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Background: The bonding process can start to develop as early as the planning of a pregnancy and can affect the relationship between mother and child through childhood. If proper bonding is not established, the child can present symptoms of depression, failure to thrive or delays in social and emotional, language or motor development. Stimulation programs implemented during pregnancy may positively affect the bonding process that act as a protective factor against negative outcomes in childhood, adolescence and adult life, for instance substance abuse, poor social coping skills and academic failure. Objectives: To determine and describe the effectiveness of The Baby Bond comprehensive stimulation program on bonding six weeks post intervention. Method: The researcher employed an experimental, pre-test-post-test randomised control group design in this study. Experimental and control groups randomly received the same pre- and post-test: the Prenatal Attachment Inventory within the third trimester of pregnancy and the Maternal Attachment Inventory six weeks post birth. The Baby Bond sensory stimulation program was added to standard antenatal care for the experimental group and the control group received a general stimulation program and standard antenatal care. The data was analysed with the SPSS program version 22.0 by the Statistical Consultation Services at the North-West University, Potchefstroom campus. SPSS was used to compile descriptive statistics from the experimental and control groups, Mann Whitney test and the effect size. Results: The twelve participants that were included in this study were from a variety of ethnic origins, in stable relationships and their ages ranged from 20-34 years. In the results, no statistical significant changes were found between the two groups with the Mann Whitney test. The pre-intervention variables (mean = 66.45) were not significantly different from the post-intervention measurements (mean = 101.03). A medium practical significant difference was identified between the groups (d=0.52) which can indicate that some changes in bonding did take place when implementing the comprehensive sensory stimulation program: The Baby Bond. Conclusion: The Baby Bond sensory stimulation program did not indicate a significant improved bonding as compared to general antenatal care between the mother and baby at six weeks after birth. However, future research in the optimal time for bonding interventions in larger sample sizes is needed, for more conclusive findings. / MCur, North-West University, Potchefstroom Campus, 2015

Background: The bonding process can start to develop as early as the planning of a pregnancy and can affect the relationship between mother and child through childhood. If proper bonding is not established, the child can present symptoms of depression, failure to thrive or delays in social and emotional, language or motor development. Stimulation programs implemented during pregnancy may positively affect the bonding process that act as a protective factor against negative outcomes in childhood, adolescence and adult life, for instance substance abuse, poor social coping skills and academic failure. Objectives: To determine and describe the effectiveness of The Baby Bond comprehensive stimulation program on bonding six weeks post intervention. Method: The researcher employed an experimental, pre-test-post-test randomised control group design in this study. Experimental and control groups randomly received the same pre- and post-test: the Prenatal Attachment Inventory within the third trimester of pregnancy and the Maternal Attachment Inventory six weeks post birth. The Baby Bond sensory stimulation program was added to standard antenatal care for the experimental group and the control group received a general stimulation program and standard antenatal care. The data was analysed with the SPSS program version 22.0 by the Statistical Consultation Services at the North-West University, Potchefstroom campus. SPSS was used to compile descriptive statistics from the experimental and control groups, Mann Whitney test and the effect size. Results: The twelve participants that were included in this study were from a variety of ethnic origins, in stable relationships and their ages ranged from 20-34 years. In the results, no statistical significant changes were found between the two groups with the Mann Whitney test. The pre-intervention variables (mean = 66.45) were not significantly different from the post-intervention measurements (mean = 101.03). A medium practical significant difference was identified between the groups (d=0.52) which can indicate that some changes in bonding did take place when implementing the comprehensive sensory stimulation program: The Baby Bond. Conclusion: The Baby Bond sensory stimulation program did not indicate a significant improved bonding as compared to general antenatal care between the mother and baby at six weeks after birth. However, future research in the optimal time for bonding interventions in larger sample sizes is needed, for more conclusive findings. / MCur, North-West University, Potchefstroom Campus, 2015

Les objectifs de cette thèse sont: i) de mettre au point de nouvelles techniques adaptées à la période néonatale d'analyse automatique des signaux physiologiques cardiaque (ECG) et respiratoire (RESP) afin d'étudier la variabilité de la fréquence cardiaque (VFC) et respiratoire (VFR), ainsi que les interrelations cardiorespiratoires; ii) de les valider et de les utiliser sur des modèles ovins pour mieux comprendre les altérations du contrôle cardiorespiratoire dans des différentes situations expérimentales. Durant les expérimentations, les agneaux étaient non sédationnés et libres de leurs mouvements, ce qui rend le traitement des signaux ECG et RESP enregistrés durant plusieurs heures difficile, à cause des artefacts. D'abord, une chaîne de traitement semi-automatique des signaux a été proposée. Elle comprend l'élimination automatique des périodes artefactuelles, l'extraction des séries temporelles des segments propres de l'ECG et du signal RESP, l'application d'un test de stationnarité sur ces séries temporelles pour extraire les segments stationnaires et le calcul de différents indices de la VFC et la VFR obtenus en appliquant des analyses linéaires et non linéaires. Ces analyses ont été complétées par la mesure des interrelations cardiorespiratoires. Cette chaîne de traitement a permis d'étudier les effets de trois situations expérimentales sur le contrôle cardiorespiratoire. La première situation cherche à étudier l'exposition d'agneaux nouveau-nés à la fumée de cigarette durant les deux premières semaines de vie. Une importante altération des interrelations cardiorespiratoires a été mise en évidence, surtout au niveau de l'arythmie sinusale respiratoire et du couplage cardioventilatoire. Ce résultat inédit donne un éclairage nouveau sur la physiopathologie des effets de l'exposition à la fumée de cigarette en période néonatale, incluant en particulier le syndrome de la mort subite du nourrisson. La deuxième situation expérimentale examine l'hyperbilirubinémie (HB) des agneaux prématurés. Une HB modérée a été induite durant 17h par injection intraveineuse de bilirubine. Les effets de l'HB modérée sur la VFC, la VFR et les interrelations cardiorespiratoires ont été évalués sur 7 heures d'enregistrement au moment de l'HB (J0) et 72h plus tard (J3), après normalisation de la bilirubinémie. À J0, une augmentation de la variabilité accompagnée d'une augmentation des indices fréquentiels de la VFC a été observée indiquant une coactivation sympathovagale. Tous ces effets ont disparu à J3. Une diminution de la fréquence respiratoire a été retrouvé avec une augmentation de la VFR; ces effets étaient maintenus jusqu'à J3. Une augmentation de l'arythmie sinusale respiratoire, de la synchronisation et du nombre de RR dans une inspiration et une expiration a été observée. Ces deux derniers effets étaient toujours présents au jour 3. La troisième situation expérimentale concerne l'application nasale d'une pression positive continue (PPC) de 6 cmH2O à des agneaux nouveau-nés sains pendant 6 heures. Une augmentation de la fréquence cardiaque a été observée avec diminution des indices temporels et fréquentiels de la VFC et augmentation de la complexité des intervalles RR. De plus, un ralentissement de la respiration a été montré avec allongement de la durée de l'expiration et diminution de la VFR indiquant une stabilisation de la respiration. Enfin, la seule altération des interrelations cardiorespiratoires retrouvée était une augmentation du nombre de RR dans le cycle respiratoire attribuable à l'augmentation de la fréquence cardiaque et à la diminution de la fréquence respiratoire. L'interprétation des résultats a été approfondie en utilisant une approche à base de modèles pour représenter le comportement des systèmes cardiovasculaire, respiratoire et du baroréflexe artériel dans les conditions expérimentales. Celle-ci permet d'accéder à des variables physiologiques difficilement observables durant les expérimentations. / The objectives of this thesis are: i) to develop new techniques, adapted to the neonatal period, for the automatic analysis of cardiac (ECG) and respiratory (RESP) signals in order to study heart rate variability (HRV), respiratory rate variability (RRV), as well as cardiorespiratory interrelations; ii) to validate these techniques and use them on neonatal ovine models to better understand alterations in the cardiorespiratory control in experimental situations mimicking exposure to postnatal environmental tobacco smoke, hyperbilirubinemia in the premature infant and continuous positive airway pressure application. In the different experimental situations, the lambs were without sedation and moving freely; this makes the treatment of ECG and RESP signals recorded for several hours difficult because of artifacts. As a first step, a semi-automated signal processing approach has been proposed. It includes the automatic elimination of artefactual periods, the extraction of time series from the clean segments of the ECG and RESP signals, the performance of a stationarity test in order to extract stationary segments, the application of linear (in time and frequency domains) and nonlinear HRV and RRV analysis as well as the calculation of cardiorespiratory interrelations indices. This approach was validated and allowed to study the effects of three different experimental conditions on cardiorespiratory control. The first condition explored the effects of exposing newborn lambs to postnatal environmental tobacco smoke (ETS) for the first two weeks of life. Significant impairment of cardiorespiratory interrelations was demonstrated, particularly for respiratory sinus arrhythmia and cardioventilatory coupling. This novel result sheds new light on the physiopathology of the effects of ETS exposure in the neonatal period, particularly for sudden infant death syndrome. The second experimental situation corresponds to hyperbilirubinemia (HB) of premature lambs. Moderate HB was induced for 17h by intravenous injection of bilirubin. The effects of moderate HB on HRV, RRV and cardiorespiratory interrelationships were assessed over 7 hours of recording during acute HB (D0) and after 72h (D3), following normalization of bilirubinemia. On D0, an increase in HRV accompanied by an increase in frequency indices of HRV was observed, indicating sympathovagal coactivation. These effects were absent on D3. A decreased respiratory rate and an increase in RRV were noted on D0; these effects were maintained until D3. The study of cardiorespiratory interrelations showed an increase in respiratory sinus arrhythmia, phase synchronization and the number of RRs in inspiration and expiration. The latter effects were still observed on day 3. The third experimental situation concerns the nasal application of a continuous positive pressure (CPAP) of 6 cmH2O in healthy neonatal lambs for 6 hours. An increase in heart rate associated with a decrease in temporal and frequency indices of HRV and an increase in RR interval complexity was observed. In addition, we observed a decrease in respiratory rate accompanied by a prolonged expiration and a decreased RRV, indicating a stabilization of breathing. Finally, no alterations of cardiorespiratory interrelations were observed excepted an increase in the number of RRs in the respiratory cycle explained by the increased heart rate and decreased respiratory rate. To further understand these results, a model of cardiorespiratory coupling comprising three compartments mimicking the functioning of the cardiovascular and respiratory systems and the arterial baroreflex, was adapted to the conditions of the experiment. Results obtained with the model allowed to gain access to variables that were not measured during the experiments.

Environ 20% des chiots nés vivants meurent au cours des trois premières semaines de vie. Cette mortalité néonatale est ainsi responsable de pertes économiques importantes pour les éleveurs. Néanmoins, les déterminants immunitaires et nutritionnels de ces cas de mortalité sont très mal connus dans l'espèce canine. L'objectif de ce travail était donc d'identifier les facteurs de risque de mortalité néonatale chez le chiot, dont en particulier l'importance de la prise colostrale pour la survie. La première partie des résultats a mis en évidence une association forte entre la croissance précoce (sur les deux premiers jours de vie) et les pertes néonatales. Cette croissance précoce reflétant directement la prise colostrale, la suite des travaux s'est ensuite intéressée aux différents apports colostraux. Le transfert d'immunité passive affecte le taux de mortalité, une concentration sérique en immunoglobulines G à l'âge de 2 jours inférieure à 2,3 g/l étant associée à un risque de mortalité néonatale plus élevé et caractérisant un déficit de transfert. Un résultat similaire a été obtenu avec l'étude de l'immunité spécifique dirigée contre le parvovirus canin de type 2 : les chiots ayant acquis les titres en anticorps les plus faibles à deux jours d'âge séroconvertissent et excrètent du virus significativement plus tôt que les chiots avec de plus forts titres d'anticorps maternels. L'apport énergétique colostral était également associé aux chances de survie : les chiots présentant une glycémie à 24 heures de vie inférieure à 0,92 g/l ayant un plus fort risque de mortalité. Outre la forte relation entre survie et prise colostrale (apportant immunoglobulines et énergie), notre travail montre également l'impact du poids et de la vitalité à la naissance (évalué par le score Apgar). Par ailleurs, la qualité immunologique du colostrum (évaluée par sa concentration en IgG), bien que non directement liée aux chances de survie, s'est montrée très variable entre les chiennes, aggravant probablement le risque de déficit de transfert de l'immunité passive chez certains chiots. Tous ces travaux contribuent à une meilleure connaissance des facteurs de risque de mortalité qu'il est important de contrôler en élevage. Ils révèlent le rôle crucial de la croissance foetale, du déroulement de la mise-bas et de l'ingestion colostrale. Une pesée des chiots au cours des premiers jours de vie peut être a minima conseillée aux éleveurs pour identifier les chiots à risque et auxquels des soins plus attentifs devront être apportés. / Neonatal mortality in dogs (within the first three weeks after birth) accounts on average for 20% of puppies born alive, being thus responsible for a great economic loss to dog breeders. However, immunological and nutritional determinants of puppies survival are poorly described. This dissertation thus investigated the risk factors of neonatal mortality in dogs, and in particular the importance of colostrum intake for survival. The first part of results revealed a strong association between early growth rate (during the first two days of life) and neonatal losses. As early growth rate reflects the colostrum intake, the role of colostrum was then addressed. Passive immune transfer was shown to affect mortality rate, with serum IgG concentration at two days of age lower than 2.3 g/L being characterized as in deficit of maternal immunoglobulins. Similar lack of immunoprotection was observed for a specific canine pathogen (canine parvovirus type 2), as puppies with low antibody titers at two days of age seroconverted or underwent parvovirus infection significantly earlier than puppies with higher titers. Energy intake, evaluated via blood glucose concentration at 24h of life, was also found associated with survival: puppies with low glucose concentration (≤ 92 mg/dl) were found at higher risk of death. Besides the strong relationship between colostrum ingestion, providing passive immunity and energy, the impact of birth weight and vitality at birth (evaluated via Apgar score) on puppies’ survival was also evidenced. Colostrum immune quality (evaluated via IgG concentration), although not directly linked with the risk of neonatal death, was found of great variability, most probably putting some puppies at a risk of passive immune deficit. The present study contributed to the knowledge about the risk factors of mortality to be controlled in breeding kennels. Results provided in this work revealed the crucial role of the fetal growth, course of parturition and intake of the colostrum for the newborn dog. Regular weighing of newborns can be advised as a practical application for dog breeders, as it allows to identify puppies at a higher risk of death and to provide puppies with additional nursing and veterinary care.

Introducción: Durante los primeros días de vida la madre es la principal fuente de alimento para el recién nacido. Sin embargo, es común que la madre presente trastornos de la lactancia y se genere una pérdida de peso neonatal mayor a la fisiológica. Objetivo: Estimar la magnitud y asociación entre los trastornos de la lactancia y la pérdida de peso neonatal mayor a la fisiológica en neonatos en el área de alojamiento conjunto de un servicio de neonatología en un hospital de la seguridad social en Lima, Perú. Métodos: Estudio de tipo transversal analítico. Registramos el peso neonatal en una evaluación de rutina (entre las 24 y 72 horas de vida) y lo comparamos con el peso al nacer. La pérdida de peso excesiva fue definida como una diferencia igual o mayor al 7%. Mediante una encuesta y verificación visual investigamos los trastornos de la lactancia materna (retraso en el inicio, posición de la boca, duración de la lactancia, frecuencia de la lactancia, sobreabrigo, dolor en el pezón y forma de la C). La asociación entre la pérdida de peso excesiva y los trastornos, ajustada por otros factores, fue cuantificada mediante un modelo linear generalizado múltiple. Resultados: En 18,8% (74/393) de los neonatos, la pérdida de peso excesiva fue igual o mayor al 7% del peso al nacer. La posición inadecuada de la boca en el pezón estuvo presente en 53,7% (211/393) de los neonatos mientras que el dolor en el pezón fue reportado en 44,0 (173/393). En el análisis ajustado, el dolor en el pezón [RP=1,50(IC95%:1,02-2,22)] y la posición inadecuada de la boca [RP=1,67(IC95%:1,09-2,57)] estuvieron asociados a una mayor ocurrencia de pérdida peso excesiva. Conclusiones: Los trastornos de la lactancia son comunes. Estos factores están directa y positivamente asociados a una mayor ocurrencia de pérdida de peso excesiva. La introducción de mejoras en las prácticas de lactancia, por ejemplo mediante programas educativos, podría disminuir la ocurrencia de pérdida de peso neonatal excesiva. / Introduction: During the first days of life the mother is the main source of nutrients for the newborn. However, breastfeeding difficulties are common and may generate excessive neonatal weight loss. Objective: Estimate the magnitude and association between breastfeeding problems and excessive neonatal weight loss beyond the physiological norm in the neonatology ward in a social security hospital in Lima, Peru Methods: We conducted a cross sectional analysis of the recorded neonatal weight in a routine evaluation (between 24 and 72 hours of life) and compared it against birth weight. Excessive weight loss was defined as a difference greater than or equal to 7 %. Breastfeeding problems (defined as problems with breastfeeding initiation, mouth position, breastfeeding duration, breastfeeding frequency, too much clothing, nipple pain and C form) were investigated using a survey and visual verification. The association between excessive weight loss and breastfeeding problems, adjusted by other factors, was quantified using a multiple generalized linear model. Results: Excessive weight loss was present in 18.8% (74/393) of the newborns. Improper positioning of the mouth on the nipple was present in 53.7% (211/393) of neonates while nipple pain was reported by 44.0% (173/393) of mothers. In the adjusted analysis, nipple pain [PR = 1.50 (95% CI: 1.02 to 2.22)] and improper positioning of the mouth [PR = 1.67 (95% CI: 1.09- 2.57)] were associated with an increased occurrence of excessive neonatal weight loss. Conclusions: Breastfeeding problems are common. These difficulties are significantly associated with an increased occurrence of excessive neonatal weight loss. Improvements in breastfeeding practices, for example through educational programs, may decrease the occurrence of excessive neonatal weight loss. / Tesis