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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
121

Communication development of high-risk neonates from admission to discharge from a Kangaroo mother care unit

McInroy, Alethea 21 July 2008 (has links)
Advances in neonatology have led to increased numbers of high-risk neonates surviving and intensified interest in the developmental outcomes of this population. In the South African context prematurity and low birth weight are the most common causes of death in the perinatal period and the same risk factors that contribute to infant mortality also contribute to the surviving infants’ increased risk for developmental delays. As a result of the interacting biological and environmental risk factors of prematurity, low birth weight, poverty and HIV and AIDS in the South African context Kangaroo Mother Care (KMC) has been developed as best practice to promote infant survival and to facilitate mother-infant attachment. Mother-infant attachment may lead to synchronous interaction patterns between the mother and infant which forms the basis of early communication development. Early communication intervention (ECI) services are recommended as early as possible as high-risk infants are especially at risk for feeding difficulties and communication developmental delays. It is, however, not clear what the content of an ECI programme should be and how it should be implemented according to the changing communication and feeding developmental needs of the infant while receiving KMC. There appears to be a dearth of research on the earliest stages of communication development in high-risk neonates, which should form the foundation of such a programme. A descriptive survey was conducted to describe the development of 25 high-risk infants and their mothers’ changing needs from admission to discharge from a KMC unit. Each participant and mother dyad was followed up over an average of 11 days of data collection with three to four data collection sessions. Data was collected by means of direct observation during routine care-giving activities. The different developmental subsystems of the participants’ feeding, communication, neuro-behavioural organization and mother-neonate interaction were described. The results demonstrated that subtle, but definite changes could be observed in the participants’ development. Development in all the different areas occurred over time as the participants progressed through the three developmental states of the in-turned state, coming-out state and reciprocity state. As the participants progressed during the 11 days of data collection and were increasingly able to attend to their environment, they also developed the ability to regulate and organize their own behaviour in order to develop more complex communication, feeding and interaction skills with their mothers. The functioning of the participants’ sensory systems developed in a specific order namely tactile, auditory and then visual. Although the participants developed consistently throughout their stay in the KMC unit, mother-neonate interaction never reached optimal levels. The importance of an individualized training programme for each mother is reflected in the finding that the neonate’s developmental level and progress needs to be considered when implementing the ECI programme. The need for speech-language therapy involvement in KMC is emphasized in the light of a shortage of practicing speech-language therapists in South Africa. It is therefore imperative that the prevention of communication delays and feeding difficulties in high-risk neonates as well as parent training assume priority. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted
122

Development of strategies to enhance quality kangaroo mother care at selected public hospitals, Limpopo Province

Malatji, Shale Audrey January 2021 (has links)
Thesis(M. A. (Nursing)) -- University of Limpopo, 2021 / BACKGROUND The quality Kangaroo Mother Care (KMC) continues to be sub-standard as it is not managed properly, despite the maternal and neonatal services provided by the midwives during postpartum and neonatal period, as this can lead to increased neonatal mortality rate and maternal depression at selected hospitals of Limpopo Province, therefore the researcher is interested in developing strategies to enhance quality KMC at selected hospitals of Limpopo Province. KMC has been found to have physiological, behavioural, psychosocial and cognitive developmental benefits, and it enhances motherinfant bonding. The aim of the study was to develop strategies to enhance quality Kangaroo Mother Care in selected hospitals of Limpopo Province. RESEARCH METHOD A quantitative descriptive cross-sectional research method was used to collect numerical data with regard to the factors that hinders the quality Kangaroo Mother Care in selected hospitals of Limpopo Province. Population size was 77, Simple Random Probability Sampling was used in this study with the sample size of 65 midwives. Data were collected using self-administered questionnaires and analysed using Statistical Package for Social Sciences (SPSS) version 24. Quantitative analysis is the numerical representation and manipulation of observations for the purpose of describing and explaining the phenomenon reflected on observations (Babbie & Roberts, 2018). RESULTS The study revealed that the factors that hinders quality of Kangaroo Mother Care are lack of education and training to midwives regarding Kangaroo Mother Care, and other sources suggested that all categories of nurses should also be trained. The midwives are knowledgeable with regard to KMC, however, the problem remains the work overload when they have to monitor both the mother and neonate during feeding. It was further indicated that family members can also assist with regard to KMC. Strategies were developed, as optimal KMC environment, optimal KMC interventions, enhance optimal mother attitude to KMC crate gender sensitive environment. CONCLUSION The study concluded that the quality of KMC should be enhanced through both the promotion of education and training to all midwives, and involvement of families to assist in KMC at selected hospitals of Limpopo Province
123

The leader-figure in three novels by D.H. Lawrence : a social and psychological study.

Piper, Thomas O. January 1970 (has links)
No description available.
124

Quasi-Experimental Longitudinal Cohort of the Perinatal Breastfeeding Program (PBP): Effects on Breastfeeding Outcomes in Taiwan

Yeh, Ching-Hsueh January 2011 (has links)
No description available.
125

Kangaroo Mother Care in Bangladesh : Experiences of Caregivers and Healthcare Providers

Sjömar, Johanna January 2024 (has links)
Kangaroo Mother Care (KMC) is an evidence-based intervention, recommended by the World Health Organization, with the potential to prevent neonatal deaths and morbidity among low-birthweight and preterm babies. In Bangladesh, where the number of neonatal deaths is high, KMC is identified as a priority intervention to be scaled up in the country. Our aim was to explore the experiences of caregivers and healthcare providers (HCPs) of KMC in Bangladesh. We conducted semi-structured interviews in two hospitals in Dhaka, where KCM service was provided. In Study I, we interviewed fifteen caregivers. The results showed conducive conditions for caregivers to perform KMC at the hospital and at home, but support is needed from both healthcare providers and their families. Caregivers felt empowered and motivated when they observed improvements in the child's well-being. However, there are challenges to KMC implementation due to the struggle to keep the baby skin-to-skin, pain after caesarean section, delayed initiation of KMC, and routines that promote an initial separation between the mother and baby. In Study II, we interviewed eleven HCPs. The results showed that HCPs experienced KMC as a continuous process that requires both support and counselling, adapted to caregivers’ needs. Commitment, supervision, and training are necessary. However, there are structural conditions that challenge KMC implementation, including clinical routines that promote the initial separation of the mother and baby, staff shortages, and incomplete follow-up. In conclusion, the findings from this exploratory research can inform the design of interventions for scaling up KMC in Bangladesh. Caregivers' and HCPs' experiences show that continuous support, counselling, and family involvement are essential in the care, and that providing KMC empowers caregivers. Their experiences also indicate that KMC is sub-optimally implemented due to structural conditions and routines that need to be addressed to scale up KMC in the country by avoiding the initial separation of mother and baby, meeting the mothers' needs for care and support, and strengthening the follow-up. Our results also suggest a need to update clinical practices in line with the new WHO recommendations. / <p></p><p></p><p></p>
126

Föräldrars upplevelse av kängurumetoden med barn på neonatalavdelningen : En litteraturöversikt

Djurfeldt, Tilda, Nestun, Tilda January 2024 (has links)
SAMMANFATTNING Bakgrund: Kängurumetoden, även kallat Kangaroo Mother Care (KMC) är en omvårdnadsmetod som främjar hudkontakten mellan förälder och barn, särskilt prematura eller underviktiga. KMC har positiva effekter för både föräldrar och barn. Därför är det väsentligt att ta reda på föräldrars upplevelse av KMC för att kunna optimera vården då metoden är essentiell för det nyfödda barnet.  Syfte: Syftet med denna litteraturöversikt var att undersöka föräldrars upplevelser av kängurumetoden med barn som vårdas på neonatalavdelningen.  Metod: En litteraturöversikt med kvalitativ design där 10 kvalitativa artiklar samlades in från databaserna PubMed och Cinahl.  Resultat: Föräldrars upplevelse av KMC uttrycktes i fyra kategorier och åtta subkategorier. Kategorierna som presenteras är Insikten om att ha blivit förälder, Emotionell upplevelse av kängurumetoden hos föräldrarna, Växande ansvar som förälder och Kommunikation med vårdpersonal under KMC. Upplevelsen av KMC var i helhet positiv, inklusive ökad lycka och lugn men även negativa upplevelser av KMC uttrycktes, såsom rädsla för att skada sitt barn och att kommunikationen med vårdpersonalen var påverkad.  Slutsats: Resultaten visar en mångfald av mestadels positiva men även negativa erfarenheter, däribland; förstärkt föräldraroll, ökad känsla av kompetens och ansvar för barnet. KMC kunde ge känslan av att känna sig som ett verktyg, men deltagandet i vården möjliggör för föräldrar att känna sig betydelsefulla vilket gör en positiv skillnad för sitt barn. Genom att lyssna på och integrera föräldrarnas perspektiv kan neonatalvården fortsätta att utvecklas och anpassas för att möta både barnets och föräldrarnas behov. / ABSTRACT Background: Kangaroo method, also called Kangaroo Mother Care (KMC) is a nursing method that promotes skin-to-skin contact between parent and child, especially for children born prematurely or underweight. KMC has positive effects for both parent and child. Therefore, it is important to find out parents' experience of KMC to optimize the care as the method is essential for the newborn child. Aim: The purpose was to investigate parents’ experience of Kangaroo Mother care with children in the neonatal unit. Method: A literature review with qualitative design where 10 qualitative articles were collected in databases PubMed and Cinahl.  Results: Parents' experience of KMC was expressed in four categories and eight subcategories that answered the purpose of this literature review. The categories presented are The realization that one has become a parent, Emotional experience of the kangaroo method by the parents, Increasing parental responsibility and Communication with healthcare staff during KMC. The experience of KMC was overall positive, including increased happiness and calmness but also negative experiences of KMC, such as fear of harming their child and that communication with healthcare professionals was affected. Conclusion: The results show a diversity of mostly positive but also negative experiences, including; strengthened parental role, increased sense of competence and responsibility for the child. KMC could give a sense of being used as a device, but participating in the care enables parents to feel meaningful for their child. By listening to parents' perspectives, neonatal care can continue to develop and adapt to meet needs of both children and parents
127

Ontwerp van 'n ouerleidingsprogram vir moeders in 'n kangaroemoedersorg-program : 'n opvoedkundig sielkundige benadering

Snyman, Amelia 06 1900 (has links)
Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)
128

Efeito do método canguru na redução do estresse crônico em gestantes, mães e bebês pré-termo através da análise do cortisol e desidroepiandrosterona em unhas / Effect of the kangaroo mother care on the reduction of chronic stress in pregnant women, mothers and preterm infants through the analysis of cortisol and dehydroepiandrosterone in fingernails

Souza, Sandra Regina de 26 January 2017 (has links)
INTRODUÇÃO: O estresse tem sido foco de interesse em diferentes áreas de estudo devido às consequências no processo saúde-doença. Destaca-se a inexistência de estudos sobre o estresse crônico no período pré e pós-natal em unhas de mulheres que tiveram parto prematuro e sua relação o método canguru (MC). OBJETIVOS: Avaliar o efeito do Método Canguru na redução do estresse psicológico materno através de escalas psicométricas e o estresse biológico crônico através dos níveis de cortisol e desidroepiandrosterona (DHEA) em unhas de mães e bebês pré-termo (PT). MÉTODO: Trata-se de estudo comparativo prospectivo. A amostra contou com 59 mães e 63 bebês, coletada num hospital com o MC implantado e em dois hospitais controle, sem o MC. Foram incluídos PT (?37 semanas), sem malformações, internados em UN; mães alfabetizadas, que tiveram contato prévio com o filho, não usuárias de drogas ou hormônios. O estresse crônico materno e do PT foi avaliado pelo Cortisol e DHEA das unhas. A primeira amostra de unhas maternas foi coletada na terceira semana de vida do PT. A segunda amostra das mães e a amostra das unhas dos PT foram coletadas três meses após parto. Para análise do cortisol e DHEA das unhas das mães foi utilizada a técnica de enzima imunoensaio e dos bebês a cromatografia líquida de alto desempenho com espectrometria de massa. As unhas foram analisadas em laboratórios especializados no Canadá. O estresse psicológico da mães foi analisado com uso das PSS-10 e PSS:NICU que foram respondidas pelas mães na semana da admissão e alta do PT. RESULTADOS: Os níveis de Cortisol e DHEA nas unhas das mães referente a gestação e puerpério não diferiu significativamente entre os grupos canguru e controle, porém, diferiu entre os tempos, sendo que, os níveis dos esteroides na gestação foi maior do que no puerpério em ambos os grupos. O estresse percebido (PSS-10) pelas mães referente a gestação (p=0,846) e puerpério (p=0,465) também não diferiu significativamente entre os dois grupos. O estresse indicado pela PSS:NICU na admissão foi moderado nos dois grupos. O maior escore foi observado na subescala alteração no papel de pais. Na alta o escore foi significativamente menor (p=0,00) no canguru do que no controle. Não houve qualquer relação entre o estresse crônico (cortisol, DHEA e razão Cort:DHEA) e o psicológico (PSS-10 na gestação e PSS:NICU no puerpério) e nem entre as duas medidas de estresse psicológico (PSS-10 e PSS:NICU na alta). O nível de cortisol foi menor nos PT submetidos ao canguru, porém, sem diferença significante (p=0,08). Diferiram significativamente a DHEA - menor no controle e a razão Cort:DHEA - menor nos PT do grupo canguru. Da análise da relação entre estresse crônico constataram-se: associação positiva entre Cort:DHEA da mãe e PT (?= 0,51canguru; ?= 0,43 controle). CONCLUSÃO: O estudo mostrou que é possível medir cortisol e DHEA em unhas de mães e de bebês PT de forma restrospectiva. Os dados sugerem que o MC pode contribuir com a regulação e redução do estresse crônico do PT e do estresse psicológico materno / INTRODUCTION: Stress has been a focus of interest in different areas of study due to the consequences in the health-disease process. We highlight the lack of studies on chronic stress in pre and postnatal period using fingernails of women who had preterm birth and its relation to the kangaroo mother care (KMC) to reduce chronic and psychological stress. OBJECTIVES: To evaluate maternal psychological stress using psicometrics tools and avaluate chronic stress of mothers and Preterm infant (PT) using the analysis of cortisol and DHEA in fingernails and analyse the implication of the kangaroo care (KMC) in reduce chronic stress. METHOD: This is a prospective comparative study. The sample were 59 mothers and 63 babies collected in a KMC\'s hospital and two controls (without the KMC). Were included PT babies (? 37 weeks), who were admitted to the NICU, those with no malformations. With regard to mothers were included that one who had saw the PT at least once and excluded those using drugs or taking hormones. Maternal and PT chronic\' stress were evaluated by fingernails\' cortisol and DHEA. The first maternal sample was collected in the third week post-delivery and the second sample in the third month after baby\'s birth. The baby\'s fingernail sample was collected in the third month of life. The enzyme immunoassay was used for analysis of mothers\' fingernails (cortisol and DHEA) and for babies\' were used high performance liquid chromatography with mass spectrometry. Fingernail\'s analysis was done in Canada. The PSS-10 and PSS: mothers filled up NICU tools on first week in NICU and at discharge of the baby from this unit. RESULTS: The cortisol and DHEA\'s level in mothers\' fingernails showed no significant difference between groups. Steroids levels in pregnancy time were higher than in puerperium in both groups (KMC and control) however, showed significant difference between times, steroids levels were higher during gestation time than the puerperium in both groups. The same occurred with the PSS-10 score (KMC\'s score referring to pregnancy (p=0,846) and puerperium (p=0,465), also had no difference was between groups. The PSS: NICU\'s stress level at admission in both groups was moderate. The highest score was showed in the subscale Parental Role. At discharge the score was significantly lower (p=0,00) in the kangaroo than in the control. There was no relationship between chronic stress (cortisol, DHEA and Cort:DHEA) and psychological stress (PSS-10 in pregnancy and PSS: NICU in the puerperium) or between the two psychological measures of stress (PSS-10 and PSS: NICU on discharge). The cortisol level was lower in PT submitted to kangaroo, however, without significant difference (p = 0.08). They differed significantly in DHEA - lower in the control and the ratio Cort:DHEA - lower in the kangaroo group. From the analysis of the relationship between chronic stress, there was a positive association between Cort: DHEA of the mother and PT (? = 0.51 kangaroo; ? = 0.43 control). CONCLUSION: The study showed that it is possible to measure cortisol and DHEA in preterm infant and mothers\' fingernails retrospectively. The data suggests that KMC can contribute to regulate and to reduce chronic stress in preterm infant and to reduce psychological mother\'s stress
129

Evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso egressos do método canguru / Very low weight preterm infants cognitive and motor development at preschool age that were former patients FROM THE KANGAROO METHOD

Gonçalves, Claudia Maria Ribeiro Martins 18 March 2014 (has links)
INTRODUÇÃO: O Método Canguru é um tipo de assistência neonatal que consiste no contato precoce pele a pele entre a mãe e o recém-nascido de baixo peso, de forma crescente e pelo tempo que ambos entenderem ser prazeroso e suficiente, permitindo dessa forma, uma maior participação dos pais no cuidado a seu recém-nascido, acompanhado de suporte assistencial, por uma equipe de saúde treinada adequadamente. Tem como premissa a interação dinâmica e continua entre fatores biomédicos e ambientais. OBJETIVO: Descrever a evolução do desenvolvimento motor e cognitivo de pré-escolares de muito baixo peso egressos do Método Canguru, que receberam leite humano durante o período de internação. MÉTODOS: Foram estudadas 54 crianças prematuras, no período de Janeiro de 2004 a Janeiro de 2011 que participaram do Método Canguru e acompanhadas no Ambulatório de Seguimento, até a idade pré-escolar. Essas crianças foram submetidas ao teste Denver II, com um ano e novamente na idade préescolar quando foi aplicada a Escala de Maturidade Mental Colúmbia. METODOLOGIA ESTATÍSTICA: As variáveis contínuas serão descritas através de suas médias e desvios-padrão. Aquelas com comportamento não paramétrico, serão descritas através da mediana e do intervalo inter-quartil. As variáveis categóricas serão descritas através de suas proporções e intervalos de confiança de 95%. Para descartar a hipótese de nulidade será utilizado o nível de corte de 5%. RESULTADOS: Na amostra houve predominância do sexo feminino de 65%, e cerca de 30% dos RNPT foram PIG. As medianas do peso de nascimento e idade gestacional foram 1316g e 32 semanas, respectivamente. A mediana da idade materna foi de 28 anos, ensino fundamental completo com nove anos de estudo e a renda per capita de R$150,00. Entre as 54 crianças do estudo, 15% tiveram Hemorragia Perintraventricular grau I, 19% desenvolveram displasia broncopulmonar e nenhuma apresentou retinopatia da prematuridade. No teste Denver II de 54 crianças na idade de um ano corrigida, constatamos um risco no desempenho do desenvolvimento motor grosso de 31%, na linguagem 7%, psicossocial 6% e motor adaptativo 2%. Na idade pré-escolar observamos uma diminuição significativa do risco no desempenho do desenvolvimento para 4% em linguagem, 3% em motor grosso e 0% em psicossocial e motor adaptativo. Na idade pré-escolar o desempenho cognitivo se assemelhou a normalidade, quando comparado com a população brasileira, de acordo com a padronização da Escala Colúmbia. Os fatores de risco para o desempenho no desenvolvimento neuropsicomotor das crianças com um ano de idade corrigida estão associados ao tempo de internação e inicio da posição Canguru e foram estatisticamente significantes (p=0,009), (p=0,013), mesmo depois de ajustar à análise para as variáveis da idade gestacional, peso de nascimento, idade materna e sexo. Embora não tenha havido significância estatística, as crianças que foram amamentadas por mais tempo (meses) tiveram percentualmente menor risco para o desempenho neuropsicomotor. Nesta amostra constatamos em relação ao aleitamento materno total a mediana de sete meses e para o aleitamento exclusivo a mediana de três meses. CONCLUSÃO: A análise da evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso e egressos do Método Canguru, mostrou que, as crianças com um ano de idade corrigida, apresentaram 38% de risco no desempenho neuropsicomotor e ao atingirem a idade pré-escolar, apenas 5% demonstraram este risco. No que diz respeito ao desenvolvimento cognitivo, os valores obtidos foram percentualmente acima da média da população brasileira. Estes achados sugerem que as crianças que foram RNPT MBP alimentadas com leite humano durante sua internação e egressas do Método Canguru podem apresentar um desempenho no desenvolvimento tanto motor como cognitivo semelhante ao padrão de normalidade / INTRODUCTION: The Kangaroo Method is a perinatal care concerning skin contact between the mother and the low birth weight (LBW) newborn as long as both consider it pleasant and necessary. It allows greater parental participation in the care of their low birth weight newborn closely followed by properly trained healthcare professionals. The dynamic and continuous interaction between biomedical and environmental factors is its premise. OBJECTIVE: To describe the cognitive and motor development of children at preschool age that were born with very low birth weight (VLBW), former patients of the Kangaroo Method that were breastfed during hospital stay. METHOD: Fifty four preterm infants were studied between January 2004 and January 2011. The infants participated in the Kangaroo Method and they were followed up to preschool age by trained professionals in a followup ambulatory. These children were submitted to Denver II test by the time they were one year old and again at preschool age. Columbia Mental Maturity scale was applied to the children at preschool age. STATISTICAL ANALYSIS: The continual variables will be described by their averages and standard deviations. The nonparametric variables will be described by the medians and the interquartile interval. The categorical variables will be described by their proportions and the confidence interval of 95%. A 5% cutoff point will be applied to discard the null hypothesis. RESULTS: In the sample 65% were female, approximately 30% of the preterm newborn were small for the gestational age. Birth weight and gestational age medians were respectively 1316g and 32 weeks. Maternal age median was 28 years old. The mothers completed elementary school in nine years and their per capita income was R$ 150,00. The fifty four children involved in the study 15% had peri-intraventricular hemorrhage level 1, 19% had bronchopulmonary dysplasia and none had retinopathy of prematurity. The fifty four children were assessed at one year old, corrected age, to Denver II test and the following development risks were detected, 31% gross motor, 7% language, 6% psychosocial and 2% adaptive motor. At preschool age there was a considerable decrease in those parameters, 4% for language and 3% for gross motor 0% for psychosocial and adaptive motor. According to the Columbia scale standardization cognitive performance at preschool age resembled normality when compared with Brazilian population. Our study identified that the children involved had a higher performance than the population of reference (Brazilian population). Hospitalization period and the beginning of the Kangaroo position determined the risks factors for psychomotor development at one year old, corrected age, even after the adjustments in the analysis for gestational age, birth weight, mother\'s age and gender (p=0,009), (p=0,013) had been made. Although there was no statistical significance children breastfed for longer period had a lower psychomotor development risk. For the sample enrolled the median for total breastfeeding was 7 months and the exclusive breastfeeding 3 months. CONCLUSION: The Kangaroo Method had an impact on motor and cognitive developmental performance of the preschool age children born preterm with very low birth weight. At one year old, corrected age, the children concerned presented a 38% risk in psychomotor performance, however at preschool age the percentage dropped to 5%. The measured values for cognitive development were above the average for the Brazilian population. These findings suggest that very low birth weight preterm newborn that were breastfed during hospital stay and submitted to Kangaroo Method may present motor as well as cognitive developmental performances similar to normal standard
130

Evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso egressos do método canguru / Very low weight preterm infants cognitive and motor development at preschool age that were former patients FROM THE KANGAROO METHOD

Claudia Maria Ribeiro Martins Gonçalves 18 March 2014 (has links)
INTRODUÇÃO: O Método Canguru é um tipo de assistência neonatal que consiste no contato precoce pele a pele entre a mãe e o recém-nascido de baixo peso, de forma crescente e pelo tempo que ambos entenderem ser prazeroso e suficiente, permitindo dessa forma, uma maior participação dos pais no cuidado a seu recém-nascido, acompanhado de suporte assistencial, por uma equipe de saúde treinada adequadamente. Tem como premissa a interação dinâmica e continua entre fatores biomédicos e ambientais. OBJETIVO: Descrever a evolução do desenvolvimento motor e cognitivo de pré-escolares de muito baixo peso egressos do Método Canguru, que receberam leite humano durante o período de internação. MÉTODOS: Foram estudadas 54 crianças prematuras, no período de Janeiro de 2004 a Janeiro de 2011 que participaram do Método Canguru e acompanhadas no Ambulatório de Seguimento, até a idade pré-escolar. Essas crianças foram submetidas ao teste Denver II, com um ano e novamente na idade préescolar quando foi aplicada a Escala de Maturidade Mental Colúmbia. METODOLOGIA ESTATÍSTICA: As variáveis contínuas serão descritas através de suas médias e desvios-padrão. Aquelas com comportamento não paramétrico, serão descritas através da mediana e do intervalo inter-quartil. As variáveis categóricas serão descritas através de suas proporções e intervalos de confiança de 95%. Para descartar a hipótese de nulidade será utilizado o nível de corte de 5%. RESULTADOS: Na amostra houve predominância do sexo feminino de 65%, e cerca de 30% dos RNPT foram PIG. As medianas do peso de nascimento e idade gestacional foram 1316g e 32 semanas, respectivamente. A mediana da idade materna foi de 28 anos, ensino fundamental completo com nove anos de estudo e a renda per capita de R$150,00. Entre as 54 crianças do estudo, 15% tiveram Hemorragia Perintraventricular grau I, 19% desenvolveram displasia broncopulmonar e nenhuma apresentou retinopatia da prematuridade. No teste Denver II de 54 crianças na idade de um ano corrigida, constatamos um risco no desempenho do desenvolvimento motor grosso de 31%, na linguagem 7%, psicossocial 6% e motor adaptativo 2%. Na idade pré-escolar observamos uma diminuição significativa do risco no desempenho do desenvolvimento para 4% em linguagem, 3% em motor grosso e 0% em psicossocial e motor adaptativo. Na idade pré-escolar o desempenho cognitivo se assemelhou a normalidade, quando comparado com a população brasileira, de acordo com a padronização da Escala Colúmbia. Os fatores de risco para o desempenho no desenvolvimento neuropsicomotor das crianças com um ano de idade corrigida estão associados ao tempo de internação e inicio da posição Canguru e foram estatisticamente significantes (p=0,009), (p=0,013), mesmo depois de ajustar à análise para as variáveis da idade gestacional, peso de nascimento, idade materna e sexo. Embora não tenha havido significância estatística, as crianças que foram amamentadas por mais tempo (meses) tiveram percentualmente menor risco para o desempenho neuropsicomotor. Nesta amostra constatamos em relação ao aleitamento materno total a mediana de sete meses e para o aleitamento exclusivo a mediana de três meses. CONCLUSÃO: A análise da evolução do desenvolvimento motor e cognitivo de pré-escolares nascidos pré-termo de muito baixo peso e egressos do Método Canguru, mostrou que, as crianças com um ano de idade corrigida, apresentaram 38% de risco no desempenho neuropsicomotor e ao atingirem a idade pré-escolar, apenas 5% demonstraram este risco. No que diz respeito ao desenvolvimento cognitivo, os valores obtidos foram percentualmente acima da média da população brasileira. Estes achados sugerem que as crianças que foram RNPT MBP alimentadas com leite humano durante sua internação e egressas do Método Canguru podem apresentar um desempenho no desenvolvimento tanto motor como cognitivo semelhante ao padrão de normalidade / INTRODUCTION: The Kangaroo Method is a perinatal care concerning skin contact between the mother and the low birth weight (LBW) newborn as long as both consider it pleasant and necessary. It allows greater parental participation in the care of their low birth weight newborn closely followed by properly trained healthcare professionals. The dynamic and continuous interaction between biomedical and environmental factors is its premise. OBJECTIVE: To describe the cognitive and motor development of children at preschool age that were born with very low birth weight (VLBW), former patients of the Kangaroo Method that were breastfed during hospital stay. METHOD: Fifty four preterm infants were studied between January 2004 and January 2011. The infants participated in the Kangaroo Method and they were followed up to preschool age by trained professionals in a followup ambulatory. These children were submitted to Denver II test by the time they were one year old and again at preschool age. Columbia Mental Maturity scale was applied to the children at preschool age. STATISTICAL ANALYSIS: The continual variables will be described by their averages and standard deviations. The nonparametric variables will be described by the medians and the interquartile interval. The categorical variables will be described by their proportions and the confidence interval of 95%. A 5% cutoff point will be applied to discard the null hypothesis. RESULTS: In the sample 65% were female, approximately 30% of the preterm newborn were small for the gestational age. Birth weight and gestational age medians were respectively 1316g and 32 weeks. Maternal age median was 28 years old. The mothers completed elementary school in nine years and their per capita income was R$ 150,00. The fifty four children involved in the study 15% had peri-intraventricular hemorrhage level 1, 19% had bronchopulmonary dysplasia and none had retinopathy of prematurity. The fifty four children were assessed at one year old, corrected age, to Denver II test and the following development risks were detected, 31% gross motor, 7% language, 6% psychosocial and 2% adaptive motor. At preschool age there was a considerable decrease in those parameters, 4% for language and 3% for gross motor 0% for psychosocial and adaptive motor. According to the Columbia scale standardization cognitive performance at preschool age resembled normality when compared with Brazilian population. Our study identified that the children involved had a higher performance than the population of reference (Brazilian population). Hospitalization period and the beginning of the Kangaroo position determined the risks factors for psychomotor development at one year old, corrected age, even after the adjustments in the analysis for gestational age, birth weight, mother\'s age and gender (p=0,009), (p=0,013) had been made. Although there was no statistical significance children breastfed for longer period had a lower psychomotor development risk. For the sample enrolled the median for total breastfeeding was 7 months and the exclusive breastfeeding 3 months. CONCLUSION: The Kangaroo Method had an impact on motor and cognitive developmental performance of the preschool age children born preterm with very low birth weight. At one year old, corrected age, the children concerned presented a 38% risk in psychomotor performance, however at preschool age the percentage dropped to 5%. The measured values for cognitive development were above the average for the Brazilian population. These findings suggest that very low birth weight preterm newborn that were breastfed during hospital stay and submitted to Kangaroo Method may present motor as well as cognitive developmental performances similar to normal standard

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