Background and aim: The Groote Schuur Hospital (GSH) Neonatal Nursery provides Level 3 care for the Metro West Health District in the Western Cape. Worldwide, VLBW neonates have improved outcomes when delivered in Level 3 neonatal units, compared with those who are transported from other facilities. This study aims to identify the characteristics and clinical outcomes of our VLBW patients, with emphasis on differences between inborns and outborns. Methodology: A retrospective cohort study. VLBW neonates admitted to the GSH Neonatal Nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Maternal and infant characteristics, and outcomes at the time of discharge from hospital were analysed. Results: A total of 1032 VLBW neonates were enrolled. 906 (87.8%) were delivered at GSH, and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors for mortality and survival without morbidity. The mothers of inborn patients were more likely to have received antenatal care (89.1% vs 57.9%, p <0.0001) and antenatal steroids (64.2% vs 15.2%, p <0.0001). Inborns required less ventilatory support (16.2% vs 57.9%, p <0.0001) and surfactant administration (25.3% vs 65.1%, p <0.0001). Inborns had a lower incidence of late infection (8.8% vs 23.4%, p <0.0001), severe intraventricular haemorrhage (3.7% vs 13.9%, p <0.0001) and chronic lung disease (5.3% vs 13.4%, p =0.003). The incidence of necrotising enterocolitis was similar between the two groups (5.9% vs 8.7%, p =0.227). 18.4% of inborns and 33.3% of outborns demised (p <0.0001), mostly on the first 2 days of admission. Mortality declined as birth weight increased. Of the survivors, 83.5% of inborns and 70.2% of outborns did not develop serious morbidity (p =0.003). Significant morbidity and mortality was noted in the outborn group weighing 800g and less, with only one outborn patient in the cohort surviving to discharge without major morbidity. Conclusion: VLBW neonates delivered at Groote Schuur Hospital had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous in-utero transfer and antenatal steroids contributing to excellent outcomes.

Background: Screening for Retinopathy of Prematurity (ROP) is recommended to prevent possible blindness. Prior to 2016, resource limitations precluded routine ROP screening at Groote Schuur Hospital (GSH). Previous pilot studies at GSH did not detect ROP requiring treatment. However, improved survival of very low birth weight infants may affect the prevalence of ROP. Objectives: The study objectives were to: i) Determine the prevalence and severity of ROP in a prospective cohort of premature infants; ii) Describe the association with pre-specified potential risk factors; iii) Assess the feasibility of screening for ROP in our resource-limited setting. Methods Infants with a birth weight of < 1251 g or gestational age < 31 weeks admitted to the GSH neonatal unit from November 2012 to May 2013 were screened. A paediatric ophthalmologist examined the infants at 4 weeks chronological age or 32 weeks corrected gestational age, with follow-up examinations as indicated. Results: Screening was performed in 135 of 191 eligible infants. A total of 313 ROP examinations were performed; 38.5% of infants required a single examination and 16.3% required more than four. The mean gestational age and weight at birth were 30.1 ± 1.9 weeks and 1056 ± 172 g respectively. Seventy-four infants were female (54.8%). Only black (57.0%) and coloured (42.9%) infants were represented. ROP was diagnosed in 40 (29.6%) infants: Eight (5.9%) infants had clinically significant ROP. No infants had stage 4 or 5 ROP. No infants weighing more than 1250 g required treatment. Two infants received laser treatment. Infants with ROP had a lower mean gestational age and lower mean birth weight than those without ROP: 29.2 ± 1.6 vs. 30.5 ± 1.9 weeks (P < 0.002) and 988 ± 181 g vs. 1085 ± 160 g (P = 0.001) respectively. Infants with ROP were more likely to have received a blood transfusion (P < 0.002); to have late onset sepsis (P = 0.024); and to have receive d exclusive breast milk feeds (P = 0.005). There were no significant differences in the level of respiratory support, the need for oxygen therapy, the occurrence of apnoea, early sepsis or severe intraventricular haemorrhage in infants with ROP compared to no ROP. On multivariate analysis, only gestational age was independently associated with ROP was gestational age (RR 0.85; 95% CI 95% 0.740 - 0.988; p=0.03). When gestational age was excluded in post-hoc analysis, birth weight (RR 0.99; 95% CI 0.997 - 0.999; P=0.03) and blood transfusions (RR 1.71; 95% CI 1.0 27 - 2.859; P=0.03) were independently associated with ROP. Infants <1000 g had a 2.5 times higher risk of having ROP than their larger counterparts (95% CI 1.05 - 5.90, P=0.03). ROP screening was completed in 91.1% (123/135) of infants. Conclusion Clinically significant ROP was found in this study. In contrast to previous studies conducted in this setting, two patients received laser treatment. Extensive resources were required for successful screening. The strong association with birth weight and gestational age suggests that infants with lower birth weights and gestational ages should be prioritized for screening in our resource-limited setting.

Advances in the field of neonatal-perinatal medicine and interventions of the 1960's have resulted in decreased mortality rates for infants suffering a variety of perinatal insults. However, it has been estimated that 25% of the survivors of high risk births will go on to have serious lifetime diabilities (Behrman, 1977). Resulting neurological morbidity may be expressed in major cognitive disabilities (i.e., cerebral palsy, mental retardation, learning disorders and the like). Early identification of these children seems Parmalee, Sigman, & Beckwith, 1982). However, the prediction of neurological outcomes remains problematic.Recognizing the psychometric concerns associated with. perinatal risk measures currently used (Crawford, 1965: Bobbin, 1963: Wenar, 1963), the Transition Scale was created as a potentially reliable measure of perinatal risks observed at the time of birth. With a sample of 116 newborn subjects, the present investigation evaluated the stability and underlying constructs of the newly created measure. In addition, comparisons were made with information obtained critical to prevention and early intervention (Cohen, from the medical chart (i.e., Apgar Score).The percentage of agreement between the two independent raters for individual items of the Transition Scale ranged from .95 to 1.00, with the overall interrater agreement calculated as .98. Similarly, an examination of the agreement between each individual rater's responses and the medical chart information revealed percentages ranging from .90 to 1.00, with overall percentages of .96 and .97. Furthermore, the results of a factor analysis indicated that the Transition Scale offers substantial construct validity.Overall, the present investigation recommends the Transition Scale as a reliable research instrument with potential clinical utility. In addition, an examination of the underlying constructs of the measure point to the potential of the Transition Scale as a valid predictor of neurological morbidity. Further research using a high risk sample of infants is recommended. / Department of Educational Psychology

The present study was an effort to empirically subtype children's learning disabilities. A review of the literature was presented with a focus on current and historical subtyping attempts. A cluster analysis was performed on 1144 school-age learning disabled children who had completed extensive neuropsychological, intellectual, and achievement measures. Four interpretable clusters emerged which were seen as (1) Verbal-Sequential-Arithmetic Deficits, (2) Motor Speed and Cognitive Flexibility Deficits, (3) Mixed Language/Perceptual Deficits, and a (4) No Deficit Subtype. Not only did these clusters indicate unique profiles for each subtype across the sample, but developmental differences were also apparent between all four clusters. The current investigation suggested the utility of an empirical-neuropsychological approach to subtyping children's learning disabilities, while also portraying the importance of neurodevelopmental considerations of subtypes. Future directions in research were discussed. / Department of Educational Psychology

<p>In the 20th century, where tobacco smoking continues to be the leading preventable cause of death, an alarming number of people continue to smoke, despite awareness of the implications of exposure for themselves and those around them. Campaigns for the promotion of effective tobacco legislation and awareness are continuously being confronted by the tobacco industry's reluctance to put the health of their consumers before company profits, leading to a ripple effect of misinformation, serious health risks and economic implications, at least for the consumers. Pregnant women are especially a concern, because exposure to tobacco smoke affects not only the smoking mother but has serious implications for the health of her unborn child. Therefore, the aim of this study was to investigate the effect of maternal exposure to nicotine during all the phases of lung development, or from the onset of the phase of rapid alveolarisation and, whether copper supplementation will prevent the adverse effects of maternal nicotine exposure, on lung development in the offspring.</p>

Eine Vielzahl von Faktoren können am Lebensanfang eine ausreichende Perfusion der Niere gefährden und ihre Funktion beeinträchtigen. Umgekehrt spiegelt eine suffiziente Nierendurchblutung meist auch eine stabile systemische Hämodynamik des Neugeborenen wieder. Laborwerte sind in diesem Alter wenig aussagefähig bezüglich der Nierenfunktion. Ziel dieser Studie war die Erstellung von dopplersonographischen Normalwerten der Blutflussparameter beim gesunden Neugeborenen am ersten und dritten Lebenstag. Es wurden Mittelwerte für die systolische, mittlere und diastolische arterielle Flussgeschwindigkeit in der A. renalis am ersten und dritten Lebenstag beim gesunden Neugeborenen durch dopplersonographische Messung bestimmt. Es konnten dopplersonographische Referenzparameter der Durchblutung der Niere ermittelt werden, die als unkompliziert messbare Parameter in der neonatologischen Praxis zur Einschätzung systemisch hämodynamischer Veränderungen sowie funktioneller Störungen der Niere bis zum akuten Nierenversagen benutzt werden können.

<p>In the 20th century, where tobacco smoking continues to be the leading preventable cause of death, an alarming number of people continue to smoke, despite awareness of the implications of exposure for themselves and those around them. Campaigns for the promotion of effective tobacco legislation and awareness are continuously being confronted by the tobacco industry's reluctance to put the health of their consumers before company profits, leading to a ripple effect of misinformation, serious health risks and economic implications, at least for the consumers. Pregnant women are especially a concern, because exposure to tobacco smoke affects not only the smoking mother but has serious implications for the health of her unborn child. Therefore, the aim of this study was to investigate the effect of maternal exposure to nicotine during all the phases of lung development, or from the onset of the phase of rapid alveolarisation and, whether copper supplementation will prevent the adverse effects of maternal nicotine exposure, on lung development in the offspring.</p>

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Made available in DSpace on 2014-06-11T19:25:37Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-09-28Bitstream added on 2014-06-13T19:32:59Z : No. of bitstreams: 1 vivan_mcr_me_araca.pdf: 2758803 bytes, checksum: a64192b41cf9bd2f30e7b776b50e6f69 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / A avaliação da perfusão tecidual com macroparâmetros não permite a detecção precoce de alteração na microvasculatura. A anestesia da gestante requer avaliação da perfusão e a eficácia do lactato na identificação de complicações em crianças após o parto já foi descrita. O presente estudo objetivou validar o lactato sanguíneo e correlacioná-lo a métodos, na avaliação de neonatos de parto normal ou cesariana eletiva sob anestesia geral inalatória. Foram utilizadas oito cadelas para realização de parto normal ou cesariana eletiva, com o protocolo composto de morfina, propofol e sevofluorano. Foram avaliados 24 neonatos de parto normal (GN) e 30 de cesariana (GC), com exames de sangue umbilical no nascimento para dosagem de lactato, hemogasometria, hematócrito, glicose e eletrólitos. No nascimento e aos 10 minutos de vida foram realizadas avaliações Apgar e neurológica. O lactato foi avaliado aos 10 minutos, 4 e 30 dias de vida. Os filhotes apresentaram acidose respiratória, acidemia e hipoxemia ao nascimento, mais elevada no GC. Os animais do GC apresentaram notas de Apgar e resposta neurológica menores ao nascimento, com melhora aos 10 minutos. O lactato sanguíneo foi maior nos animais do GN no nascimento, e foi maior nos animais que morreram. A correlação entre o lactato e as variáveis ocorreu em GN. O lactato sanguíneo associado aos demais parâmetros foi útil na avaliação dos neonatos do GN, porém nos animais do GC não houve correlação com a condição clínica dos animais no momento do nascimento. O procedimento anestésico influencia nos valores de lactato, e a determinação do melhor intervalo para sua avaliação nesses pacientes é necessária. / The assessment of tissue perfusion using macro parameters does not allow early detection of changes in the microvasculature. Anesthesia for pregnant patient requires evaluation of perfusion, and the lactate effectiveness in identifying complications in children after birth has been described. This study aimed to validate the blood lactate and its correlation with other methods, in the evaluation of neonates born from vaginal delivery or elective cesarean section under inhalator anesthesia. Eight dogs were used to perform normal delivery or cesarean section, with the protocol consisting of morphine, propofol and sevoflurane. At birth were evaluated 24 neonates born from vaginal delivery (NG) and 30 born from cesarean section (CG) using umbilical blood to test lactate, blood gas, hematocrit, glucose and electrolytes. Apgar score and neurologic tests were performed at birth and at 10 minutes of life. Lactate levels were evaluated at 10 minutes, 4 and 30 days of life. The puppies showed respiratory acidosis, hypoxemia and acidemia at birth, higher in the CG. The animals of CG presented lower Apgar scores and neurological response at birth, which improved in 10 minutes. Blood lactate was higher in NG animals at birth, and was higher in those who died. The correlation between lactate and the variables occurred on NG. Association of blood lactate with other parameters was useful in the evaluation of neonates on NG, but in the animals of CG there was no correlation with the clinical condition of animals at birth. Anesthesia influences the lactate values, and it is necessary to determine the best interval for evaluation in these patients.