 antigens were detected in 94.5% of all placentas by immunohistochemistry. Infiltration of CD56+ was found in 98% of placental tissue. The analysis revealed that the presence of p24 antigens in placental tissue was not influenced by maternal viral load or CD4+ cell counts. Lower median NK cell values were observed in placentas of mothers with infected babies as compared with the uninfected cluster. Although not statistically significant, the risk of vertical transmission was increased 3.4 times more in placentas which had lower NK cell values. According to the odds ratio, babies CD4+ counts were affected by every 1 log increase in mother's viral load. Overall, maternal viral load emerged as a strong predictor for risk of infection from infected mothers to their infants. Our analysis indicated that female babies were 3.7 times more likely to acquire the infection than males. Using data obtained from real-time PCR we investigated the relationship between maternal viral load and the quantity of HLA-G expression (p = 0.045; 95%CI 1.029- 11.499). Logistic regression models revealed that mother's viral load was the strongest risk factor for vertical transmission. No statistically significant correlation was noted with HLA-G and viral transmission. However, the odds ratio indicated that the risk of infection increased by 1.3 with every 1 fold increase in HLA-G expression. An analysis of mother-to-child transmission rates by gender revealed that the odds ratio for transmission was 3.4 times more in female babies than in males. We then investigated the relationship between maternal viraemia and HLA-G expression. A positive correlation between maternal viral load and placental HLA-G was observed (p = 0.038). When gender susceptibility to HLA-G expression was explored a statistically significant association was observed in placental tissue of mothers with infected and uninfected male babies and HLA-G expression (p = 0.013). To conclude, the analysis found that HLA-G was up regulated 3.95 times more in placental tissue of mothers with infected babies than in mothers with uninfected babies. / Thesis (Ph.D.)-University of KwaZulu-Natal, Durban, 2007.

Thesis (MNutr (Interdisciplinary Health Sciences. Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of the study was to determine the prevalence of certain known risk factors for intra-uterine growth restriction (IUGR) in women who gave premature birth to growth-restricted infants at a large regional hospital (Kalafong) in the Gauteng province of South Africa and to investigate the possible associations between the presence of various risk factors and the severity of growth restriction found in these infants. METHOD: The study was designed as cross-sectional, descriptive and observational. The subjects included singleton growth-restricted premature infants (n=80), without congenital abnormalities and their mothers (n=80). Anthropometric data [weight, height, mid-upper arm circumference (MUAC) and triceps skinfold thickness (TSF)] were collected from these mothers three to four days post-partum. Infant birth weights were recorded at birth, while the lengths and head circumferences were recorded within 2 days post-partum. Additional information, such as birth spacing, maternal age, smoking habits and alcohol use, was collected by personal interview and blood pressure data and HIV status was obtained from medical records. Data capturing and descriptive statistics were done using Microsoft Excel and comparative analytical statistics were performed with the Statistical Package for the Social Sciences (SPSS), version 12.0. RESULTS: The study demonstrated a high prevalence (69%) of infants born with a birth weight <3rd percentile. In the sample, 81% of the mothers were aged 17-34 years and most (93%) had their children 18 months or longer apart. Malnutrition prevalence was moderate. In 58% of the mothers the BMI was normal (18.5-24.9 kg/m2) and in 47% the upper arm muscle area (UAMA) was between the 10th-85th percentile. Grade III overweight occurred in 3% and TSF ≤5th percentile occurred in 35% of the mothers. About half (51%) of the mothers in the sample population had hypertension during the second trimester of pregnancy. Smoking and alcohol use during pregnancy was rare (1% and 6% respectively) and the prevalence of HIV infection in the mothers was 26%. The prevalence (16%) of Grade II overweight among the mothers of symmetric growth-restricted (SGR) infants was higher than among the mothers of asymmetric growth-restricted (AGR) infants (7%). Of the hypertensive mothers, 55% had infants with SGR compared to 45% with AGR (p=0.47). Although rare, smoking occurred only in mothers with AGR infants (3%). No significant differences were found between the smoking and non-smoking group (p=0.21). Although the use of alcohol was more prevalent at 6% in mothers with SGA infants and 7% in mothers with AGR infants, no significant associations were found (p=0.95). Although not significant (p=0.76), there was a higher prevalence of HIV infection in mothers with SGR infants at 29%, compared to 23% of mothers of AGR infants. CONCLUSION: Although further studies are needed before intervention strategies can be planned and implemented, the findings of this study suggest that apart from the usual factors (maternal age and nutritional status, smoking and alcohol use during pregnancy and birth spacing) that may influence intra-uterine growth, hypertension may contribute greatly to IUGR in this study population.

Thesis (M. Tech.) - Central University of Technology, Free State, 2010 / Early detection of mother-to-child transfer of Human Immunodeficiency Virus (HIV-1) is of the utmost importance for monitoring the success of intervention strategies, as well as for optimal treatment of HIV-positive children. Serology can only be used confidently after 18 months, as remaining antibodies from the mother may give false positive results. This leaves only molecular methods for early detection of the virus; unfortunately, the technology is still too expensive for general use. The aim of this project was to develop and validate a cost-effective, fast, early detection method for HIV infection in infants. PCR was chosen as the developmental method, a technique that amplifies proviral sequences of HIV DNA, detecting HIV infection in peripheral blood mononuclear cells (PBMC) from infants of seropositive women during neonatal (age less than 28 days) and post-neonatal periods. A method based on the commercial Roche HIV-1 DNA assay was chosen for implementation on the Roche LightCycler instrument. The published primer set was used to detect both HIV-1 DNA and an internal control. The target DNA for use as internal control was constructed from the plasmid pBR322 so that an AT-rich part of the plasmid was flanked by the HIV-1 primer-binding sites. The resulting amplicon was cloned into a vector and multiplied in E. coli. Amplification of the plasmid by PCR in the Roche LightCycler in the presence of SYBR Green created an amplicon having a Tm different (81 ± 1°C ) from that of the HIV-1 amplicon (84 ± 1°C) so that post-amplification melting can be used to differentiate between HIV-1 and internal control. After construction of the internal control, the reaction conditions were optimised so that the internal control would amplify strongly only in the absence of HIV-1 target DNA. Then 50 previously tested patient samples were analysed using the assay developed here. Only half of the known positive samples came up positive in the assay, indicating that it is not sensitive enough for diagnostic use in its current form. Various ways of improving the sensitivity are suggested for further development of the assay as described here.

Submitted in fulfilment of the requirements of the Degree of Master of Technology: Biomedical Technology, Durban University of Technology, 2013. / The purpose of the study was to evaluate knowledge and effects of Haemolytic Disease of the Newborn (HDN) in postnatal women from the Umgungundlovu District. Although the prevalence of HDN has declined because of prophylaxis from 45 cases per 10,000 births to 10.2 cases per 10,000 births but it is still a cause of infant and neonatal morbidity and mortality. The effects of the disease range from jaundice, kernicterus and in severe cases death. Methodology : An interviewer-administered questionnaire was used to obtain information about the knowledge and effects of HDN amongst postnatal women. The incidence rate was calculated using the number of cases that were found divided by the total number of deliveries during the study period. A total of 300 women were interviewed. SPSS version 19.0 was used to analyse data. Findings : Fifteen (15) of the 300 women had babies with confirmed HDN and only four of the 15 (26%) women had knowledge of HDN. Two hundred and eighty five women had babies with jaundice but were not affected by HDN and, of these women, 12 (4.2%) of them knew what HDN was. Overall, only 16 (5.3%) knew what HDN was. All 15 women who had babies with HDN indicated financial and emotional effects because of HDN. The total incidence was 0.09% for the first 12 months of the study period. Conclusion : Postnatal women with jaundiced babies lack knowledge of HDN and HDN has financial and emotional effects on these women. Although the incidence rate of HDN was found to be even smaller than previously reported, it still exists and threatens the lives of infants and neonates.

Gestational diabetes mellitus (GDM) and infant macrosomia are important obstetric health concerns for Aboriginal populations in Canada. Previous research in non-Aboriginal populations has established that GDM and macrosomia are associated with increased risk of fetal morbidity. Specifically, GDM is a risk factor for infant macrosomia, hypoglycemia, polycythemia, hypocalcemia, and hyperbilirubinemia. Furthermore, macrosomia is an independent risk factor for shoulder dystocia, clavicular fracture, brachial plexus injury, birth asphyxia and operative delivery. The main objectives of this study were to determine prevalence rates of GDM and macrosomia related neonatal complications for the James Bay Cree population of northern Quebec, and to identify risk factors for specific birth trauma injuries and metabolic complications in the population. The prevalence of macrosomia (≥4500 g) was 10.4%, and the estimated prevalence of GDM was 16.6% (95% CI 14.6-18.6) (n = 229/1379). Shoulder dystocia was the most common birth trauma event among the Cree, affecting 2.5% (n = 42/1650) of all Cree births, and 9.3% (n = 16/172) of macrosomic deliveries ≥4500 g. The prevalence of neonatal hypoglycemia was also high, affecting 8.8% (n = 144/1650) of all Cree newborns, and 18.1% (n = 34/192) of GDM deliveries. Macrosomia (BW ≥ 4500 g) was a significant risk factor for shoulder dystocia, clavicular fracture, hypoglycemia, and caesarean section delivery. After adjusting for maternal age, parity, and gestational age, GDM was identified as a significant risk factor for macrosomia (≥4500 g), hypoglycemia, polycythemia, and hypocalcemia. In summary, this study identified a high incidence of neonatal complications among the James Bay Cree compared with rates in the general North American population. These outcomes can be explained, in part, by high prevalence rates of gestational diabetes and infant macrosomia. Further studies to investigate the long-term consequences of GDM and

Thesis (MPH.) -- University of Limpopo, 2021 / Introduction: HIV/AIDS remains a disease of public health importance and mother-to-child transmission (MTCT) is one of the major problems. Sub-Saharan Africa is the most severely affected region, accounting for more than 90 percent of paediatric HIV infections. Most of these infections occurred during pregnancy, delivery or breastfeeding making the prevention of mother-to-child transmission (PMTCT) a public health priority. Over the last few years, efforts have been made in Sub-Saharan countries to improve PMTCT and the success of prevention of mother‐to‐child transmission of HIV (PMTCT) is dependent upon high retention of mother‐infant pairs within the PMTCT cascade. Assessing the risk factors for MTCT will help to decrease child morbidity and mortality and strengthen PMTCT programs as there is dearth of evidence regarding factors determining MTCT HIV infection to infants born to HIV positive mothers. The purpose of this study was to investigate the determinants for the human Immunodeficiency Virus positivity rates in the Greater Letaba Municipality. The study objectives were to describe the demographic characteristics of mothers and babies who tested polymerase chain reaction test (PCR)-positive in the Greater Letaba Municipality during the two-year period from 2015 to 2016, in order to determine maternal and neonatal factors associated with high positive PCR; and to determine health system-related factors associated with a high positive PCR result. Methodology The current study followed a quantitative approach in which convenient and purposive sampling was used, focusing on records of infants born from HIV-positive women in all clinics at Greater Letaba Municipality were reviewed. All records of infants who were tested for HIV and the PCR results were positive from birth up to 12 months of age were retrospectively reviewed and for the health care workers, all nurses working as managers of a clinic were interviewed. The Statistical Package for the Social Sciences (SPSS) version 23 computer software and Stata 15 was used. for comparison of categorical variables was done using a Chi-Squared test, whereas continuous variables were compared using a t-test and P-value of <0.05 was considered significant. To determine maternal and neonatal factors associated with high positive PCR, Factor analysis was used with rotated factor loadings done using the Varimax method. Results: A total of 107 records were retrieved and audited. Fisher’s exact test was used to determine the relationship between selected variables, where p<0.05 was set as level of significance. The findings reveal that the number of infants exposed to HIV during pregnancy has steadily increased. The current study further indicates that health system factors such as unskilled or untrained NIM-ART nurses in the facilities is a contributory factor to infant’s positivity rate in Greater Letaba hospital. Equal proportions of both male and female babies were found to be PCR positive at 6 weeks. The study further revealed that the highest proportion of the mothers who gave birth to PCR positive babies for the reporting period were married mothers, in the age group 25-29 years (46.1%). The second largest proportion of mothers who gave birth to PCR positive babies were single mothers in the age group 25-29 years (38.4%). The results show that high PCR positivity can be attributed to about 5 main Factors namely: maternal antenatal history (22% contribution to total variance), maternal HIV care history (18% contribution to total variance), measures of adherence to treatment (17% contribution to total variance), maternal exposure to HIV (14% contribution to total variance) and lastly the ART regimen (12% contribution to total variance). Conclusion: The study findings revealed that there is still vertical transmission of HIV to infants and the prevalence of HIV among infants born from seropositive mothers despite the availability of the latest Prevention of Mother to Child Transmission (PMTCT) Guidelines in all health care facilities. Even though transmission is reduced to the meaningful number (< 5%), there are still appropriate measures that should be taken to reduce the transmission of HIV from mothers to infants. The delayed diagnosis, adherence to ART by mothers, infant ARV prophylaxis at birth and feeding practices contributed the vertical transmission of HIV to infants. Strengthening of the PMTCT of HIV programme, increasing antenatal HIV screening and linking it to care and treatment of HIV positive mothers to obtain zero infant HIV prevalence in the region. Infant prophylaxis and maternal PMTCT interventions should be provided to all exposed infants and mothers based on the guidelines by the health institutions. Nurse-initiated management of antiretroviral treatment (NIM-ART) training of professional nurses is being offered by the Department of Health in South Africa, but it does not yield positive results as far as the PMTCT is concerned. This may be due to shortage of staff, especially trained professional nurses (PN), as well as the workload. Key concepts: Infant and Human immune deficiency virus

No description available.

The dramatic improvement of neonatal intensive care has produced vexing ethical and legal questions. One of the most striking issues is to determine whether the most defective neonates should be provided with intensive care and to what extent they should be treated. This thesis demonstrates that an attempt to answer this question and an analysis of the demands and limitations of a duty to treat defective neonates cannot properly occur without first considering the legal concerns and ethical issues surrounding the notion of "person". The author examines germane ethical theories and North-American jurisprudence to see what approaches and standards commentators and courts have adopted in this respect. This thesis demonstrates that in the context of the cessation or non-initiation of intensive care, the legal and moral status of very defective neonates remain ambiguous. In particular, the author suggests that a legal best interests analysis that includes quality of life considerations may actually involve the use of criteria similar to those supported by the authors of the controversial moral theories that negate the personhood of seriously handicapped newborns. The author ultimately concludes that a clear divide between the legal definition of the "person" and the moral and social perceptions of that term is misleading.