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.

No description available.

Title from title page of PDF (University of Missouri--St. Louis, viewed March 22, 2010). Includes bibliographical references.

Thesis (PhD. (Nursing Science)(Faculty of Health Sciences))--University of Pretoria, 2006. / Summary in English. Includes bibliographical references.

This diploma thesis addresses the issue of prematurely born children. It focuses on the cooperation between neonatologic nurses in perinatal centers and the parents of the newborns. There are 3 goals of this thesis: 1. To explore and describe the level of cooperation and support of the parents and their involvement in the care of the premature newborns in perinatal centers in the Czech Republic. 2. To find out which priorities and expectations of the parents of the premature newborns are. 3. To contribute with these results to the improvement of mutual relationship between a medic and a parent. To achieve the goals described above the methods of quialitative and quiantitative research were used in the empirical part of the thesis. The quantitative research was carried out in perinatal centers in the Czech Republic using questionnaires filled by the nurses who work there. The qualitative research was carried out by questioning the mothers of the premature newborns using individual thematic semi-standardized interview. The results of the research will be provided to all perinatal centers in the Czech Republic that cooperated and can be used to improve the quality of cooperation between neonatologic nurses and parents of premature newborns.

Experiences of women regarding unexpected neonatal resuscitation were studied in this research. The objective of the study was to explore and describe the experiences of labouring women whose babies required unexpected resuscitation at birth. Recommendations were made based on the findings of the study. Labour and birth do not always go as well as expected as deviations could happen at any of the four stages of labour. Midwives tend to focus on the neonate when resuscitation is needed and leave the mother unattended and wondering what is happening as they rush away with the neonate. The situation motivated the researcher to conduct the study. The focus was on the experience of during the time of resuscitation. The study is qualitative, and exploratory, descriptive, contextual and narrative research approaches were used to reach the objective. The research population included women who delivered in the identified site from six hours to six weeks post delivery period. Inclusion criteria were the following: Women must have attended antenatal care at least four times. Their pregnancies were categorized as low risk. The ages of the women were 18-35 years. Gestational age was 38-41 weeks. The neonate should have been resuscitated successfully and admitted for observation in the nursery. Non-probability, purposive sampling was used. Data was collected by conducting semi-structured one-on-one interviews using a tape recorder. The site for the study was a public hospital, and the managers and operational midwives were used as gatekeepers. Fifteen participants gave permission to participate in the study willingly and were interviewed individually and anonymously. The interviews were transcribed, and Creswell’s data analysis spiral image was used. The period for data collection was seven months in one academic year. An independent coder’s services were utilized to increase the trustworthiness of the findings. The trustworthiness of the study was also ensured by conforming to Lincoln and Guba’s model of trustworthiness. Strategies used to ensure trustworthiness were credibility, transferability, dependability and conformability. The researcher maintained the ethical standards for conducting research by adhering to ethical principles, such as human rights, beneficence and justice. Confidentiality was maintained by using numbers instead of names, and only the researcher knows the participants’ names. Only the researcher, supervisor and the independent coder have access to the information. The data is kept in a locked cabinet and will be kept for the next five years following the publication of results. Two main themes emerged from the data analysis with each having two sub-themes Mothers verbalized varying emotions regarding their neonates’ inability to breathe properly. Mothers verbalized the importance of receiving support and information from midwives. To optimise the discussion of research findings, direct quotes were used from the raw data of interviews to support the description of experiences. Recommendations for midwives were to prepare the pregnant women during antenatal care for unexpected emergencies during labour and to reinforce this information on admission when labour commences. Managers are to update the guidelines on maternity care and the health education checklist. Nursing schools should train student midwives in debriefing and counselling skills. Both study objectives were successfully met.

Submitted by RAFAELA SPERANZA BAPTISTA null (rafa.baptista@terra.com.br) on 2016-12-21T10:55:12Z No. of bitstreams: 1 DISSERTAÇÃO RAFAELA SPERANZA BAPTISTA.pdf: 2858885 bytes, checksum: 10670fa21899fbde7f86a510301fcf2d (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-12-22T12:48:47Z (GMT) No. of bitstreams: 1 baptista_rs_me_araca.pdf: 2858885 bytes, checksum: 10670fa21899fbde7f86a510301fcf2d (MD5) / Made available in DSpace on 2016-12-22T12:48:47Z (GMT). No. of bitstreams: 1 baptista_rs_me_araca.pdf: 2858885 bytes, checksum: 10670fa21899fbde7f86a510301fcf2d (MD5) Previous issue date: 2016-12-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / 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. / 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 albumin, 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 normal 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 neonate). 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. Transferrin has higher levels in animals with higher gestational age, demonstrating potential as a marker of neonatal maturation. / FAPESP: 2011/18810-3

Orientador: Valéria Nobre Leal de Souza Oliva / Banca: Paulo Sérgio Patto dos Santos. / Banca: Rodrigo Cardoso Rabelo. / Resumo: 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. / Abstract: 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. / Mestre

Orientador: Marcelo Addas de Carvalho, Abimael Aranha Neto. / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-10T05:18:05Z (GMT). No. of bitstreams: 1 Araujo_AcaciraOliveiraBezerrade_M.pdf: 782094 bytes, checksum: 803757c0eadf299c0497a605f75a5973 (MD5) Previous issue date: 2007 / Resumo: A transfusão de concentrado de hemácias (CH) é parte freqüente do arsenal terapêutico de suporte avançado nas unidades de terapia intensiva neonatal (UTINeo); o número de transfusões utilizadas depende de fatores como idade gestacional e peso ao nascer, porém observam-se grandes variações quando comparadas crianças em mesmas condições clínicas em diferentes centros, pois não existem indicações claramente estabelecidas para transfusão neonatal baseada em estudos controlados. Assim, o objetivo do presente trabalho foi comparar e descrever a prática transfusional de CH: suas indicações, repercussões e técnicas hemoterápicas utilizadas; avaliando a presença e a adequação a protocolos, por meio de estudo científico, descritivo, observacional, direto, extensivo; através de análise qualitativa e quantitativa de respostas a questionários em 42 serviços de UTINeo do Brasil. Deste modo, sugerindo um protocolo mais uniforme para a utilização de concentrado de hemácias em neonatologia no Brasil. Das 42 unidades hospitalares pesquisadas, 20 são hospitais universitários, onde 17 ligados a instituições de ensino público e 03 instituições de ensino particular. Quanto ao tipo de atendimento, 26 unidades pertencem à rede do SUS, 09 têm atendimento particular ou ligado a convênios ou planos de saúde e 07 atendimento misto (público e privado). Representando 04 regiões do país: 11 no Nordeste, 21 no Sudeste, 03 no Centro-oeste e 07 no Sul do Brasil; abrangendo 670 leitos de UTI neonatal e 450 leitos de unidades intermediárias; captadas através do CNES - Cadastro Nacional de Estabelecimentos de Saúde. Os dados obtidos foram submetidos à análise estatística resultando nas freqüências absolutas simples e acumuladas assim como as freqüências relativas de cada questão trabalhada dos questionários aplicados. Não encontramos diferenças significativas no tocante à utilização, preparo e indicações quando analisamos serviços particulares e ligados a instituições de ensino, porém nos serviços públicos não ligados a universidades ou faculdades, sobretudo nas regiões Norte e Nordeste e nas instituições geograficamente distantes das capitais, há dificuldades de acesso às informações hospitalares, de implementação e uso de tecnologias específicas. Na maioria dos serviços há falta de interação entre os serviços de hemoterapia e as UTINeo; dificultando discussão envolvendo os profissionais que prestam assistência direta. Há elevado número de serviços que consideram parâmetros clínicos associados ao nível de hemoglobina (Hb) e outros que associam dados clínicos e laboratoriais associados ao hematócrito (Ht) como base para indicação de uso de CH. Concluindo, a decisão de transfundir um paciente deve ser sempre do médico assistente levando em consideração parâmetros técnicos, médicos, éticos e legais alicerçados na utilização de protocolos com indicações transfusionais mais legítimas adaptadas aos recursos de cada instituição, porém protegendo os pacientes do risco de transfusões inadequadas / Abstract: The transfusion of Red Blood Cells (RBC) is often one of the therapeutical tools in advanced support in newborn intensive care units (NICU); the number of transfusions required depends on factors such as pregnancy duration and weight at birth. However, great variations are observed when comparing children in similar clinical conditions in different centers, as there are no controlled studies with established indications for newborn transfusion. Thus, the goal of the present study is to compare and describe the use of RBC transfusion through the qualitative and quantitative analysis of questionnaires in 42 services of NICUs in Brazil, focusing on its indications, repercussions and techniques; evaluating the presence and the adequacy of the protocols established from a scientific, descriptive, observational and longitudinal study. From this analysis, a more uniform protocol for the transfusion of RBC in Brazilian newborns is suggested. From the 42 hospital units studied, 20 are university hospitals, of which 17 are public institutions and 03 are private institutions. With respect to the service type, 26 units belong to SUS, 09 have private or insurance service and 07 work with both services (public and private). Furthermore, the institutions represent 4 regions of the country: 11 in the Northeast, 21 in the Southeast, 03 in Center-west and 07 in the South of Brazil; representing 670 NICU beds and 450 intermediate unit beds. The data collected was submitted to statistical analysis calculating the absolute and cumulative frequencies as well as the relative frequencies of each question of the applied questionnaires. No significant differences with respect to the use, preparation and indications were found when we analyzed private and educational institutions. However, the North and Northeast regions and the institutions geographically distant from the capitals, public services unrelated to universities have difficulty to access the hospital information, implementation and use of specific technologies. In the majority of the services, there is no interaction between the blood transfusion services and the NICUs; resulting in a difficult task for the professionals providing direct assistance. There are a large number of services that consider clinical parameters associated to the hemoglobin level (Hb) while others consider parameters associated to hematocrit (Hct) levels as a reference for the indication of transfusion of RBC. In conclusion, the decision of performing a transfusion in a patient must always be made by the leading doctor taking technical, medical, ethical and legal parameters into account, based on the use of protocols with more precise transfusion indications, adapted to the resources of each institution, in order to protect the patients from the risk of badly indicated transfusions / Mestrado / Ciencias Basicas / Mestre em Clinica Medica

Com objetivos de validar o modelo de anóxia neonatal apresentado e analisar a distribuição de neurônios imunorreativos à proteína Fos (IR-Fos) no encéfalo de ratos neonatos submetidos ao insulto anóxico, foram utilizados 24 ratos wistar neonatos machos divididos em dois grupos: Anóxia (n=12) e Controle (n=12). O grupo Anóxia apresentou decréscimo de 75% no valor da saturação periférica de oxigênio durante a exposição ao nitrogênio, enquanto o Controle não apresentou alterações nos valores (97%±0,5). A análise do número de células IR-Fos mostrou ativação de áreas encefálicas relacionadas ao controle da respiração, estruturas límbicas e núcleos da rafe. Tais dados sugerem que o modelo experimental de anóxia neonatal utilizado é eficiente em produzir privação temporária de oxigênio em ratos neonatos, levando a respostas condizentes com a anóxia. Espera-se, com estes resultados, facilitar a compreensão dos eventos relacionados à neurodegeneração e neurorregeneração após anóxia neonatal e, se possível, abrir caminho para novas abordagens e perspectivas terapêuticas. / The aim of this study is to validate the experimental model of neonatal anoxia and evaluate by Fos imunoreactivity (Fos-IR) the effects of anoxic insult. Twenty-four male wistar neonates (weighting 6-8g) were divided in two groups: Anoxia (n=12) and Control (n=12). The anoxic group presented decrease of 75% in the value of the peripheric saturation of oxygen during exposure to the nitrogen while control group did not present alterations in the values of the peripheric saturation of oxygen during the studied time (97 % ± 0,5). These data suggest that the experimental model of neonatal anoxia presented is efficient in producing temporary deprivation of oxygen in neonates rats, leading to responses that characterize anoxia. Fos-IR neurons analisis showed important activation of respiratory regions, limbic strutures and raphe nuclei in anoxic group when compared to control group. We hope facilitate the understanding of neonatal anoxia neurodegeneration and neuroregeneration and possibly contribute for new approaches and therapeutic perspectives.