In this thesis, we develop and test a technology for computer-assisted assessments of newborn brain maturity from sleep electroencephalogram (EEG). Brain maturation of newborns is reflected in rapid development of EEG patterns over a number of weeks after conception. Observing the maturational patterns, experts can assess newborn’s EEG maturity with an accuracy ±2 weeks of newborn’s stated age. A mismatch between the EEG patterns and newborn’s physiological age alerts clinicians about possible neurological problems. Analysis of newborn EEG requires specialised skills to recognise the maturity-related waveforms and patterns and interpret them in the context of newborns age and behavioural state. It is highly desirable to make the results of maturity assessment most accurate and reliable. However, the expert analysis is limited in capability to estimate the uncertainty in assessments. To enable experts quantitatively evaluate risks of brain dysmaturity for each case, we employ the Bayesian model averaging methodology. This methodology, in theory, provides the most accurate assessments along with the estimates of uncertainty, enabling experts to take into account the full information about the risk of decision making. Such information is particularly important when assessing the EEG signals which are highly variable and corrupted by artefacts. The use of decision tree models within the Bayesian averaging enables interpreting the results as a set of rules and finding the EEG features which make the most important contribution to assessments. The developed technology was tested on approximately 1,000 EEG recordings of newborns aged 36 to 45 weeks post conception, and the accuracy of assessments was comparable to that achieved by EEG experts. In addition, it was shown that the Bayesian assessment can be used to quantitatively evaluate the risk of brain dysmaturity for each EEG recording.

Texas House Bill 790 resulted in the expansion of the newborn screening panel from 7 to 27 disorders. The long-term economic implications of this expansion have not been studied. The objective of this study was to estimate the incremental cost-effectiveness of the expanded newborn screening program compared to the previous standard screening in Texas. A Markov model (for a hypothetical cohort of Texas births in 2007) was constructed to compare life-time costs and QALYs between the expanded newborn screening and pre-expansion newborn screening. Estimates of costs, probabilities of sequelae, and utilities for disorder categories were obtained from Texas statistics, the literature, and expert opinion. A baseline discount rate of 3% was used for both costs and QALYs, with a range of 0% to 5%. Analyses were conducted from a payer's perspective, so only direct medical cost estimates were included. The life-time incremental cost-effectiveness ratio (ICER) for expanded versus pre-expansion screening was about $12,000/QALY. Probabilistic sensitivity analysis using key variables showed that results ranged from about $9,500 to $13,000 /QALY. This range is well below the commonly cited willingness to pay threshold of $50,000/QALY. Therefore, expanded newborn screening results in additional expense to the payer but also improves patient outcomes by preventing avoidable morbidity and mortality. The screened population benefits from greater QALYs as compared to the unscreened population. Overall, expanded newborn screening in Texas was estimated to be a cost-effective option as compared to unexpanded newborn screening. / text

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

published_or_final_version / abstract / toc / Speech and Hearing Sciences / Master / Master of Science in Audiology

No description available.

No description available.

Thirteen nurses were interviewed over an eight week period to explore their adaptive responses to neonatal death. A process of adaptation was identified that included several phases through which these nurses proceeded before they finalized the death experience for themselves. These phases included responses to the resuscitation of the infant; the measures taken to console the bereaved parents; feelings associated with difficult moments during the dying process; the behaviors utilized to strengthen themselves before and after the death; reactions to the silence in the unit that occurred afterwards; the values they discovered when reflecting on how the death was handled; and the development of a philosophical meaning from their experiences. Data were collected and analyzed using grounded theory methodology.

No abstract available.

Globally neonatal mortality accounts for 40% of under-five deaths. Participatory interventions where the local problems are addressed have been successful in some settings. The aim of this thesis was to describe challenges in perinatal health in a Vietnamese province, and to evaluate the effect of a facilitated intervention with local stakeholder groups that used a problem-solving approach to neonatal survival during three years. The NeoKIP trial (Neonatal Knowledge Into Practice, ISRCTN44599712) had a cluster-randomized design (44 intervention communes, 46 control). Laywomen facilitated Maternal-and-Newborn Health Groups (MNHGs) and used Plan-Do-Study-Act cycles to address perinatal health problems. Births and neonatal deaths were monitored. Interviews were performed in households of neonatal deaths and randomly selected live births. Use of health services was mapped. The primary healthcare staff’s knowledge on newborn care was assessed before and after the intervention. Neonatal mortality rate (NMR) was 16/1000 live births (variation 10 - 44/1000 between districts). Home deliveries accounted for one fifth of neonatal deaths, and health facilities with least deliveries had higher NMR. Main causes of death were prematurity/low birth-weight (37.8 %), intrapartum-related deaths (33.2 %) and infections (13.0 %). Annual NMR was 19.1, 19.0 and 11.6/1000 live births in intervention communes (18.0, 15.9 and 21.1 in control communes); adjusted OR 1.08 [0.66-1.77], 1.23 [0.75-2.01], and 0.51 [0.30-0.89], respectively. Women in intervention communes more frequently attended antenatal care, prepared for delivery and gave birth at institutions. Primary healthcare staff’s knowledge on newborn care increased slightly in intervention communes. This model of facilitation of local stakeholder groups using a perinatal problem-solving approach was successful and may be feasible to scale-up in other settings. / NeoKIP project in Vietnam

With increases in medical technology, infant mortality has decreased, while infant morbidity has increased over the past half century. Moreover, the definition of high-risk pregnancy continues to lack true universal acceptance. Thus, continued research in the area of perinatal complications is warranted. There have been studies that have suggested short-term and long-term deficits considered to be secondary to perinatal complications. Psychologists often gather information about a given child’s perinatal history, but do not always have means to interpret how those complications may impact the child later in life. The Maternal Perinatal Scale (MPS) has been shown to have good reliability and validity in past studies, but a scoring system has yet to be established. This project consisted of two studies. The first study created a preliminary scoring system for the developmental questionnaire, the Maternal Perinatal Scale. This questionnaire has proven to have potential for good clinical utility, but prior to this study, had nothing beyond item-by-item analysis for interpreting the results. To test the validity of the proposed scoring system, a second study was conducted to determine cutoff scores and classification rates for the scoring system on data previously collected with children in elementary school. Results revealed proposed scores for each item on the MPS and classification rates associated with certain developmental disorders later in life. / Department of Educational Psychology