It is understood that the organization of perinatal care, according to the risk approach, implies that every pregnant and newborn are adequately cared for at the level of complexity they need. The purpose of the present study was to describe the structure and processes of care for pregnant women and newborns, including essential neonatal care, in maternity hospitals in the State of Sergipe. It is an integrated cross-sectional study to the research Born in Sergipe: survey about pre - natal, delivery and puerperium, conducted between June 2015 and April 2016 in public, mixed and private hospitals of Sergipe that had performed a minimum of 500 births in 2014, totaling 11 hospitals. Initially, a questionnaire was administered to managers of the eligible units on the existing structure and work processes. Subsequently, a representative number of postpartum women from these hospitals were interviewed and, after discharge, their medical records and those of their newborns were analyzed. The results showed that Sergipe has 78 beds of Neonatal Intensive Care Unit (NICU) and 90 Units of Intermediate Unit (UI) to meet spontaneous and programmed demand. Only six maternity hospitals (54.5%) performed the risk classification, and four (36.3%) had protocols for attending high-risk deliveries. Moreover, regarding components of the Essential Newborn Care corresponding strategies which aim to improve the health of the newborn at different stages, from conception to the postnatal period, only 18% of women had the presence of Companion always for delivery, 41% had skin-to-skin contact early with their child and 33.1% breastfed in the first hour of life. It was observed an adequate distribution of NICU beds between Capital and Interior considering the current legislation, low adherence to protocols of hypertensive and hemorrhagic emergencies; there was low coverage also for the humanization policies, risk rating for the pregnant woman and practices of Essential Newborn Care, especially the skin - to - skin contact and breastfeeding in the first hour of life. / A organização da assistência perinatal, segundo o enfoque de risco, implica que toda gestante e recém-nascido sejam atendidos adequadamente no nível de complexidade que necessitam. O presente estudo teve por objetivo descrever a estrutura e os processos de atendimento à gestante e ao recém-nascido, incluindo os cuidados neonatais essenciais, das maternidades do Estado de Sergipe. Trata-se de um estudo transversal integrado à pesquisa Nascer em Sergipe: inquérito sobre assistência pré-natal, parto e puerpério, realizado entre junho de 2015 e abril de 2016 nas maternidades públicas, mistas e privadas de Sergipe que tiveram pelo menos 500 partos em 2014, totalizando 11 maternidades. Inicialmente foi aplicado um questionário aos gestores das unidades elegíveis sobre a estrutura e os processos de trabalhos existentes. Posteriormente, um número representativo de puérperas desses hospitais foi entrevistado e, após a alta, seus prontuários e os de seus recém-nascidos foram analisados. Os resultados mostraram que Sergipe dispõe de 78 leitos de Unidade de Terapia Intensiva Neonatal (UTIN) e 90 de Unidade Intermediária (UI) para atendimento da demanda espontânea e programada. Somente seis maternidades (54,5%) realizam a classificação de risco e quatro (36,3%) possuem protocolos para atendimento das parturientes de alto risco. Além disso, os componentes do Essential Newborn Care que correspondem a estratégias que têm o objetivo melhorar a saúde do recém-nascido em diferentes estágios, desde a concepção até o período pós-natal, estavam presentes em apenas 18% das mulheres que tiveram a presença do acompanhante em todos os momentos do parto, 41% que tiveram contato pele a pele precoce com seu filho e 33,1% que amamentaram na primeira hora de vida. Observou-se uma distribuição adequada de leitos de UTIN entre Capital e Interior levando-se em consideração a legislação vigente, baixa adesão aos protocolos das emergências hipertensivas e hemorrágicas; houve baixa cobertura também em relação às políticas de humanização, classificação de risco para a gestante e às práticas do Essential Newborn Care, principalmente o contato pele a pele precoce e a amamentação na primeira hora de vida.

Necrotizing enterocolitis (NEC) is a costly and deadly disease in neonates. Composite risk for NEC is poorly understood and consensus has not been established on the relevance of risk factors. This two-phase study attempted to validate and test a neonatal NEC risk index, GutCheck(NEC). Phase I used an E-Delphi methodology in which experts (n=35) rated the relevance of 64 potential NEC risk factors. Items were retained if they achieved predefined levels of expert consensus or stability. After three rounds, 43 items were retained (CVI=.77). Qualitative analysis revealed two broad themes: individual characteristics of vulnerability and the impact of contextual variation within the NICU on NEC risk. In Phase II, the predictive validity of GutCheck(NEC) was evaluated using a sample from the Pediatrix BabySteps Clinical Data Warehouse (CDW). The sample included infants born<1500 grams, before 36 weeks, and without congenital anomalies or spontaneous intestinal perforation (N=58,818, of which n=35,005 for empiric derivation and n=23,813 for empiric validation). Backward stepwise likelihood-ratio method regression was used to reduce the number of predictive factors in GutCheck(NEC) to 11 and derive empiric weights. Items in the final GutCheck(NEC) were gestational age, history of a transfusion, NICU-specific NEC risk, late onset sepsis, multiple infections, hypotension treated with Inotropic medications, Black or Hispanic race, outborn status, metabolic acidosis, human milk feeding on both day 7 and day 14 (reduces risk) and probiotics (reduces risk).Discrimination was fair in the case-control sample (AUC=.67, 95% CI .61-.73) but better in the validation set (AUC=.76, 95% CI .75-.78) and best for surgical NEC (AUC=.84, 95% CI .82-.84) and infants who died from NEC (AUC=.83, 95% CI .81-.85). A GutCheck(NEC) score of 33 (range 0-58) yielded a sensitivity of .78 and a specificity of .74 in the validation set. Intra-individual reliability was acceptable (ICC (19) =.97, p<.001). Future research is needed to repeat this procedure in infants between 1500 and 2500 grams, complete psychometric testing, and explore unit variation in NEC rates using a comprehensive approach.

No description available.

The thesis presented here describes original research in the field of Natural Language Generation (NLG). NLG is the subfield of artificial intelligence that is concerned with the automatic production of documents from underlying data. This thesis in particular focuses on developing new and novel methods for generating text that takes into consideration the recipient’s level of stress as a factor to adapt the resultant textural output. This consideration of taking the recipient level of stress was particularly salient due to the domain that this research was conducted under; providing information for parents of pre-term infants during neonatal intensive care (NICU). A highly technical and stressful environment for parents where emotional sensitivity must be shown for the nature of information presented. We have investigated the emotional and informational needs of these parents through an extensive past literature review and two separate research studies with former and current NICU parents. The NLG system built for this research was called BabyTalk Family (BT-Family). A system that can produce a textual summary of medical events that has occurred for a baby in NICU in last twenty-four hours for parents. The novelty of this system is that is capable of estimating the level of stress of the recipient and by using several affective NLG strategies it is able to tailor it’s output for a stressed audience. Unlike traditional NLG systems where the output would remain unchanged regardless of emotional state of the recipient. The key innovation in this system was the integration of several affective strategies in the Document Planner for tailoring textual output for stress recipients. BT-Family’s output was evaluated with thirteen parents that previously had baby in neonatal care. We developed a methodology for an evaluation that involved a direct comparison between stressed and unstressed text for the same given medical scenario for variables such as preference, understandability, helpfulness, and emotional appropriateness. The results, obtained showed the parents overwhelming preferred the stressed text for all of the variables measured.

No description available.

Class of 2012 Abstract / Specific Aims: The purpose of this study is to evaluate and compare clinical outcomes and cost involved with use of poractant versus beractant for the treatment of respiratory distress syndrome (RDS) in a level III, neonatal intensive care unit (NICU) within an academic medical center. Methods: This retrospective cohort study included patients if they were admitted to the NICU for RDS between April 1, 2010 to November 30, 2010 and December 1, 2010 to June 30, 2011 treated with beractant and poractant respectively. Patients were excluded from the study if they were greater than 35 weeks gestational age and survived less than 48 hours. This is a review and the information needed from the patients was submitted in a data extraction form. Data collected included demographic variables (age, birthweight, birth length, gender, and race/ ethnicity), FiO2 measurement, mechanical ventilation time, length of hospitalization in the NICU, the incidence complications in the first 28 days, number of doses given, use of the nasal CPAP, concurrent complications or comorbidites such as pulmonary hemorrhage, bronchopulmonary dysplasia, patent ductus arteriosis, intraventricular hemorrhage, and retinopathy of maturity. Main Results: Data from 27 neonates in beractant and 13 in poractant groups were collected. The FiO2 measurements in both groups were generally similar. However, FiO2 was consistently lower in the poractant group. (p = 0.044 from a runs statistical test) Conclusions: The FiO2 measurement is poractant group was lower compared with beractant group, however the difference was noted to be not statistically significant.

M.Cur. / Please refer to full text to view abstract

Magister Curationis - MCur / Parents undergo negative experiences that include parental anxiety, depression, and posttraumatic stress when their new-born babies are hospitalised in neonatal intensive care unit. During this stressful period, parents need assistance from staff in order to cope. A quantitative, descriptive survey design was used to describe parents’ perception of nursing support during their baby’s admission in neonatal intensive care units (NICU) at three selected private hospitals in the city of Cape Town in the Western Cape Province. A structured existing 21- item Likert type questionnaire, the Nurse-Parent Support Tool (NPST) was used to collect data from an all-inclusive sample of 85 parents with a response rate of 78.8% (n=67). The purpose of the questionnaire was to determine their perception of information giving and communication by nurses; emotionally supportive behaviours by nurses; care given support or instrumental support and to identify parents’ perception of esteem or appraisal support while in the NICU environment. The data was analysed using Statistical Package for Social Sciences (SPSS) version 24. The findings of this study suggested that the overall mean score for parents’ perception of nursing support was high 4.6 (±0.5) out of a possible of 5. There was no significant difference in the overall mean perceived support score between the different facilities. No significant differences were found in terms of all the demographics characteristics with regard to perceptions of the support that was received, thus indicating that there was no relationship between the demographic variables and perception of support. The findings suggested that though high parental support was reported, the area of involving parents in the care of their babies i.e. letting them decide whether to stay or leave during procedures need improvement.

Objective: The purpose of this study was to determine the characteristics, assessment, and treatment of infants with Neonatal Abstinence Syndrome (NAS) as perceived by Speech-Language Pathologists (SLP) and whether it differed from those of other Neonatal Intensive Care Unit populations. Methods: A secure web-based questionnaire with 62 questions collected information on NAS, caseloads, treatment environment, and demographics. Twenty-six respondents initiated the survey; 42% completed most or all questions. Response analyses included descriptive and nonparametric inferential statistics. Results: Infants with NAS were on the caseloads of 73% of respondents. The majority (79%) only saw infants with NAS and feeding problems. Primary problems included incomplete or increased time to complete feeds, increased/excessive/irregular sucking rates, and reflux. Working on teams, respondents provided assessment, treatment, and education of infant feeding and state. Conclusion: Growing demand for SLP intervention with infants with NAS is likely to persist if opioid use continues to increase as projected.

Introdução: A internação em unidade neonatal está intimamente ligada à mortalidade neonatal e compartilham muitas causas e determinantes. Apesar de inúmeros estudos sobre os fatores de risco para mortalidade neonatal, pesquisas sobre os determinantes da internação dos recém-nascidos em unidade neonatal logo após o nascimento são iniciativas recentes. Objetivos: Analisar os fatores determinantes da internação de neonatos nas primeiras 24 horas de vida em uma unidade neonatal da região Oeste do município de São Paulo. Método: Tratou-se de um estudo retrospectivo, do tipo caso-controle não pareado, realizado em uma maternidade municipal. A amostra foi composta por 205 casos e 205 controles, no período de 01 de janeiro de 2016 a 31 de dezembro de 2017. Para verificar a associação entre a variável dependente internação na unidade neonatal nas primeiras 24 horas de vida e as variáveis independentes, foram realizadas análises bivariadas com cálculo de Odds Ratio (OR), com nível de significância de 5%, e intervalo de confiança 95%, por meio de testes qui-quadrado ou testes exatos (teste da razão de verossimilhanças ou teste exato de Fisher). As variáveis com valor de p<0,20 foram analisadas pelo modelo de regressão logística múltipla hierarquizada. No entanto, fizeram parte do modelo final apenas as variáveis com significância estatística. Resultados: as variáveis que permaneceram no modelo final associadas à internação nas primeiras 24 horas de vida em unidade neonatal de uma maternidade da região Oeste do município de São Paulo, por ordem decrescente de associação ao desfecho foram: índice de apgar no 1º <7 (OR=227,56; IC95% 35,49 - 1458,66), idade gestacional < 37 semanas (OR= 31,66; IC95% 7,47-134,121), não ter realizado consulta de pré-natal (OR=21,224; IC95% 1,65 - 271,91), peso ao nascer <2500g (OR=9,88; IC95% 2,01 - 48,57), uso de drogas ilícitas durante a gestação (OR= 5,31; IC95% 1,18 - 23,87), presença de líquido amniótico com mecônio (OR= 2,69; IC95% 1,25 - 7,54), tempo decorrido entre admissão e parto > 24 horas (OR= 2,68; IC95% 1,08 - 6,63),. A variável raça/cor da pele da mãe não branca apresentou-se como um fator protetor, com uma chance de internação de recém-nascidos nas primeiras 24 horas de vida em unidade neonatal 69% menor que os recém-nascidos de mães brancas.(OR=0,314; IC95% 0,157 -0,627; p=0,001).Conclusão: Comportamentos maternos de risco e problemas no acompanhamento pré-natal, e de assistência ao trabalho de parto e parto podem desencadear situações que aumentam a demanda por internação em unidade neonatal nas primeiras 24 horas de vida. Os achados deste estudo corroboram a importância de se investigar fatores associados à internação em unidade neonatal logo após o nascimento, pois possibilita identificar grupos expostos a diferentes conjuntos de fatores e detectar distintas necessidades de saúde, fornecendo subsídios para ações direcionadas aos recém-nascidos graves ou potencialmente graves, e a consequente redução dos óbitos neonatais. / Introduction: Neonatal unit hospitalization is closely linked to neonatal mortality and shares many causes and determinants. Despite numerous studies on risk factors for neonatal mortality, researches on the determinants in neonatal hospital admission to the neonatal unit right after birth are recent. Studying those aspects makes it possible to identify groups exposed to different sets of circumstances and to detect different health needs, providing resources for actions directed towards the serious or potentially serious ill newborns, and therefore reducing neonatal deaths. Objectives: To assess the determinants of neonatal hospitalization in the first 24 hours of life in a neonatal unit in the Western region of the city of São Paulo. Method: This was a retrospective, unpaired case-control study carried out in a municipal maternity hospital in the western region of the city of São Paulo (SP). The sample consisted of 205 cases and 205 controls. The criteria to be considered as a case was to be born alive by hospital delivery and admitted in a Neonatal Unit (Neonatal ICU or Regular Neonatal Intermediate Care Unit) during the first 24 hours of life, from January 1, 2016 to December 31, 2017. The controls are the babies that were born alive in the same period of cases and who were referred together with their mothers to the joint maternal accommodation unit. Twin neonates, anencephalic, home-delivered babies who were later admitted in the hospital, and newborns whose medical records were in external file, being unavailable for analysis. In order to assess the association between the dependent variable \"hospitalization in the neonatal unit in the first 24 hours of life\" and the independent variables, bivariate analyzes were performed as Odds Ratio (OR), with significance level of 5%, and a confidence interval of 95%, by Chi-square tests or exact tests (likelihood ratio test or Fisher\'s exact test). The variables that presented a p value <0.20 were analyzed by the hierarchical multiple logistic regression model. However, only the statistically significant variables were part of the final model. Results: Independently of the other characteristics evaluated, the variables that remained in the final model associated to the hospitalization in the first 24 hours of life in a neonatal unit of a maternity hospital in the western region of the city of São Paulo, in decreasing order of association to the outcome were: first minute Apgar Score < 7 (OR=227,56; IC95% 35,49 - 1458,66), gestational age <37 weeks (OR= 31,66; IC95% 7,47-134,121), absence of a prenatal visit appointment (OR=21,224; IC95% 1,65 - 271,91), birth weight <2500g (OR=9,88; IC95% 2,01 - 48,57), use of illicit drugs during the pregnancy (OR= 5,31; IC95% 1,18 - 23,87), presence of amniotic fluid with meconium(OR= 2,69; IC95% 1,25 - 7,54), time elapsed between admission and delivery > 24 hours (OR= 2,68; IC95% 1,08 - 6,63). The race / color variable of the non-white mother presented as a protective factor, with a chance of hospitalization of newborns in the first 24 hours of life in a neonatal unit 69% lower than the newborns of white mothers. Conclusion: Maternal risk behaviors and problems in prenatal care, assistance to labor and delivery may trigger situations that increase the demand for hospitalization in neonatal unit in the first 24 hours of life. The findings of this study corroborate the importance of investigating factors associated with hospitalization in a neonatal unit shortly after birth, as it allows the identification of groups exposed to different sets of factors and the detection of different health needs, providing resources for actions aiming the serious ill newborns or potentially seriously ill newborns, and consequent reduction of neonatal deaths.