Wong Pui On Raymond. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 105-120). / Abstracts in English and Chinese. / Contents --- p.i / Abstract --- p.vi / Statement of originality --- p.xii / Acknowledgments --- p.xiii / List of figures and tables --- p.xiv / Abbreviations --- p.xvii / Publications --- p.xx / Text / Chapter Chapter 1: --- Introduction and Objectives --- p.1 / Chapter 1.1 --- Neonatal Sepsis --- p.2 / Chapter 1.2 --- Markers of Infection --- p.4 / Chapter 1.2-1 --- Clinical markers for sepsis --- p.4 / Chapter 1.2-2 --- Cytokines as markers of sepsis --- p.7 / Chapter 1.2-3 --- Cell surface receptors as markers of sepsis --- p.8 / Chapter 1.3 --- The immune system in response to pathogen challenge --- p.10 / Chapter 1.3-1 --- Source of cytokines --- p.11 / Chapter 1.4 --- General outline of cytokines implicated in sepsis --- p.12 / Chapter 1.4-1 --- IL-2 --- p.13 / Chapter 1.4-2 --- IL-4 --- p.15 / Chapter 1.4-3 --- IL-5 --- p.16 / Chapter 1.4-4 --- IL-6 --- p.17 / Chapter 1.4-5 --- IL-10 --- p.18 / Chapter 1.4-6 --- IFN-γ --- p.19 / Chapter 1.4-7 --- TNF-α --- p.21 / Chapter 1.5 --- General outline of cell surface receptors implicated in sepsis --- p.23 / Chapter 1.5-1 --- CDllb --- p.23 / Chapter 1.5-2 --- CD64 --- p.24 / Chapter 1.5-3 --- CD45RO --- p.25 / Chapter 1.5-4 --- CD25 --- p.26 / Chapter 1.6 --- Aims of study --- p.27 / Chapter Chapter 2: --- Materials and methods --- p.31 / Chapter 2.1 --- Patients inclusion criteria and classification --- p.32 / Chapter 2.2 --- Sample collection and sepsis screening --- p.33 / Chapter 2.3 --- Quantitation of cell surface antigens --- p.35 / Chapter 2.3-1 --- Cell acquisition and calculation --- p.37 / Chapter 2.4 --- Quantitation of plasma cytokines --- p.38 / Chapter 2.4-1 --- Cytometric Beads Array assay --- p.40 / Chapter 2.5 --- Statistical Analysis --- p.41 / Chapter Chapter 3: --- "Cell surface and plasma cytokine markers for the diagnosis of late-onset sepsis in preterm, very low birthweight (VLBW) infants" --- p.51 / Chapter 3.1 --- Results --- p.52 / Chapter 3.1-1 --- Lymphocyte markers: CD25 and CD45RO --- p.52 / Chapter 3.1-2 --- Neutrophil markers --- p.53 / Chapter 3.1-2a --- CD64 --- p.54 / Chapter 3.1-2b --- CDllb --- p.55 / Chapter 3.1-3 --- Purified CDllb --- p.56 / Chapter 3.1-4 --- Comparison of cell surface markers --- p.56 / Chapter 3.1-5 --- Interluekin 6 (IL-6) and C-Reactive Protein (CRP) --- p.57 / Chapter 3.2 --- Combined analysis of diagnostic markers --- p.58 / Chapter 3.3 --- Discussion --- p.58 / Chapter Chapter 4: --- Proinflammatory and anti-inflammatory cytokine response in preterm very low birthweight infants (VLBW) with systemic infections --- p.82 / Chapter 4.1 --- Results --- p.83 / Chapter 4.1-1 --- Correlation of cytokine levels in infected patients --- p.84 / Chapter 4.2 --- Subgroup analysis --- p.85 / Chapter 4.2-1 --- Proinflammatory and anti-inflammatory cytokine ratios --- p.85 / Chapter 4.2.2 --- The deceased case --- p.86 / Chapter 4.3 --- Discussion --- p.87 / Chapter Chapter 5: --- General Discussion and Conclusions --- p.97 / Chapter 5.1 --- General Discussion --- p.98 / Chapter 5.1-1 --- Cell surface markers --- p.98 / Chapter 5.1-2 --- Infection markers with prognostic significance --- p.100 / Chapter 5.1-3 --- Limitations of infection markers in clinical applications --- p.100 / Chapter 5.2 --- Conclusions and future development --- p.102 / Chapter 5.2-1 --- Conclusions --- p.102 / Chapter 5.2-2 --- The future development --- p.102 / References --- p.105

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

Philosophiae Doctor - PhD / Adverse pregnancy outcomes such as preterm birth and low birth weight are major causes of maternal and neonatal morbidity and mortality. Increasing evidence points to an association between periodontal disease and adverse pregnancy outcomes and thus a better understanding of the nature of this association will assist in treatment planning to reduce adverse pregnancy outcomes. Among the Gram-negative anaerobic bacteria frequently associated with periodontal disease are Treponema denticola, Tannerella forsythia and Porphyromonas gingivalis which may be detected in plaque using the BANA test (N-benzoyl-DL-arginine-2-naphthylamide). The aim of this study was to investigate the effect of periodontal disease on pregnancy outcomes and evaluate the use of BANA as a screening test for the risk of adverse pregnancy outcomes. This study complied with the Declaration of Helsinki (2013) and included 443 pregnant women attending ante-natal clinics in KwaZulu Natal. At first visit, maternal oral health status was assessed by the measurement of periodontal indices and BANA testing of dental plaque from the same teeth. Patient demography and medical history were obtained by means of a questionnaire and all data compared with pregnancy outcomes. While controlling for other factors, significant differences were found between the distributions of periodontal disease at BANA-negative and BANA-positive sites and between infant birth weight and maternal periodontal index scores such as plaque index and gingival index. The birth weight and gestational age at delivery of infants born of BANA-positive periodontally diseased mothers were significantly lower than those born of BANA-negative mothers with no periodontal disease. We may conclude that the presence of periodontal disease during pregnancy has a significant association with negative pregnancy outcomes and suggest that the risk for adverse pregnancy outcomes may be reduced by monitoring the oral health status of women during pregnancy.

The aims of the study were to examine postural development in very low birthweight and normal birthweight infants and to determine whether deviant postures were predictive of adverse neurodevelopmental outcome. In the first part of the study the 7 postural responses selected by Vojta to evaluate neuromotor development were applied to 69 very low birthweight (VLBW < 1 500 grams) infants and to 28 healthy full-term infants of normal birthweight (> 2500 grams). Of the 69 VLBW infants, 43 were small for gestational age and 26 appropriate for gestational age. All infants were examined at term and 4 months corrected age. They were all later assessed on the Griffiths Mental Development Scale at 12 and 18 months corrected age. There were significant differences in postural reactions between the 2 groups which confirmed the lower tone and greater extension previously described in VLBW infants. An important finding in the study was that poor head and trunk righting noted at 4 months corrected age in VLBW infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Development Scale. Thus, a delay in maturation in VLBW infants which was apparent from the assessment of postural responses was still identifiable on the locomotor sub-scales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants. In the second part of the study, the 5 useful Vojta responses were incorporated into the Infant Neurodevelopmental Assessment (INA) which was used to assess 76 high risk VLBW infants. The 76 infants consisted of 34 infants with intracranial lesions on ultrasound and 42 without intracranial lesions. All infants were assessed at term and 4 % months corrected age using the INA. At 12 months corrected age they were all assessed on the Griffiths Mental Development Scale. Six infants were diagnosed as having cerebral palsy, all of whom had intracranial lesions. Several clinical signs indicative of cerebral palsy were significant at 4 % months corrected age and will be useful in future studies to diagnose cerebral palsy early. The association between lack of head and trunk control at 4 % months corrected age and a lower locomotor score at 12 months corrected age proved to be significant again and reinforces the finding that early delay in maturation is identifiable on the locomotor scale at 12 months corrected age.

A research report submitted to Faculty of Health Sciences, as a requirement for completion of Masters of Medicine in Paediatrics, University of the Witwatersrand, Johannesburg, 2018 / Background. Candidemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans candida (NAC) is increasing in incidence and resistance to azoles. Very low birth weight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidemia. Methods. A retrospective case control study of candidemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital (CMJAH) between 01 January 2015 to 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidemia, commonest Candida species, antifungal susceptibility profiles and outcomes defined as death were identified. 71 infants with confirmed positive blood cultures for candidemia from the NHLS database were selected and each case was allocated 3 controls; the final sample comprised 284 infants. Results. Bacterial sepsis, chronic lung disease (CLD), necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases respectively. The difference in death between the two groups was not statistically significant. 7 A research report submitted to Faculty of Health Sciences WITS, as a requirement for completion of Masters of Medicine; Paediatrics. Johannesburg, South Africa 2018. Conclusions. The study demonstrated a predominance of NAC isolates, increasing rate of candidemia and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented / GR 2020

No description available.

No description available.

Impairments in executive function have been posited to account for some of the poor cognitive and educational outcomes associated with very preterm birth. As part of a prospective, longitudinal study, this research examined executive function in a regionally representative sample of 103 children born very preterm and/or very low birth weight (<33 weeks GA / <1500g) and a comparison sample of 108 full term children at age 6 years (corrected for prematurity). The specific aims of the study were 1) to describe the performance of children born very preterm and full term on a range of executive function measures, 2) to identify the antecedent medical, neurological and socio-familial factors associated with executive function performance within the very preterm group, and 3) to examine linkages between children’s executive function performance and their academic achievement at age 6 years. Children underwent a comprehensive developmental assessment, including standardised tests of IQ and academic achievement in mathematics, reading and receptive language. Additionally, they completed a number of executive function tasks selected to assess verbal working memory (Digit Span), spatial working memory (Corsi Blocks), planning and problem-solving (Tower of Hanoi), selective attention (Visual Search), shifting and inhibitory control (Detour Reaching Box) and sustained attention and inhibition (Kiddie-Conner’s Continuous Performance Task; K-CPT). Parents and teachers of these children also completed the Behavioural Rating Inventory of Executive Function and teachers rated children’s performance in reading, arithmetic and comprehension in relation to their classroom peers. Results revealed a pervasive pattern of impairment across multiple measures of executive function in children born very preterm relative to their full term peers. Specifically, children born very preterm were less likely to be able to complete any backward Digit Span trials (p<0.05) and showed lower raw scores on this task (p<0.1) than children in the full term group. Children born very preterm showed lower spatial span scores on the Corsi Blocks Task (p<0.01). They also showed lower planning performance, as assessed by the Tower of Hanoi (p<0.05). Children born very preterm made more inhibitory control/shift errors on the Detour Reaching Box and demonstrated less accuracy in their Visual Search (p<0.001) than children born full term. Finally, they showed lower levels of sustained attention on the K-CPT (p<0.001). Parents, teachers and examiners rated these children as having greater difficulties across multiple areas of executive function. These differences remained significant after controlling for group differences in socioeconomic status and after exclusion of children with severe cognitive and motor impairments. Within the very preterm group, antecedent predictors of poorer working memory and planning performance included male gender (p<0.001), intrauterine infection (p<0.05) and severity of cerebral white matter abnormality on term-equivalent MRI (p<0.05). Lower gestational age (p<0.05) and male gender (p<0.001) were related to poorer executive attention performance. Familial predictors of poorer executive performance included instability in parenting (p<0.05), higher levels of parental intrusiveness (p<0.1) and lower levels of interactional synchrony (p<0.05) between parent and child, recorded at earlier follow-up points. Finally, children’s executive function performance was highly correlated with school achievement in reading, arithmetic and language comprehension (p<0.001). Findings suggest a global pattern of executive impairment amongst children born very preterm, with these difficulties placing children at risk for poor academic performance and learning difficulties. Findings also suggest that both neurological pathology and early parenting experiences are important mediators of the relationship between very preterm birth and poor executive function, highlighting the importance of these areas for early intervention.

No description available.

MSc, Child Health Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand / Background: Prematurely born very low birth weight (VLBW) infants are at high risk for neurodevelopmental problems and require regular follow up. Within the South African context, one needs a reliable and user-friendly screening tool to identify those who require intervention. The Molteno Adapted Scale (MAS) is used for this purpose in many clinics, but it has never been validated. Aim: To assess if the MAS performed on young prematurely born infants reliably predicts the neurodevelopmental outcome at 2 years of age as determined by the Griffiths Mental Development Scales (GMDS). Methods: A retrospective study of records of VLBW infants between 1998 and 2006, from the Panorama Medi-Clinic Neonatal Intensive Care Unit follow up clinic. Infants with birth weights < 1500g and accurately assessed gestation < 34 weeks were included. Those who suffered brain insults e.g. meningitis, between the early assessments and the GMDS were excluded. For each child, quotients obtained from the MAS at early assessments were compared to quotients obtained on the GMDS after 2 years of age using Spearman correlations. Results: Fifty-two (27 boys) VLBW infants were included in the study, with a mean birth weight of 981.2 ± 225.5 g and mean gestation of 27.7 ± 1.9 weeks. Thirteen (25%) infants had cerebral palsy and two had visual impairment. MAS assessments were performed at mean ages of 5.1, 10.1 and 16.8 months and the GMDS at a mean age of 28.8 months. Correlations between the MAS and the GMDS ranged from 0.1 - 0.43 at the first assessment, 0.29 - 0.46 at the second assessment and 0.52 - 0.63 at the third assessment. Correlations were statistically significant for the Fine Motor quotient on the MAS at the first assessment, the General quotient and Personal Social quotient at the second assessment, and all quotients except Personal Social at the third assessment. Conclusion: Developmental quotients on the MAS at 5.1 and 10.1 months have a weak positive correlation with the GMDS at 28 months. The MAS at 16.8 months significantly correlated with the developmental outcome as assessed on the GMDS at a mean age of 28 months in prematurely born VLBW infants.