Com o objetivo de avaliar os parâmetros clínicos e zootécnicos dos efeitos da substituição do leite in natura por colostro na alimentação de bezerros até 60 dias de vida, foram utilizados bezerros machos Holandeses, do nascimento aos 60 dias de vida. Os animais, em número de 24, foram trabalhados dentro de um delineamento em blocos casualizados, formando-se quatro blocos de seis animais, com repetição dentro de blocos, para atender a três tratamentos. Os blocos foram formados com neonatos, cuidando-se para que a diferença de idade dentro de bloco não superasse 21 dias. Os tratamentos compreenderam em misturas iniciadoras idênticas e feno de coast cross, fornecidas desde a primeira semana de vida, e leite mais colostro nas seguintes formas: Grupo 1, colostro diluído em água na proporção 2:1 até os 60 dias de idade, Grupo 2, colostro diluído em água na proporção 2:1 até os 30° dia de idade e leite in natura do 30° ao 60° dia, Grupo 3, leite in natura até os 60° dia de idade. Todos os animais receberam colostro materno (4,0 kg por animal/dia) durante os três primeiros dias de vida. Amostras de sangue foram colhidas nas idades de 0, 24, 48, 72 horas, 5° dia, 7° dia, 15° dia, 30° dia, 60° dia para avaliação do proteinograma. Semanalmente foi executadas pesagens para avaliar ganhos de peso. Não foi encontrado nos diferentes tratamentos alterações significantes no proteinograma e ganho de peso dos animais. Conclui-se que a diluição de colostro nos tratamentos estudados é viável na alimentação dos bezerros. / In order to evaluate clinical and zootechinical effects of the use of diluted colostrum as maternal milk replacement on Holstein Friesian calves feeding on the first 60 days of life, twenty four new born male calves were enrolled and randomly allocated on 4 blocks of six animals, with repetition of blocks in order to attend to three treatments. Animals from the same block should not have more than 21 days of age difference. Treatments consisted on starter mix, coast cross hay and liquid diet presented as: Group 1 diluted colostrum on water (2:1) for 60 days; Group 2 diluted colostrum on water (2:1) until 30 days and milk from 31 to 60 days, and Group 3 milk for 60 days. Blood samples were collected on 0 h, 24 h, 48 h, 72h and on days 5, 7, 15, 30, and 60 in order to evaluate serum protein. Weight gain and was evaluated every weekly. Solid and liquid intakes were evaluated daily. No significant difference was found among the treatments for serum protein and weight gain. Therefore, the colostrums dilution is viable option on calf feeding.

It is essential that neonatal practitioners are able to use their theoretical knowledge in clinical practice in an appropriate manner, in order to render competent quality care to the critically ill neonate. However, theory and practice integration is also very difficult to achieve. Managers of neonatal units and neonatal students had voiced concerns regarding the integration of theory and practice in the neonatal programme offered by an Institution of Higher Education (IHE). Therefore the purpose of this research was to develop standards and criteria to facilitate the integration of theory and practice in the IHE Neonatal Programme A combined qualitative/quantitative exploratory, descriptive, contextual approach was followed, based on Muller's Model for the Development of Nursing Standards (1990:49-55). The design consisted of a development phase and a quantification phase. Standard development began with conceptualisation, that is, the definition of the research concepts and the integration of the study into existing theoretical frameworks. The legislative frameworks used for the study were those of the South African Qualifications Authority and the South African Nursing Council, that govern nursing education and nursing practice. The theoretical frameworks promote theory/practice integration. Standards and criteria were developed from the legislative and theoretical frameworks in order to facilitate the theory/practice integration of the IHE neonatal programme. Ten experts who met specific criteria for inclusion in the study were then asked to validate the standards. The quantification phase consisted of the statistical determination of the content validity of the standards, using a questionnaire. The original ten experts together with another forty participants who complied with specific inclusion criteria, were asked to evaluate the standards, using a four-point rating scale. A standard or criterion with a content validity index of 3.5 to 4. 0 was accepted as valid. The results of the data analysis for the fifty participants showed that all criteria had a mean score of over 3. 5 and thus could be considered valid and useful as a guideline for neonatal programmes. However it was evident from standard deviation scores that the expert group showed greater consensus than the additional participants regarding the validity of the standards. Further research may therefore be required in order to confirm the validity of the standards and criteria.

Increasingly, multimedia technology is permeating the educational arena worldwide, and many colleges and universities are moving towards the use of digital technology to enhance the teaching and learning process of both the students and educational practitioners (Kachian & Wieser, 1999:[online]; Mat, 2000:[online]). South Africa is a developing country that is undergoing radical social, political, economic and cultural changes and advances in computer technology have also dramatically changed the learning and teaching process and provided new learning opportunities and access to educational resources beyond those traditionally available. This research study describes a design experiment in which a multimedia learning environment (MMLE) was crafted for nursing students in neonatology at a university in Johannesburg, South Africa. At the outset, the integrated design principles derived from the constructivist perspectives on learning, multimedia learning design principles generated from Instructional Design Theory and the learning styles according to Kolb’s Learning Style Inventory, are established as a theoretical point of departure. This theoretical position led to the generation of a design framework that exploits the congruencies between constructivist perspectives on learning, the individual attributes of learners as defined by learning styles and multimedia design principles. The design experiment is conducted in five phases: the establishment of the design framework after an extensive literature review, the development of the MMLE, a pilot study, the final implementation and data analysis. Both quantitative and qualitative data are collected. The preliminary results of the study show that the students had an overwhelmingly positive experience of the MMLE, and that their preferred learning style had some influence on their experience. Little evidence has been found in the literature about the interaction between learning styles and constructivist learning principles for the design of multimedia learning and it is in this area that the study makes a contribution. The study also makes a contribution to the field of Nursing Science education, as it designs and develops multimedia learning materials, and assesses the value of those learning materials for learners which may be adopted in similar contexts within the broader South African context. / Prof. D. Van Der Westhuizen

Thermoregulation is considered a top priority in neonatology due to the fact that relative to adults, neonates have a morphological susceptibility to excessive heat exchange with the environment, and exhibit limited physiological/behavioural responses to thermal strain. Consequently, the environmental conditions in which they are nursed must be tightly regulated to maintain body temperature stable. Neonatal intensive care units (NICU) use radiant warmers (RW) to thermally manage many newborns. However, recent evidence suggests that RW induce intermittent bouts of thermal strain that could adversely affect patients. This warrants further investigation of neonatal heat balance and the pertinent factors affecting it. Conducting an exhaustive audit of heat exchanges affecting the body during standard care under a RW could yield important information that would lead to the improvement of clinical practice in NICUs. The present thesis focuses on neonatal thermoregulatory responses, various body heat exchange mechanisms and processes during standard care under RW.

Nurses in neonatal special care nurseries with a philosophy of family centered care involve parents in the care of preterm infants. There is little research describing nurses' perspectives of parental participation in care. Using interview data obtained from one secondary level neonatal special care nursery, this study attempts to understand the meaning parental participation in care has for neonatal nurses and the way that meaning is expressed in various nursing activities. Twelve nurses were interviewed about their reaction to parental participation in various activities such as feeding and bathing their babies. These nurses are all full time staff members in the nursery. Findings of the research are that there are two main nursing perspectives of parental participation in the care of preterm infants in a special care nursery. These two perspectives are labelled the 'our baby' and 'their baby' perspective. The 'our baby' group of subjects maintain a traditional role of control of care. The 'their baby' group are committed to the philosophy of family centered care within certain boundaries. An example of the difference., in the two perspectives was discovered in the area of infant feeding. The 'our baby' nurses thought that parents engaged in this activity increased the workload while the 'their baby' nurses thought that parents decreased workload. The 'our baby' nurses treated most parents in a similar way but the 'their baby' nurses individualized their approach to parents. The 'their baby' nurses' enjoyed spending time with parents but the other group said that there were less parents to deal with when they were working at night. Both groups work side by side with little conflict. Implications for the selection and training of nurses are noted as well as implications for further research. / Education, Faculty of / Curriculum and Pedagogy (EDCP), Department of / Graduate

M.Cur. / An explorative, descriptive, contextual qualitative design was employed in an endeavour to unravel experiences of mothers with infants in the NICU regarding emotional support that they received from the nurses while nursing their infants in the unit. The sample of the study comprised eight (8) mothers who were selected through purposive sampling. Data were collected through the use of semi- structured questions. All the interviews were audiotaped. Data were collected in the Neonatal Intensive Care Unit (NICU) of Princess Marina Hospital, Botswana. Data were analysed through the use of Tesch's method of data analysis, which is based on thematic content analysis. Themes which emerged were acceptance of the infant, encouragement to keep on visiting the infant every three hours, information provided on caring for the infant, encouragement on giving the infant motherly love e.g. cuddling, nurses having no time for the mothers, nurses' mistrust of mothers and finally neglect. The results of the study revealed that mothers did receive the emotional support that they needed, perceived as an important aspect to mothers nursing infants in the Neonatal Intensive Care Unit. It was found that some nurses did provide emotional support to mothers while other nurses had no time to support the mothers in need.

Orientadores: Gabriel Hessel, Sandra Cecilia Botelho Costa / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-07T22:25:30Z (GMT). No. of bitstreams: 1 Brandao_MariaAngelaBellomo_D.pdf: 1559118 bytes, checksum: 46a37bd9b6548c781556e1780d459ae7 (MD5) Previous issue date: 2006 / Resumo: A colestase neonatal pode ser a manifestação inicial de um grupo muito heterogêneo de doenças. O citomegalovírus (CMV) está entre as possíveis etiologias e os critérios para o diagnóstico não estão ainda definidos. A freqüência do CMV como causa de colestase intra-hepática (CIH) varia em função do método utilizado para o diagnóstico. O objetivo do presente estudo foi estabelecer a freqüência do CMV na colestase neonatal intra-hepática por meio dos seguintes métodos: sorologia para CMV (IgM-ELISA), N-PCR e imunohistoquímica no fragmento da biópsia hepática parafinada, e indicadores de histologia (célula de inclusão citomegálica e microabscesso) e verificar a concordância entre os métodos diagnósticos citados. Participaram do estudo 101 pacientes com o diagnóstico de CIH e que realizaram biópsia hepática . A idade dos pacientes na 1ª consulta variou de 13 dias a 7 meses, com mediana de 1 mês e 21 dias. Para determinar a freqüência da infecção por citomegalovírus foram calculados os valores de sensibilidade, especificidade, valor preditivo positivo, valor preditivo negativo e acurácia, considerando o método de N-PCR como referência. Para verificar a concordância entre os métodos, foi calculado o coeficiente kappa. A freqüência de positividade para o CMV por meio da sorologia foi de 8% (5/62), por PCR foi também de 8% (6/77), por imunohistoquímica foi de 2% (1/44). Pela avaliação histológica, nenhum em 84 pacientes apresentava células de inclusão citomegálica e 17/84 (20%) apresentavam microabscesso. A sensibilidade da sorologia em relação à N-PCR foi nula, a especificidade de 88,89%, o valor preditivo positivo nulo, o valor preditivo negativo de 90,91% e a acurácia foi de 81,63. Na pesquisa de microabscessos a sensibilidade foi de 50% em relação à N-PCR, a especificidade de 77,05%, o valor preditivo positivo de 17,65%, o valor preditivo negativo de 94% e a acurácia de 74,63%. Não houve concordância para a pesquisa de CMV entre os métodos de sorologia (ELISA-IgM) e N-PCR e fraca concordância entre os demais métodos isolados ou agrupados. Conclusões: 1. A freqüência de positividade para o citomegalovírus variou de 2% a 20% dependendo do método diagnóstico empregado, 2. Não houve concordância entre os métodos, 3. Não foram encontradas células de inclusão citomegálica e a imunohistoquímica foi positiva em apenas 1/44 casos, 4. A sorologia (ELISA-IgM) e a presença de microabscessos não foram sensíveis em relação à N-PCR para a determinação do diagnóstico de CMV na CIH, mas foram úteis, quando negativos, para predizer resultado negativo da N-PCR. Palavras chaves: lactente, hepatite / Abstract: A heterogeneous group of diseases may present initially as neonatal cholestasis, a syndrome made up of jaundice, coluria and fecal hypo or acolia. Cytomegalovirus (CMV) is one of the most common causes of neonatal intrahepatic cholestasis (IHC), but the CMV best diagnostic criteria is not yet established since the positivity of different diagnostic tests varies considerably. The aim of this study was to determine the CMV frequency in neonatal intrahepatic cholestasis and to compare results of different diagnostic tests: IgM by ELISA test, IHQ and PCR in paraffin-embedded hepatic biopsy sample and a review of liver histological features (liver microabscess and cytomegalic inclusion cells). The study has included 101 patients neonatal IHC patients who had been submitted to a liver biopsy during investigation. Median age at the first medical visit was 1 month and 21 days (13 days to 7 months). Sensibility, specificity, negative predictive value, positive predictive value and accuracy were calculated of each test in relation to N-PCR. To analyze concordance among laboratorial methods Kappa (?) coefficient was calculated. Frequency of CMV positive tests: CMV ELISA - IgM was positive in 5/62 (8%), N-PCR in 6/77 (8%), and IHQ in 1/44 (2%). Liver histological features showed 0/84 cytomegalic inclusion cells and 17/84 (20%) liver microabscess. Sensibility of serology was null, specificity was 88,98%, negative predictive value was 90,91%, positive predictive value was null, and accuracy was 81,63%. Sensibility of searching for microabscess was 50%, specificity was 77,05%, negative predictive value was 17,65%, positive predictive value was null94%, and accuracy was 74,63%.There was no concordance between ELISA-IgM and N-PCR (Value of ? =-0, 1) and weak concordance between other methods when considered as a group or individually. Conclusions: 1. Frequency of CMV varied of 2% to 20%, according the diagnostic test. 2. There was no concordance among tests. 3. Searching for inclusion cells was null and IHQ was 2%( 1/44). 4. ELISA-IgM and microabscess sensitivity were poor in relation to N-PCR, but if these methods are negative, probably N-PCR will be negative too. Key words: hepatitis, infant / Doutorado / Pediatria / Doutor em Saude da Criança e do Adolescente

Antimicrobials are the most frequently used medications in the Neonatal Intensive Care Unit (NICU). Antimicrobial Stewardship (AMS) efforts may be used to mitigate the consequences of antimicrobial overuse while optimizing clinical outcomes through the safe, judicious use of antimicrobials. One target of AMS efforts is to reduce the incidence of necrotizing enterocolitis (NEC), a serious intestinal infection in neonates of which a necessary component is dysbiosis, the development of aberrant intestinal microbiota typically associated with prior antibiotic use. The goal of this ILE is to implement and enhance AMS efforts in the neonatal population with a focus on preventing NEC. The specific aims progress through three relevant, practical examples of AMS in a stepwise manner. Methods: In Aim 1, a systematic review of the literature evaluating the relationship between antimicrobial therapy and subsequent development of NEC and a meta-analysis including non-interventional studies was performed. Data were pooled on adjusted odds ratios (OR) and analyzed using the generic inverse variance method. All analyses were random effects models. A sensitivity analysis was performed based on a range (0-40%) of credibility ceilings. In Aim 2, institutional guidelines for early and late onset neonatal sepsis using the principles of AMS and the evidence for safe restriction of antimicrobials targeted for reduction in use in neonates by the National Healthcare Safety Network (NHSN) were created and implemented . In Aim 3, a reproducible 2-class latent variable model to extract a date-stamped diagnosis of NEC from the Pediatric Health Information System (PHIS) database was created as a tool to enhance research evaluating antibiotic use and NEC from large databases. This model was created using a subset of infants at two PHIS sites that were able to be validated. M plus software was used. Conclusions: For Aim 1, 36 studies met inclusion criteria for the systematic review, with 33 proceeding to quantitative analysis. There were 10 RCTs, the remaining being observational studies. Using the ROBINS-I or RoB 2.0 tools as appropriate, all studies including the RCTs had a least a moderate or high risk of bias respectively. The overall analysis failed to provide evidence of an association between prior antimicrobial use and NEC when all 33 studies were included, with a summary OR of 1.13, CI95 (0.88, 1.45) and significant heterogeneity, I2 = 77%. Multiple subgroup analyses were performed: “intent” of antibiotic use (prophylaxis versus not) drug delivery method (oral versus parenteral) and study type. Subgroup analysis of prophylactic enteral antibiotics showed a reduction in NEC: OR 0.2 CI95 (0.08, 0.54), I2 = 35% while prior use of parental antibiotics showed a positive association with NEC OR 1.48, CI95 (1.18, 1.86), I2 72%; for this subgroup, using a c% shows heterogeneity first reaching an estimate of 0% at a ceiling of 10% with nominal statistical significance is maintained starting at a ceiling of 10%. This shows that consideration of the biologic mechanism of the exposure-disease association, as indicated by the subgroup analyses in this study, must be considered when performing further dataset evaluations lest biased conclusions will be reached. For Aim 2, Four guidelines were created and implemented and are being validated: • The evaluation and management of infants ≥ 35 weeks gestational age at risk for early onset sepsis at Tufts Medical Center • The evaluation and management of infants ≥ 36 weeks gestational age at risk for early onset sepsis at BronxCare Hospital Center • The evaluation and management of infants < 36 weeks gestational age at risk for early onset sepsis at BronxCare Hospital Center • The evaluation and management of infants at risk for late onset sepsis at BronxCare Hospital Center For Aim 3 a model was successfully created that can be used to add an important layer of detail, time-of-event, to patient level variables in a large data set. This model can also be used to tabulate the sensitivity of a disease in the absence of a gold standard. The model is portable and could serve as a template for the PHIS or other large databases where certain important exposures may not be date stamped. The model may be adapted to not only allow for appropriate extraction of variables, but also allow the correct modelling of time-dependent co-variables.

Orientador: Luiz Claudio Nogueira Mendes / Coorientadora: Fernanda Bovino / Banca:Francisco Leydson Formiga Feitosa / Banca:Marcio Carvalho da Costa / Resumo: Ao final da gestação o neonato deve estar preparado, por meio de modificações funcionais e estruturais de órgãos e sistemas para dar início à vida extra-uterina. Os animais prematuros nascem antes deste processo estar completo, apresentando falhas na maturação. O objetivo deste estudo foi tentar identificar por meio da técnica de eletroforese em gel de poliacrilamida em dodecil sulfato de sódio (SDS-PAGE) proteínas de fase aguda, dentre elas, albumina, ceruloplasmina, transferrina, haptoglobina, glicoproteína ácida e imunoglobulinas A e G, que possam indicar a maturação no neonato prematuro. Os cordeiros foram divididos em seis grupos experimentais (parto normal, cesárea a termo, cesárea prematura, cesárea prematura com administração pré-parto materna de dexametasona, cesárea com administração de surfactante nos prematuros e cesárea prematura com administração pré-parto materna de dexametasona e surfactante ao neonato). Os resultados indicaram que após a administração de colostro, independente do tratamento, os valores séricos de proteína total e imunoglobulinas G aumentaram, indicando que há transferência de imunidade passiva através do trato gastrointestinal. A transferrina tem seus teores superiores em animais com idade gestacional superior, demonstrando potencial para ser utilizado como marcador de maturação neonatal. / Abstract:At the end of gestation the neonate should be prepared, with functional and structural modifications of organs and systems to initiate extrauterine life. Premature animals are born before this process is complete, presenting maturation failures. The aim of this study was to identify an acute phase protein, such as a lbumin, ceruloplasmin, transferrin, haptoglobin, acid glycoprotein and immunoglobulins A and G, that demonstrates that different treatments indicate a maturation in the premature neonate using sodium dodecyl sulfate polyacrylamide gel electrophoresis technique (SDS - PAGE) . The lambs were divided into six experimental groups (normal birth, full - term cesarean section at norma l time of gestation, premature cesarean section, premature cesarean section whose mothers received prepartum dexamethasone, cesarean section giving surfactante to the prematures and premature cesarean giving prepartum dexamethasone to the mothers and surfactant to the n eonate). The results indicated that after administration of colostrum, regardless of treatment, total serum protein and immunoglobulins increased, showing the transfer of passive immunity through the gastrointestinal tract. Transfer rin has higher levels in animals with higher gestational age, demonstrating potential as a marker of neonatal maturation / Mestre

Modern intelligent monitoring systems use digital computer technology to analyze and evaluate physiological vital signs. This analytical and evaluative process is performed by algorithms developed for this purpose. The degree of 'intelligence' of the monitoring system is dependent on the 'sensitivity' and 'specificity' of these algorithms. In order to develop robust and clinically valid algorithms, a database of representative waveforms is required. The aim of this thesis was to create a neonatal vital signs database to be used for this purpose, by means of a computer-based central station. The computer was interfaced to a number of neonatal monitors (Neonatal ICU, Groote Schuur Hospital). The monitors were interrogated to obtain patient condition, ECG waveforms and respiration waveforms using the impedance technique. When possible, percentage oxygen saturation was also captured. The database contains 509 documented clinical records obtained from 35 patients and 20 records containing examples of technical alarm conditions and high frequency noise. Additional patient record data is included. Clinical events recorded include apnoea, bradycardia, periodic breathing tachycardia, tachypnoea and normal traces. These events were recorded against a variety of signal quality conditions that have been characterized in Appendix C. A prototype rate detection algorithm was checked using samples from the database.