Hintergrund Ein rascher enteraler Nahrungsaufbau bei Frühgeborenen verkürzt die Zeit der parenteralen Ernährung. Somit lassen sich bestimmte Risikofaktoren beeinflussen, die evt. die Morbiditätshäufigkeit der Kinder senken könnten. Mehrere Kohortenstudien zeigten, dass ein standardisierter Nahrungsaufbau mit einer geringeren Komplikationsrate und einem schnelleren Nahrungsaufbau assoziiert ist. Ziel der Studie ist zu überprüfen, ob ein standardisiertes Ernährungsprogramm einen rascheren und komplikationsärmeren enteralen Nahrungsaufbau bei Frühgeborenen ermöglicht. Patienten und Methode In die vorliegende randomisierte, kontrollierte Studie wurden 99 Frühgeborene mit einem Geburtsgewicht von ≤1750 g aufgenommen. In der Gruppe mit standardisierter Ernährung (ST) wurde der enterale Nahrungsaufbau mit Muttermilch oder gespendeter Frauenmilch nach einem speziell ausgearbeiteten Protokoll durchgeführt. In der Gruppe mit der individuellen Ernährungsform (IN) wurde je nach Bedarf und Zustand des Kindes auch semi-elementare Nahrung (Pregomin®) gefüttert. Über die Steigerungsdynamik und Nahrungspausen wurde hier individuell entschieden. Primäres Zielkriterium war die Dauer bis zum Erreichen der vollenteralen Ernährung. Ergebnisse In der ST-Gruppe war die vollständig enterale Ernährung nach 14,93 ± 9,95 (Median 12) Tagen, in der IN-Gruppe nach 16,23 ± 10,86 (Median 14) Tagen möglich. Es konnte kein signifikanter Unterschied gefunden werden. Nur bei hypotrophen Frühgeborenen erwiesen sich die Unterschiede bei der ST-Gruppe gegenüber der IN-Gruppe als statistisch signifikant: 10,20 ± 4,78 (Median 8,5) vs. 16,73 ± 8,57 (Median 15) Tage (p = 0,045). Die Gewichtsentwicklung verlief in beiden Studiengruppen nicht different. Die Kinder in der ST-Gruppe konnten bei einem Gewicht von 116% des Geburtsgewichtes vollständig enteral ernährt werden, in der IN-Gruppe bei einem Gewicht von 122% des Geburtsgewichtes. Die Inzidenz der nekrotisierenden Enterokolitis (4%) und anderer Komplikationen blieb in beiden Studiengruppen niedrig. Die Diagnose „Ernährungsschwierigkeiten“ wurde mit klaren Symptomen definiert und in der IN-Gruppe doppelt so oft gestellt, wie in der ST-Gruppe (14 vs. 7) Schlussfolgerung Das Standardisieren führte unter den Studienbedingungen nicht zu einer Beschleunigung des Nahrungsaufbaus. Anhand unserer Ergebnisse ist es möglich, dass die hypotrophen Frühgeborenen von der standardisierten Ernährung entsprechend des Ernährungsprotokolls profitieren. Diese Hypothese muss in einer neuen Studie überprüft werden. Diese Kinder konnten schneller vollständig enteral ernährt werden, als Frühgeborene, mit individuellem enteralem Nahrungsaufbau. Ein standardisiertes Nahrungsprotokoll ist im klinischen Alltag durchsetzbar, und darauf aufbauend ein enteraler Nahrungsaufbau unter strenger klinischer Beobachtung ohne Komplikationen erfolgreich durchführbar.

In this retrospective cohort from 2002 through 2007, 104,003 singleton live births in Hillsborough County, Florida were analyzed to elucidate the relationship between feto-infant morbidity outcomes and prenatal exposure to six criteria air pollutants. This study is based on three linked databases: The Florida Hospital Discharge database; The vital statistics records of singleton live births; Air Pollution meteorological data from the Environmental Protection Agency. There are six common air pollutants, particulate matter 2.5 (PM2.5), particulate matter 10 (PM10), ground-level ozone (O3), carbon monoxide (CO), nitrogen (NOx), and lead (Pb). These pollutants are harmful to human health and the environment. The primary outcomes of interest were low birth weight (LBW), preterm births, and small for gestational age (SGA). The intent of this project is to address these issues of air pollution effects and the methodology surrounding the study of air pollution. Using modeling, exposure values of the six criteria air pollutants were assigned to mothers over their period of pregnancy. To address these methodological concerns, this study utilizes the structural equation modeling, quartile groupings with dose response, and trimester groupings to evaluate the relationship between air pollution and birth outcomes of pregnant residents. Using structural equation modeling a significant B value of 0.35 indicated that exposure to the six criteria pollutant in pregnancy may have a significant relationship to all five birth outcomes if they are broken down into latent variables. Quartile data demonstrated that NOx seemed to have most significant associations with all outcomes with a dose response for SGA. PM10 and PM2.5 had some association to LBW and VLBW at high levels. PM10 demonstrated significance in the higher doses for SGA. However, the only dose response relationship that was demonstrated for PM10 and PM2.5 was in VLBW. PM10 also demonstrated a dose response with very preterm. If sub-divided into trimester data, PM10 demonstrated a significant relationship between exposures in all trimesters and LBW, VLBW, and SGA. PM2.5 demonstrated a significant relationship between exposures in all trimesters and VLBW. CO demonstrated a significant relationship in the 2nd trimester for LBW as well as for SGA. Mothers and their babies are a vulnerable population who are more susceptible to lower levels of pollution. These air pollutants can possibly have long-term effect on their children. Implantation of laws and regulations, warning system, or more strict EPA standards may be needed to adequately control the cost to our society.

Background: Children born very preterm are at an elevated risk of behavioural adjustment problems, particularly Attention-Deficit/Hyperactivity Disorder (ADHD) or inattention/hyperactivity difficulties. Importantly, these risks remain even after controlling for the effects of social risk factors correlated with very preterm birth. Behavioural outcomes in follow-up studies of children born very preterm are typically assessed using parent reports only. However, the extent to which behavioural problems are evident across multiple contexts (i.e., parent or teacher report) is not well known. Furthermore, the neonatal neuropathology underlying these behavioural difficulties in this population remains poorly understood. Aims: Three research studies are undertaken primarily to examine: (1) the degree of agreement between parent and teacher reports of child behaviour adjustment, and the extent of situational (parent- or teacher-identified) and pervasive (parent- and teacher-identified) inattention/hyperactivity problems at ages 4, 6, and 9 years among children born very preterm and full-term; (2) to cross-validate the classification of children with situational and pervasive inattention/hyperactivity problems across the ages of 4 to 9, for a clinical diagnosis of ADHD at age 9 years; (3) to document risk of persistent ADHD symptoms between ages 4 and 9 years in children born very preterm, and to examine associations between qualitative measures of neonatal cerebral white matter injury/abnormality and quantitative volumetric measures of cerebral structural development, identified using magnetic resonance imaging (MRI) at term equivalent age, and children’s later risks of persistent symptoms. Persistent ADHD symptoms were defined as behavioural inattention/hyperactivity problems shown at ages 4, 6, and 9, along with meeting the criteria for an ADHD clinical diagnosis at age 9 years. Methods: As part of a prospective longitudinal study, a regional cohort of 110 very preterm (≤ 33 weeks of gestation) and 113 full-term children born between 1998 and 2000 were studied from birth to age 9 years. At term equivalent age, all children born very preterm and 10 children born full-term underwent an MRI scan that was analysed using qualitative measures for cerebral white matter injury/abnormality, and quantitative volumetric techniques with tissue segmentation and regional parcellation for cortical and subcortical grey matter, myelinated and unmyelinated white matter, and cerebrospinal fluid. At ages 4, 6 (corrected for the extent of prematurity), and 9 years (uncorrected), children were screened for behavioural adjustment problems including inattention/hyperactivity symptoms using the parent and teacher rated Strengths and Difficulties Questionnaire (SDQ). At age 9, the Development and Well-Being Assessment (DAWBA) structured psychiatric interview was also completed with primary caregiver and an independent clinical diagnosis of ADHD determined by a child psychiatrist blinded to child’s perinatal history and group status. Results: Agreement between parent and teacher reports regarding child behaviour adjustment was lower for children born very preterm than full-term (mean alternative chance-correlated coefficient, AC₁ = 0.63 vs. 0.80). Across all assessment time-points, very preterm birth was associated with on average a 2-fold increased risk of behavioural inattention/hyperactivity problems. These elevated risks largely reflected high rates of situational symptoms (very preterm = 22.3% − 31.7%; full-term = 10.9% − 16.7%). In contrast, rates of pervasive symptoms were relatively modest (very preterm = 6.8% − 11.5%; full-term = 4.7% − 7.3%). Examination of the predictive validity of inattention/hyperactivity problems identified using parent and teacher reports showed that children exhibiting situational symptoms at ages 4 and 6 were much less likely than those exhibiting pervasive symptoms, for a subsequent clinical diagnosis of ADHD at age 9 years (very preterm = 29% − 47.8% vs. 66.7% − 75%; full-term = 13.3% − 22.2% vs. 33.3% − 40%). Furthermore, receiver operating characteristic curves fitted to the data showed that children born very preterm exhibiting inattention/hyperactivity problems at two or three time-points (area under curve, AUC = .909) have better predictive validity for later ADHD diagnosis, compared to those exhibiting symptoms at age 4 (AUC = .794) or 6 years (AUC = .813) only. Children born very preterm were also at an elevated risk of persistent ADHD symptoms across the ages of 4 to 9 years, with the risk being 5-fold higher than their full-term peers (13.1% vs. 2.8%). Results also revealed possible associations between neonatal neuropathology and later risk of persistent ADHD symptoms. There were no significant linear associations between increasing severity of qualitative neonatal MRI measures of white matter injury/abnormality and very preterm children’s later risk of persistent ADHD symptoms. However, reduction in total cerebral tissue volumes and corresponding increase of cerebrospinal fluid (adjusted for intracranial volume) were significantly associated with increased risk of persistent symptoms in children born very preterm (p = .001). In terms of regional tissue volumes, total cerebral tissues in the dorsal prefrontal region showed the largest volumetric reductions among all the subregions in children born very preterm exhibiting persistent ADHD symptoms, with 3.2 ml (7%) and 8.2 ml (16%) lower tissue volumes than children born very preterm and full-term without persistent symptoms, respectively. Conclusions: Reliance on a single informant to examine child behaviour outcomes at a single time-point may lead to an under- or over-estimation of later ADHD risks. Combining reports from multiple informants and repeated assessments over time may provide better clinical prognostic validity. Children born very preterm are at an increased risk of behavioural inattention/hyperactivity problems during their early school years; although risks of more severe, pervasive problems are relatively modest compared with situational problems. Behavioural adjustment difficulties recognised as early as during preschool age using standardised behaviour screening tools can be a reliable indicator for identifying children born very preterm at risk of subsequent ADHD diagnosis. Finally, study findings suggest that increased risk of ADHD symptoms in children born very preterm can at least in part be accounted for by disturbances to neonatal cerebral growth and maturation.

Many parents experience high levels of stress after the birth of a premature infant admitted to a neonatal intensive care unit (NICU) given the often fragile status of their infant and the numerous medical interventions necessary to stabilize the infant. Previous research has found that parents of very preterm (VPT; <32 weeks‟ gestation) infants often experience high levels of stress, particularly in relation to feelings of having lost their parental role. Of particular concern are findings which suggest that such symptoms may last beyond the immediate hospitalization period to have an adverse effect on the parental ability to provide quality infant care-giving at home. However, little is known about the paternal NICU stress response, the role of stressors external to the NICU environment and the perceptions of NICU staff. Against this background, aims of this thesis were: 1) to describe and compare sources of NICU stress for mothers and fathers of VPT infants, 2) to identify key predictors of parental NICU stress, 3) to describe staff perceptions of parental NICU stress, and 4) to identify parental stressors external to the NICU. Two cohorts of parents of VPT infants were studied: 11 mothers and 10 fathers of VPT infants (<32 weeks' gestation) admitted to a level III NICU, Christchurch Women's Hospital; and 68 mothers and 68 fathers of VPT infants (<30 weeks' gestation) who participated in the Victorian Infant Brain Studies, admitted to the Royal Women‟s Hospital NICU, Melbourne. Twenty-three NICU nurses from Christchurch Women‟s Hospital, level III NICU were also interviewed. The Parental Stressors Scale: NICU (PSS: NICU) determined sources of stress among parents. NICU nurses completed an adapted version of the PSS: NICU that measured nursing staffs‟ perceptions of parental NICU stress. Parents also completed the Life Events Scale on upsetting life events from the previous 12 months. An external stressors scale which measured stress relating to finances, transport and childcare was developed and completed by parents and staff. Familial demographic and infant clinical information was collected from birth records and hospital databases. Results showed across both cohorts studied that mothers reported significantly higher levels of NICU stress than fathers on the “sights and sounds”, “infant appearance”, and “loss of parental role” subscales on the PSS: NICU (p < .05). The number of upsetting life events (B = .33, p = .01)) and paternal level of NICU stress predicted maternal NICU stress (B = .23, p = .03). Maternal NICU stress also predicted paternal NICU stress (B = .37, p = .01). Staff consistently overestimated parental stress levels (p < .05). The most stressful item on the external stressors scale reported by parents and staff was “fitting in everything else I have to do”. Findings emphasize the need for increased awareness of NICU-specific and NICU-external factors contributing to parental stress. Research into the extent to which staff perceptions of parent experiences may affect the quality of staff-parent relations in the NICU is also warranted. These findings contribute to our understanding of the parental experience of having a preterm infant in the NICU and implications for practice and future research are discussed.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2056. Adviser: Maureen Sanderson. Includes bibliographical references.

Thesis (M.N.)--Memorial University of Newfoundland, School of Nursing, 2000. / Typescript. Bibliography: p. 100-112.

Thesis (M.N.)--Memorial University of Newfoundland, 1999. / Typescript. Bibliography: p. 113-123.

Orientador: Elenice Deffune / Resumo: Introdução: As transfusões de concentrados de hemácias (CHs) são frequentes em recém-nascidos (RNs) apesar do aumento do tempo para clampeamento de cordão umbilical ao nascer, da redução no volume de sangue coletado para exames laboratoriais e da adesão aos protocolos restritivos de sua indicação. Diversas correlações já foram descritas entre transfusões e piores desfechos perinatais. Casuística e métodos: Estudo analítico, observacional, transversal do tipo coorte realizado na Unidade de Terapia Intensiva Neonatal (UTIN) do Hospital das Clínicas da Faculdade de Medicina de Botucatu, com análise de prontuários de 170 recém-nascidos menores de 1500g ao nascimento admitidos durante os anos de 2015 e 2016, divididos em grupos transfundido (Tf) e não transfundido (NTf). Calculadas diferença de proporções e frequências simples e relativa; para comparação entre os grupos foi usado o teste t-student e em caso assimétrico foi utilizado o modelo de distribuição gama. Resultados: No grupo Tf, a média de peso foi 966,8 (±242,2) gramas e de idade gestacional 27,70 (±2,63) semanas, no grupo NTf, estes valores foram 1214,5 (±263,8) g e 30,37 (±3,07) semanas. Houve cerca de 1,2 transfusões por paciente. Valores médios de hemoglobina das primeiras 72h de 16,65g/d e de peso de nascimento de 1184g, não se associaram a transfusões. Houve correlação entre sepse, HPIV, SDR, DBP, ECN, permanência na UTIN e óbito com transfusões de CHs. Conclusão: Menores peso de nascimento e idade gestacional asso... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Introduction: Red blood cell transfusions (RBCTs) are common in newborns (NBs) despite the increased time for umbilical cord clamping at birth, reduced blood volume collected for laboratory tests and adherence to protocols restricting their indication. Several correlations have already been described between transfusions and worse perinatal outcomes. Patients and methods: An analytical, observational, cross-sectional, cohort study performed at the Neonatal Intensive Care Unit (NICU) of the Clinical Hospital of the Botucatu Medical School, with an analysis of medical records of 170 newborns less than 1,500 g at birth admitted during the years 2015 and 2016, divided into transfused (Tf) and non-transfused (NTf) groups. Calculated difference of proportions and simple and relative frequencies; the t-student test was used for comparison between the groups, and in the case of asymmetric, the gamma distribution model was used. Results: In the Tf group, the mean weight was 966.8 (± 242.2) grams and the gestational age was 27.70 (± 2.63) weeks. In the NTf group, these values were 1214.5 (± 263, 8) grams and 30.37 (± 3.07) weeks. There were about 1.2 transfusions per patient. Mean values of hemoglobin of the first 72h of 16.65g / d and birth weight of 1184g were not associated with transfusions. There was a correlation between sepsis, IVH, RDS, BPD, NEC, NICU stay and death with RBC transfusions. Conclusion: Lower birth weight and gestational age are associated with RBC transfusions. A... (Complete abstract click electronic access below) / Mestre

Objective: to evaluate the risk of obstetric and perinatal outcomes in teenage pregnancy in comparison with adult pregnancy. Methods: retrospective cohort study of 67.693 pregnant women attended in a public hospital in Lima between 2000 and 2010. Obstetric and perinatal outcomes were evaluated. The adolescent group was divided in late adolescents (15-20 years), and early adolescents (<15 years) and was compared among the adult group (20-35 years). Adjusted odds ratios were calculated by education, civil status, prenatal care, previous pregnancies, parity, and pre-gesta-tional BMI. Results: higher risk of cesarean (OR=1,28; CI95%=1,07-1,53) and puerperal infection (OR=1,72; CI95%=1,17-2,53) was found in teenager under 15 years old; as well as higher risk of episiotomy (OR=1,34; CI95%=1,29-1,40) in late teenagers. In addition, this study identified a lower risk of teenage pregnancy for preeclampsia (OR=0,90; CI95%=0,85-0,97), 2nd half-pregnancy bleeding (OR=0,80; CI95%=0,71-0,92), premature rupture of membranes(OR=0,83; CI95%=0,79-0,87), preterm labor (OR=0,87; CI95%=0,80-0,94) and vaginal tearing (OR=0,86; CI95%=0,79-0,93). Conclusion: pregnancy behaves as a risk factor for some obstetric outcomes in the adolescent group, especially in the youngest ones. In addition to maternal age, there are other factors that constitute the need to form multidisciplinary teams to reduce obstetric outcomes in this population. / diego.maticorena@gmail.com / Objetivos: analizar el riesgo de complicaciones obstétricas y perinatales en adolescentes embarazadas en un hospital de Lima, Perú. Métodos: estudio de cohorte retrospectiva de 67.693 gestantes atendidas en el período 2000-2010. Se evaluó complicaciones obstétricas y perinatales. Las adolescentes se clasificaron en tardías (15-19 años) y tempranas (< 15 años) y se compararon con las adultas (20-35 años). Se calculó OR ajustados por educación, estado civil, control prenatal, gestaciones previas, paridad e IMC pregestacional. Resultados: se encontró mayor riesgo de cesárea (OR=1,28; IC95%=1,07-1,53) e infección puerperal (OR=1,72; IC95%=1,17-2,53) en las adolescentes menores de 15 años, así como mayor riesgo (OR=1,34; IC95%=1,29-1,40)de episiotomía en las adolescentes tardías. Asimismo, se identificó un menor riesgo del embarazo adolescente para preeclampsia (OR=0,90; IC95%=0,85-0,97), hemorragia de la 2da mitad del embarazo (OR=0,80; IC95%=0,71-0,92), ruptura prematura de membranas (OR=0,83; IC95%=0,79-0,87), amenaza de parto pretérmino (OR=0,87; IC95%=0,80-0,94) y desgarro vaginal (OR= 0,86; IC95%=0,79-0,93). Conclusión: el embarazo se comporta como factor de riesgo para ciertas complicaciones obstétricas en la población adolescente, especialmente en las adolescentes tempranas. Existen además otros factores, que sumados a la edad materna, constituyen la necesidad de formar equipos multidis-ciplinarios para reducir complicaciones obstétricas en esta población. / Revisión por pares