Purpose: The purpose of this study was three-fold; to investigate the use of pain assessment tools and pain reduction strategies during minor painful procedures in neonatal units in Australia; to map the history of an infant’s prolonged hospitalisation in a tertiary neonatal intensive care unit with respect to painful procedures and pain management practices, and to describe the effectiveness of oral sucrose in reducing procedural pain during the course of an infant’s prolonged hospitalisation (greater than/equal to 28 days). (For complete abstract open document)

Jaundice is probably the most common newborn infant problem dealt with on a daily basis by the family practitioner and paediatrician. Jaundice occurs when the liver cannot clear a sufficient amount of bilirubin from the plasma. When the problem is excessive bilirubin formation or limited uptake or conjugation, unconjugated (i.e., indirect reacting) bilirubin appears in the blood and indirect hyperbilirubinemia is the predominant form of jaundice found in the newborn infant. In the vast majority of newborns, hyperbilirubinemia is transient and benign but, in rare cases, the serum bilirubin rises to a level that is toxic to the central nervous system. Understanding the pathogenesis and epidemiology of neonatal hyperbilirubinemia; recognizing, the problems involved in appropriate surveillance and monitoring of the jaundiced infant and the factors contributing to bilirubin encephalopathy; and implementing treatment of the jaundiced neonate in a timely fashion, are issues that have engaged clinicians and researchers for some 6 decades. This work will summarize my contributions to the field of neonatal hyperbilirubinemia and it includes papers published between 1971 and 2007. The description of this work will not follow its chronological sequence, but will be divided into the categories of diagnosis, epidemiology, pathogenesis, management, treatment, and bilirubin encephalopathy.

MSc, Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009

Orientador: Ercília Maria C. Trezza / Banca: Ercília Maria Carone Trezza / Banca: Lígia Maria Suppo de Souza Rugolo / Banca: Sthella Zanchetta / Resumo: Analisar os resultados iniciais da triagem auditiva neonatal, obtidos na maternidade antes da alta hospitalar, em recém-nascidos de dois hospitais públicos de Campo Grande, MS. Método: estudo de coorte transversal com 20044 recém-nascidos de dois hospitais no período de janeiro de 2002 a dezembro de 2005. Foram utilizadas as Emissões Otoacústicas Evocadas Transientes (EOAETs) e a Pesquisa do Reflexo Cócleo-palpebral (RCP). Os resultados dos testes foram classificados em "passa" e "falha" para as EOAETs e em "presente" ou "ausente" para o RCP. Foram analisados em relação ao(s): local de nascimento, tempo de vida no momento da avaliação, peso ao nascimento, sexo, tipo de parto, valores de Apgar, convênio assistencial e risco para deficiência auditiva segundo o Joint Committee Infant Hearing (JCIH). Resultados: Foram testados 95,96% dos recém-nascidos dos dois hospitais; nesta amostra 87,52% de recém-nascidos foram de baixo risco e 12,48% de alto risco para a deficiência auditiva. Houve predominância de respostas "passa" nas EOAETs para o sexo feminino e para o parto normal. Também foi observada relação de aumento de peso e aumento das respostas "passa". Na população de baixo risco auditivo, conforme aumentava o tempo de vida no momento da avaliação, os resultados de "passa" também aumentavam; já na população de alto risco auditivo esta relação não foi observada. Conclusão: Este programa pode ser considerado como válido de acordo com as recomendações do JCIH. / Abstract: To analyze the initial results of the neonatal hearing sreening, gotten in the maternity before the discharge hospital, in newborns of two public hospitals of Campo Grande, MS. Method: transversal study of coorte with 20044 newborns of two hospitals in the period of January of 2002 the December of 2005. The Transient Evoked Otoacoustic Emissions (TEOAEs) and the cochleo-palpebral refex (CPR) had been used. The results of the tests had been classified in "pass" and "fail" for the TEOAEs and in "present" or "absent" for the CPR . They had been analyzed in relation the: place of birth, time of life at the moment of the evaluation, weight to the birth, sex, type of childbirth, values of Apgar, assistencial accord and risk for hearing impairment according to Joint Committee Infant Hearing (JCIH). Results: 95.96% of the newborns of the two hospitals had been tested; in this sample 87.52% of newborns had been of low risk and 12.48% of high risk for the hearing loss. It had predominance of answers "pass" in the TEOAEs for the feminine sex and the normal childbirth. Also relation of weight increase was observed and increased of the answers "pass". In the population of low auditory risk, as it increased the time of life at the moment of the evaluation, the results "pass" increased; already in the population of high auditory risk this relation was not observed. Conclusion: This program can be considered as valid in accordance with the recommendations of the JCIH. / Mestre

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O atendimento ao recÃm-nascido na unidade de terapia intensiva requer conhecimentos teÃrico-prÃticos no cuidado com a pele, tendo em vista que vÃrios procedimentos levam à quebra desta barreira protetora e podem causar feridas severas. AlÃm disso, à necessÃrio favorecer sua maturidade em recÃm-nascidos prematuros. Diante disso, o estudo objetivou investigar a eficiÃncia do uso da membrana semipermeÃvel como recurso tecnolÃgico a ser utilizado na pele do RNPT para reduÃÃo das perdas de Ãgua transepidÃrmica e dos distÃrbios hidroeletrolÃticos. Estudo experimental, tipo ensaio clinico randomizado, realizado no perÃodo de marÃo a agosto de 2008, na Unidade de Terapia Intensiva Neonatal (UTIN), da Maternidade Escola Assis Chateaubriand â MEAC, na cidade de Fortaleza-CearÃ. A amostra foi constituÃda de 42 RNPTs que atenderam aos seguintes critÃrios de inclusÃo: ter peso ≤ 1.500 gramas e idade gestacional ≤ 32 semanas; permanecer na unidade durante pelo menos sete dias; nÃo apresentar malformaÃÃes graves que afetassem a integridade da pele; e o consentimento dado pelos pais e/ou responsÃveis pelos RNs. As variÃveis do estudo foram peso, balanÃo hÃdrico, densidade urinÃria, controle da glicemia, dosagem do sÃdio e a cota hÃdrica diÃria. Com os dados compilados no Excel e a anÃlise estatÃstica no programa SPSS. O nÃvel de significÃncia adotado no estudo foi 5% e os dados foram apresentados em tabelas e quadros. Todas as recomendaÃÃes Ãticas foram seguidas durante as etapas da pesquisa. Todos os RNPTs foram admitidos do Centro ObstÃtrico e os diagnÃsticos mÃdicos principais foram: prematuridade, sÃndrome do desconforto respiratÃrio e doenÃa da membrana hialina. Os RNPTs do GI e GC permaneceram em incubadora de parede dupla (100%), sob ventilaÃÃo mecÃnica (95,2%) e (100%), em uso de hidrataÃÃo venosa por acesso central (81%) e (100%), comumente, faziam uso de antibioticoterapia, nutriÃÃo parenteral (71,4%,) e (95,2%), alimentaÃÃo enteral (81%) e (61,9%), fototerapia (71,4%) e (66,7%) respectivamente. Em relaÃÃo ao peso pode-se constatar que grupo de intervenÃÃo (GI) ocorreu um decrÃscimo do peso de 20g diÃrio e o grupo controle (GC), o decrÃscimo de peso foi de 18g. Quanto à diurese, os dados mostraram que a regressÃo à estatisticamente significativa. Quanto à glicemia evidenciou-se que o GC teve 4,4 vezes mais episÃdios de hiperglicemia do que o GI. Os resultados em relaÃÃo à cota hÃdrica nos mostraram uma regressÃo de 7,220 para o GI, enquanto que para o GC foi de 6,094. O que se pÃde observar em relaÃÃo aos resultados da densidade urinaria foi que o GI teve ligeiro decrÃscimo de apenas 0,777, enquanto que no GC houve aumento, a cada dia, de 22,892, ou seja, este grupo apresentou maior densidade urinÃria do que o GI. Em relaÃÃo ao sÃdio mostrou que o GI teve regressÃo em torno de 0,603, enquanto o GC apresentou regressÃo de 1,835. Podemos constatar que os RNs do GC tiveram 3,0 vezes mais chances de ter hipernatremia que os RNs do GI no decorrer dos sete dias. Podemos constatar que, no decurso de aplicaÃÃo da membrana semipermeÃvel, os RNPTs do GI tiveram uma diminuiÃÃo de nÃveis de sÃdio e de exigÃncias fluidas diÃrias, como tambÃm apresentaram menores episÃdios de hiperglicemia e a densidade urinÃria foi mantida dentro dos padrÃes de normalidade. A membrana semipermeÃvel Ã, de fato, um recurso terapÃutico eficaz para minimizar as perdas de Ãgua transepidÃrmicas nos RNPTs. / Care delivery to newborn infants at the intensive care unit demands theoretical-practical knowledge on skin care, as different procedures lead to the breaking of this protective barrier and can cause severe injuries. Moreover, skin maturity needs to be stimulated in premature infants. Thus, this study aimed to examine the efficiency of the semipermeable membrane as a technological resource for use on premature newborn infantsâ (PMNI) skin to reduce transepidermal water loss and electrolyte disorders. This experimental study is a randomized clinical trial and was carried out at the Neonatal Intensive Care Unit (NICU) of the Teaching Maternity Assis Chateaubriand â MEAC in Fortaleza-CearÃ, Brazil, between March and August 2008. The sample included 42 PMNI who complied with the following inclusion criteria: birth weight ≤ 1,500 grams and gestational age ≤ 32 weeks; permanence of at least seven days at the unit; no severe malformations that affected skin integrity; and the consent of parents and/or persons responsible for the infants. The study variables were weight, water balance, urine density, glucose control, sodium dosage and daily water quota. The data were compiled in Excel and statistical analysis was performed in SPSS. A five-percent significance level was adopted and data were presented in tables and charts. All ethical recommendations were followed during all research phases. All PMNI were admitted from the Obstetric Center and the main medical diagnoses were: prematurity, respiratory discomfort syndrome and hyaline membrane disease. The PMNI were accommodated in a double wall incubator (100%), received mechanical ventilation (95,2%) and (100%), used intravenous hydration via central access (81%) and (100%) , commonly antibiotics therapy, parenteral nutrition (71,4%) and (95,2%), enteral feeding (81%) and (61,9%) , phototherapy (71,4%) and (66,7%). As to birth weight, a daily weight loss of 20g occurred in the intervention group (IG), against 18g in the control group (CG). What diuresis is concerned, data showed a statistically significant regression. As for glucose, 4,4 times more episodes of hyperglycemia were evidenced in CG than in IG. The results for the water quota showed a regression of 7,220 for IG, against 6,094 for CG. What the urine density results is concerned, a slight decrease of only 0,777 was found for IG, against a daily increase of 22.892 for CG, that is, the latter presented higher urine density than IC during the seven days. As to sodium, regression for IG was around 0,603, against 1,835 for CG. Infants in CG had 3.0 times higher chances of hypernatremia in the study period. It was found that the application of the semipermeable membrane, the PMNI for IG was associated with decreased sodium levels and daily fluid demands during the first week of life in PMNI, who also presented less episodes of hyperglycemia and whose urine density was maintained within normal standards in comparison with PMNI in CG. The semipermeable membrane is actually an effective therapeutic resource to minimize transepidermal water losses in PMNI.

Diss. (sammanfattning) Linköping : Univ., 2004. / Härtill 5 uppsatser.

<p>Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation.</p><p>After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. </p><p>We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. </p><p>We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. </p><p>Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.</p>

Glucose is the most important fetal nutrient and the production of this substrate increases in the pregnant woman. In the last trimester the increased insulin resistance directs energy substrates to the fetus. Fetal growth is sometimes disturbed, often without an obvious explanation. After birth the newborn infant must produce its own glucose, primarily for the brain. Fatty acids from lipolysis are also important energy substrates. Hypoglycaemia can be a problem, occurring frequently in preterm infants and infants born small for gestational age (SGA). In addition, SGA infants are at risk of developing the metabolic syndrome in adulthood. Neonatal medication can influence energy metabolism. One such medication is theophylline, administered in preterm infants to prevent apnoea. We investigated energy substrate production in women with normal and IUGR pregnancies, in preterm neonates, before and after theophylline treatment and in newborn SGA infants, using stable isotope-labelled compounds and gas chromatography-mass spectrometry. We found that late pregnancy was associated with an almost twofold increase in the rate of lipolysis. This provides substrates for maternal energy metabolism, which may spare glucose for the fetus. Even though glucose production was comparable in the two groups of pregnant women, those with IUGR had a lower rate of lipolysis. A reduced supply of energy substrates could be one factor underlying IUGR. In spite of the insulin resistance of late pregnancy, insulin still had a regulatory role in energy substrate production in the women with normal pregnancies, but not in those with IUGR. Although infants born preterm and/or SGA have limited energy stores, we demonstrated that they are capable of both lipolysis and glucose production. Theophylline had no adverse effects on energy substrate production. Data on insulin and IGFBP-1 in the SGA infants indicate that in such infants insulin sensitivity is increased peripherally but reduced in the liver.

Diss. (sammanfattning) Linköping : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.