No description available.

Cette étude se concentre sur l'administration de sucrose pour soulager la douleur chez les nouveau-nés prématurés en unité de soins intensifs néonatals (USIN). En utilisant la Théorie du Comportement Planifié (TCP) d'Ajzen, les chercheurs ont examiné le comportement, l'intention, les attitudes, les normes subjectives et la perception de contrôle des infirmières travaillant dans une USIN d'un centre hospitalier universitaire de niveau III. Les résultats ont révélé que la majorité des infirmières ont déclaré avoir administré du sucrose aux nouveau-nés prématurés au cours des deux dernières semaines de travail en USIN, et qu'elles avaient l'intention de continuer à le faire lors des prises de sang au talon. De plus, les attitudes, les normes subjectives et la perception de contrôle des participantes étaient favorables à l'utilisation du sucrose pour soulager la douleur des prématurés. Ces résultats soulignent l'importance de sensibiliser et de former les infirmières à l'utilisation appropriée des interventions non pharmacologiques, telles que l'administration de sucrose, pour soulager la douleur chez les nouveau-nés prématurés. Ils mettent en évidence le rôle crucial des infirmières dans la gestion de la douleur chez cette population vulnérable et suggèrent des pistes d'amélioration pour une prise en charge optimale. En conclusion, cette étude met en lumière les facteurs influençant le comportement des infirmières concernant l'administration de sucrose pour soulager la douleur des prématurés en USIN. Elle souligne l'importance de considérer les variables de la TCP dans la planification des stratégies visant à améliorer les soins et à réduire la douleur chez les prématurés en USIN. / This study focuses on the administration of sucrose for pain relief in preterm infants in the neonatal intensive care unit (NICU). Using Ajzen's Theory of Planned Behavior (TPB) as a theoretical framework, the researchers examined the behavior, intention, attitudes, subjective norms, and perceived control of nurses working in a level III university hospital NICU. The results revealed that the majority of nurses reported administering sucrose to preterm infants in the past two weeks of their work in the NICU, and they had the intention to continue doing so during heel-stick procedures. Furthermore, nurses' attitudes, subjective norms, and perceived control were favorable towards the use of sucrose for pain relief in preterm infants. These findings highlight the importance of raising awareness and providing training for nurses regarding the appropriate use of non-pharmacological interventions, such as sucrose administration, for pain relief in preterm infants. They underscore the crucial role of nurses in managing pain in this vulnerable population and suggest avenues for improvement in optimizing care. In conclusion, this study sheds light on the factors influencing nurses' behavior regarding the administration of sucrose for pain relief in preterm infants in the NICU. It underscores the importance of considering the variables of the TPB in planning strategies to enhance care and reduce pain in preterm infants in the NICU.

This study examined healthcare professionals’ perceptions on feeding difficulties experienced by infants with NOWS, the involvement of SLP in care, knowledge and experience levels of professionals, and trends in education and follow up care. A 34-question survey was developed to obtain data from participants involved in the care of exposed infants using the secure webbased RedCap™ platform. Nonparametric inferential statistics and descriptive analysis were used to interpret data. Feeding difficulties in infants exposed were reported by all respondents with SLP involvement reported by 42.2%. Results found that 51.9% of respondents were confident in their ability to educate families about feeding difficult with 60% reported inadequate time to provide education. Discharge follow up was inconsistent amongst facilities. The study supports early involvement of SLPs to address feeding difficulties and improve education.

Nel presente lavoro di tesi sono riportati i risultati di un innovativo progetto di ricerca longitudinale nell'ambito della psicobiologia. I recenti progressi nel campo dell'epigenetica sono stati applicati allo studio delle conseguenze di esperienze avverse precoci sullo sviluppo socio-emozionale in bambini nati fortemente pretermine. La nascita pretermine costituisce un fattore di rischio per lo sviluppo socio-emozionale, in parte per l'esposizione ad eventi stressanti (es.: dolore neonatale) durante l'ospedalizzazione in terapia intensiva neonatale (TIN). L'epigenetica si riferisce a processi biochimici altamente sensibili alle esperienze ambientali e che alterano la funzione di trascrizione di specifici geni, senza modificare la struttura della sequenza di DNA. Il candidato ha sviluppato un razionale clinicamente rilevante per la ricerca epigenetica comportamentale della prematurità. Inoltre il progetto di ricerca ha dimostrato che il livello di esposizione a procedure dolorose si associa a esiti avversi sul piano temperamentale e della risposta allo stress a tre mesi e che tale associazione è mediata da alterazioni epigenetiche a livello del gene che codifica per il trasportatore della serotonina. Le implicazioni teoriche, cliniche ed etiche di questi risultati sono trattate nella sezione conclusiva. Il progetto di epigenetica comportamentale della prematurità fornisce una nuova prospettiva teorica ed empirica sul tema dell’interazione tra genetica ed ambiente. / In the present work, the candidate reports the results of an innovative longitudinal research project in the field of psychobiology. The recent epigenetic progresses have been applied to the study of the consequences of early adverse event exposures on the socio-emotional development of very preterm infants. Preterm birth is a major concern for socio-emotional development, partly due to the exposure to adverse stressful stimulations (i.e., skin-breaking procedures) during the Neonatal Intensive Care Unit (NICU) stay. Epigenetics refers to biochemical processes which are sensitive to environmental cues and which alter the transcriptional activity of specific genes without changing the DNA structure. The candidate has developed a clinically relevant rationale for preterm behavioral epigenetics (PBE). The research project has demonstrated that the early exposure to high levels of skin-breaking procedures during NICU stay associate with non-optimal temperamental profile and stress regulation at 3 months of age. This association was mediated by epigenetic modifications (DNA methylation) of the stress-related gene encoding for serotonin transporter. The theoretical, clinical and ethical implications of these findings are discussed further in the final section of the thesis. The PBE project provides a new framework for the issue of the interconnections between nature and nurture.

Thesis (MScMedSc (Interdisciplinary Health Sciences. Speech-Language and Hearing Therapy))--University of Stellenbosch, 2007. / Noise is a noxious stimulus with possible negative physiological effects on the infant, especially in the Neonatal Intensive Care Unit (NICU). The present study conducted a detailed noise assessment in a NICU of a state hospital in the Cape Metropole and documented 6 infants’ physiological responses to noise levels. Noise levels ranged from 62.3-66.7dBA (LAeq), which exceed all American and British standards (50dBA -60dBA) for a NICU. Continuous exposure to noise of these levels is potentially harmful to the infants’ auditory system and health stability. The general well-being of the staff working in the NICU may also be compromised. Analysis of the noise events revealed that staff conversations were the largest single contributor to the number of noise events, while the largest single non-human contributor was the alarm noise of the monitors. No significant correlations were found between the heart rates and noise levels and the respiratory rates and the noise levels for any of the participants in either room. The NICU was found to be an extremely reverberant environment, which suggested that the NICU noise levels were largely a result of reverberant noise reinforcements. NICU nursing staff’s most common suggestion for noise abatement strategies was reduction of staff conversation. Results of this study highlight the need for NICU noise abatement to optimise newborn patient care, reduce the risk of acoustic trauma and to improve the neonate’s quality of life, thus enhancing the infant’s physiologic stability, growth and health.

Infants with hypoxic-ischaemic encephalopathy (birth asphyxia) have a high risk of death or disability. Those with poor prognosis are sometimes allowed to die after withdrawal of intensive care. In recent years, doctors have used new types of brain scan, magnetic resonance imaging (MRI), to predict the type and severity of impairment if the infant survives and to help with such decisions. In this thesis, I analyse the issues arising from the use of MRI for prognostication and decision-making in newborn infants. I argue that previous prognostic research has been hampered by a failure to identify and focus on the most important practical question and that this contributes to uncertainty in practice. I outline recommendations for improving research. I then look at existing guidelines about withdrawal of life-sustaining treatment. I identify several problems with these guidelines; they are vague and fail to provide practical guidance, they provide little or no genuine scope for parental involvement in decisions, and they give no weight to the interests of others. I argue that parental interests should be given some weight in decisions for newborn infants. I develop a new model of decision-making that, using the concept of a Restricted Life, attempts to set out clearly the boundaries of parental discretion in decision-making. I argue that where infants are predicted to have severe cognitive or very severe physical impairment parents should be permitted to request either withdrawal or continuation of treatment. I justify this model on the basis of overlapping interests, (prognostic, experiential and moral) uncertainty, asymmetrical harms, and the burden of care. In the conclusion, I set out a guideline for the use of MRI in newborn infants with hypoxic-ischaemic encephalopathy. I suggest that this guideline would provide a more robust, coherent and practical basis for decision-making in newborn intensive care.

Made available in DSpace on 2014-07-29T15:26:22Z (GMT). No. of bitstreams: 1 TeseMariaAparecidaSVieira2010.pdf: 800058 bytes, checksum: 8dafcb160a1972a06f2d836a5f52d813 (MD5) Previous issue date: 2010-07-05 / Nasal carriage of Staphylococcus aureus methicillin-resistant (MRSA) is known to be a risk for subsequent infection. The MRSA carriers are an emergent and hidden reservoir in community and in the health-care environment. The aim of this investigation were to assess the prevalence and risk factors for MRSA nasal carriage in children attending emergency departments (ED) and Neonatal Intensive Care Units (NICU), and to describe the molecular features of such isolates. Methods: Nasal swabs were obtained from children less than 60 months of age attending ED, and from newborns of the four NICUs of Goiânia city, central Brazil, in 2007 and 2008. The definition of MRSA followed the CLSI criteria. Exposure variables to S. aureus and MRSA carriers were gathered through in-person interviews with mothers and hospital records. Univariate and multivariate logistic regression were performed to identify risk factors for S. aureus and MRSA carriage. Molecular typing was evaluated by pulsed field gel electrophoresis, staphylococcal cassette chromosome mec (SCCmec) typing, and multilocus sequence type (MLST). Results: A total of 2,735 children were enrolled. At the ED (n=2.034), the prevalence respectively of nasal carriages for S. aureus and MRSA were 20% (n=408) and 0.2% (n=4). Among NICUs (total of infants = 701), the prevalence of nasal carriage ranged from 0.03% to 15.7% for S. aureus and, from 0.0% to 2.0% for MRSA. At the ED, MRSA carriage was independently associated with child-care attendance in the previous 6 months (OR=10.6; p=0.045) and congenital malformation (OR=26.8; p=0.002). All nasal carriers at NICUs were from private hospitals. Only length of hospitalization was associated with MRSA nasal carriage at NICUs (p=0.023). Among four MRSA nasal carrier at ED, one harbored SCCmec type III, and three SCCmec type IV. Among four children from at the NICUs two infants harbored SCCmec type III, and two SCCmec type IV. All MRSASCCmec type III were multidrug-resistants. Strains related to Pediatric/USA800 and Brazilian MRSA clones were detected in both, ED and NICUs. One MRSA cluster related to Western Australia/USA400 was detected in ED. Conclusions: Children visiting ED, especially those reporting day-care attendance, and neonates from NICUs may play a role in spreading MRSA in healthcare settings. The study suggests cross transmission of MRSA type III and type IV between ED and hospital environments. / Portador nasal de Methicillin-resistant Staphylococcus aureus (MRSA) é um preditor de infecção subseqüente. Portadores de MRSA são um reservatório oculto, emergente na comunidade e nos serviços de saúde. Os objetivos deste estudo foram avaliar a prevalência e fatores de risco do portador nasal por S. aureus e MRSA em crianças atendidas em Pronto Atendimento (PA) e admitidas em Unidades de Cuidado Intensivo Neonatal (UCINs) e descrever as características moleculares de tais isolados. Método: Swabs nasais foram obtidos de crianças menores de 60 meses atendidas em PA e de neonatos de quatro UCINs do município de Goiânia, Brasil, em 2007 e 2008. A definição de MRSA seguiu critérios definidos pelo CLSI. Variáveis de exposição para portadores de S. aureus e MRSA foram obtidas por meio de entrevistas com mães e registros hospitalares. Regressão logística multivariada foram realizadas para identificar fatores de risco. A tipagem molecular foi feita por meio de staphylococcal cassette chromosome mec (SCCmec) typing, Pulsed Field Gel Electrophoresis (PFGE) e seqüenciamento de multilocus enzimáticos (MLST). Resultados: Um total de 2.735 crianças foi recrutado. No PA (n=2.034), as prevalências de portador nasal para S. aureus e MRSA foram de 20,1% (n=408) e de 0,2% (n=4), respectivamente. Nas UCINs (n= 701), a prevalência de portador nasal variou de 0,03% a 15,7% para S. aureus (n=64) e, de 0,0% a 2,0% para MRSA (n=4). No PA, o portador de MRSA foi independentemente associado à frequência de creche nos últimos 6 meses (OR=10,6; p=0,045) e malformação congênita (OR=26,8; p=0,002). Todos os portadores nasais de MRSA nas UCINs eram crianças internadas em hospitais privados e a única variável associada ao portador MRSA foi tempo de internação (p=0,023). Das quatro crianças portadores de MRSA no PA, uma portava SCCmec tipo III e, três, SCCmec tipo IV. Nas UCINs, duas crianças eram SCCmec tipo III e duas, SCCmec tipo IV. Todas as cepas SCCmec tipo III eram multidrogarresistentes (CLSI). Cepas MRSA relacionadas ao clones pediátrico/USA800 e epidêmico brasileiro foram detectados no PA e nas UCINs. Um cluster MRSA relacionado ao clone Western Australia/WA-1/ USA400 foi encontrado no PA. Conclusão: Crianças atendidas no pronto atendimento, especialmente aquelas que freqüentaram creche, e neonatos de UCINs apresentam potencial para disseminação de MRSA nos serviços de saúde. O estudo sugere transmissão cruzada de MRSA SCCmec tipo III e tipo IV entre serviços de emergência e hospitais.

This Ph.D. dissertation processes and analyzes signals from the neonatal intensive care units (NICUs) for the study of maturity, systemic infection (sepsis) and the influence of immunization in the premature newborn. A special attention is payed to the electroencephalography and the breathing signal. The former is often contaminated by several sources of noise, thus methods based on the signals decomposition and optimal noise cancellation, adapted to the characteristics of the immature EEG, were proposed and evaluated objectively on real and simulated signals. By means of the EEG and delta burst analysis, detected automatically by a proposed classifier, infant's maturation and the effects of vaccination are studied. Concerning the second signal, breathing, non-linear and fractal methods are adapted to evaluate maturity and sepsis. A robustness study of estimation methods is also conducted, showing that the Hurst exponent, estimated on respiratory variability signals, is a good detector of infection.

Ce mémoire de thèse porte sur le traitement et l'analyse des signaux issus des unités de soins intensifs néonatales (USIN) pour l'étude de la maturité, de l'infection généralisée et de l'influence de l'immunisation chez le nouveau-né prématuré. Une attention particulière est portée sur l'électroencéphalographie et le signal de respiration. Pour le premier, ce signal est souvent bruité en USIN et des méthodes de décomposition du signal et d'annulation optimale du bruit, adaptées aux particularités des EEG immatures, ont été proposées et évaluées objectivement sur signaux réels et simulés. L'analyse de l'EEG et des bouffées delta, repérées automatiquement par un classificateur proposé, ont permis d'étudier la maturation et les effets de la vaccination. Pour la seconde modalité, la respiration, des méthodes non-linéaires et fractales sont retenues et adaptées pour évaluer la maturité et l'infection généralisée. Une étude de robustesse des méthodes d'estimation est menée et on montre que l'exposant de Hurst, estimé sur des signaux de variabilité respiratoire, est un bon détecteur de l'infection. / This Ph.D. dissertation processes and analyzes signals from the neonatal intensive care units (NICUs) for the study of maturity, systemic infection (sepsis) and the influence of immunization in the premature newborn. A special attention is payed to the electroencephalography and the breathing signal. The former is often contaminated by several sources of noise, thus methods based on the signals decomposition and optimal noise cancellation, adapted to the characteristics of the immature EEG, were proposed and evaluated objectively on real and simulated signals. By means of the EEG and delta burst analysis, detected automatically by a proposed classifier, infant's maturation and the effects of vaccination are studied. Concerning the second signal, breathing, non-linear and fractal methods are adapted to evaluate maturity and sepsis. A robustness study of estimation methods is also conducted, showing that the Hurst exponent, estimated on respiratory variability signals, is a good detector of infection.

Comprehensive management in the neonatal nursery involves medical treatment of the infant, as well as developmental care and the provision of guidance, counselling and information to the family who are part of the decision-making process regarding the infant’s care. Neonatal communication intervention is of utmost importance in a country such as South Africa, which has an increased prevalence of infants at risk for disabilities and where the majority of these infants live in poverty. Speech-language therapists fulfil an important role in the neonatal nursery and are an integral part of the team involved with the high risk neonatal population. Local literature showed a dearth of information on the current service delivery and roles of speech-language therapists and audiologists in neonatal nurseries in the South African context. From an asset-based perspective it appears that the South African population receiving services in neonatal nurseries have unique characteristics. This provides speech-language therapists with ample opportunity to intervene, providing that intervention is well-timed in the neonatal nursery context. The country-wide initiative to implement the evidence-based technique of kangaroo mother care indicates that speech-language therapists should recognise its importance and develop communication based materials and tools to complement this successful neonatal intervention. The aim of the research was to establish whether speech-language therapists have needs for assessment and intervention tools/materials in this context. The study furthermore aimed to compile a locally relevant neonatal communication intervention instrument/tool for use by speech-language therapists in the neonatal nurseries of public hospitals in South Africa in order to propose a solution to address the shortage of tools in the public health context. The study entailed descriptive, exploratory research. During Phase 1, a survey was received back from 39 speech-language therapists and two audiologists in six provinces. The data revealed that participants performed different roles in neonatal nurseries, which were determined by the environment, tools, materials and instrumentation available to them. Many participants were inexperienced, but were resourceful in their attempts to develop and adapt tools/materials. Participants expressed a need for culturally appropriate and user-friendly instruments for parent guidance and staff/team training on the topic of developmental care. During Phase 2 a tool for parent guidance titled “Neonatal communication intervention programme for parents” was compiled for use by speech-language therapists and justified by participants’ roles and needs as well as current early communication intervention (ECI) literature. The programme was piloted by three participants. Certain suggestions for enhancements of the programme were made such as providing a glossary of terms, adapting the programme’s language and terminology, and providing more illustrations. The programme complied with the guiding principles for best practice in ECI (ASHA, 2008) and can therefore contribute to neonatal care of high risk infants in South Africa. Speech-language therapists and audiologists must contribute to neonatal care of high risk infants to facilitate optimal health and development and to support their families. AFRIKAANS : Omvattende intervensie in die neonatale sorgeenheid behels mediese behandeling van die neonaat, sowel as ontwikkelingstoepaslike sorg en die verskaffing van leiding, berading en inligting aan die gesin wat deel is van die besluitnemingsproses rakende die baba se sorg. Neonatale kommunikasie intervensie is van uiterste belang in Suid-Afrika aangesien daar ‘n hoër prevalensie van babas is wat ‘n risiko het vir ontwikkelingsafwykings en aangesien die meerderheid van hierdie babas in armoede leef. Spraak-taalterapeute vervul ‘n belangrike rol in die neonatale sorgeenheid en is ‘n integrale deel van die span wat betrokke is by die hoërisiko neonatale populasie. Plaaslike literatuur dui op ‘n tekort aan inligting rakende die huidige dienslewering van die spraak-taalterapeut en oudioloog in neonatale sorgeenhede in die Suid-Afrikaanse konteks. Vanuit ‘n bate-benadering kom dit voor of die Suid-Afrikaanse populasie wat dienste in neonatale sorgeenhede ontvang, unieke eienskappe het. Dit bied genoegsame geleenthede aan spraak-taalterapeute om intervensie te verskaf, solank die behandeling betyds in die neonatale sorgeenheid konteks aanvang neem. Daar is ‘n landswye inisiatief om die bewysgerigte tegniek van kangeroe moedersorg toe te pas. Spraak-taalterapeute moet dus die belang daarvan herken en kommunikasie gebasseerde terapiemateriaal ontwikkel om hierdie suksesvolle neonatale intervensie te komplementeer. Die navorsing se doel was om vas te stel hoe wyd spraak-taalterapeute en oudioloe ‘n behoefte aan evaluasie en intervensie instrumente en –materiaal in hierdie konteks het. Die navorsing het verder ten doel gestel om ‘n relevante terapie instrument saam te stel vir spraak-taalterapeute in die neonatale sorgeenhede as ‘n moontlike oplossing vir die tekort aan relevante terapiemateriaal in die plaaslike publieke gesondheidsorgkonteks. Die studie het beskrywende, eksplorerende navorsing behels. Gedurende Fase 1 is ‘n vraelys terug ontvang van 39 spraak-taalterapeute en twee oudioloë in ses provinsies. Die data het aangedui dat deelnemers verskillende rolle in hierdie konteks vervul, wat beïnvloed was deur die omgewing, die instrumentasie en materiaal wat tot hulle beskikking was. Die meerderheid van die deelnemers was onervare, maar was vindingryk in hulle pogings om terapiemateriaal aan te pas en te ontwikkel. Deelnemers het ‘n behoefte vir kultureel toepaslike- en gebruikersvriendelike instrumente en materiaal uitgedruk met die oog op ouerleiding en personeel/span opleiding oor die onderwerp van ontwikkelingstoepaslike sorg. Gedurende Fase 2 is ‘n terapie instrument naamlik “Neonatale kommunikasie intervensie program vir ouers” saamgestel vir die gebruik in die neonatale sorgeenhede deur spraak-taalterapeute. Die samestelling van hierdie program is verantwoord deur die deelnemers se rolbeskrywing en behoeftebepaling van Fase 1, sowel as deur huidige vroeë kommunikasie intervensie (VKI) literatuur. Die program is deur drie deelnemers in ‘n loodsstudie geëvalueer. Voorstelle vir die verbetering van die program is verskaf, naamlik die byvoeging van ‘n terminologielys, aanpassing van die program se taalgebruik en terminologie en verskaffing van meer illustrasies. Die program het ooreengestem met die beginsels vir beste praktyk in VKI (ASHA, 2008) en kan daarom tot neonatale sorg van hoërisikobabas in Suid-Afrika bydra. Spraak-taalterapeute en oudioloë moet bydra tot neonatale sorg van hoërisiko neonate om sodoende optimale gesondheidsorg en ontwikkeling te fasiliteer en gesinne te ondersteun. Copyright / Dissertation (MCommunication Pathology)--University of Pretoria, 2010. / Speech-Language Pathology and Audiology / unrestricted