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.

M.Cur. (Midwifery and Neonatal Nursing) / The purpose of this study is to determine the experiences of the parents after the death of a congenital abnormal baby. Parents who have lost a baby go through a process of grief. This also applies to parents of a baby with congenital abnormalities. Parents whose congenital abnormal baby dies, not only grieve because of the abnormality of their baby, but also because it died Unstructured in-depth interviews were held with six couples within a year after the death of their babies. The experiences of the six couples were afterwards compared. A literature study was undertaken in order to determine what the conclusions of other researchers field were. The result of the literature study was compared with that of the present study. Recommendations are made at the end of this study on the practical applications, education and further research that can be undertaken on this subject.

Digoxin, a steroidal glycoside that inhibits Na⁺/K⁺-ATPase, is the most commonly prescribed cardiac medication in North America. Blood levels of this drug are routinely measured to reduce the risks of toxicity. Reports questioning the specificity of antisera used in radioimmunoassays for serum digoxin measurements began to appear after 1975¹ when plasma from patients with renal failure, not on glycoside therapy, showed false-positive digoxin levels. Since then, digoxin-like immunoreactive substances (DLIS) have been found in sera from patients with hepatic failure, hypertension, pre-eclampsia, in amniotic fluid and cord blood. Some of the highest values for DLIS have been detected in premature infants, where levels have often exceeded the therapeutic range (0.2-2.0 µg/L) for digoxin. Cord blood has been identified as a rich source of DLIS. Dahl et al² were the first to suggest that a circulating saluretic substance "endoxin", may cause hypertension in salt sensitive rats. Gruber et al³ reported on the existence of digoxin-like factor(s) in the plasma of volume-expanded dogs. Plasma from these dogs inhibited Na⁺/K⁺ATPase activity. A number of other studies have supported the concept that such digoxin-like factors may be of etiological significance in hypertension⁴. In view of these observations, a study was undertaken to isolate and fractionate DLIS from mixed cord blood and determine whether or not any of this digoxin-like material possessed Na⁺/K⁺-ATPase inhibitory properties. Cord blood collected in the Grace Hospital Maternity Unit (Vancouver, BC), was pooled and DLIS extracted using C₁₈,R-Sep Paks. Extracts were resolved by high performance liquid chromatography (HPLC) into several fractions containing digoxin equivalent immunoactivity as measured by radioimmunoassay (RIA). A number of steroids and bile acids (dehydroepi-androsterone-sulfate, cortisone, Cortisol, deoxycortisone, ∆⁴androstene-dione, progesterone and glycochenodeoxycholic acid) cross-reacted with digoxin antisera and had HPLC retention times similar to DLIS-containing fractions. The ability of HPLC generated DLIS positive cord blood fractions to inhibit Na⁺/K⁺-ATPase activity was determined in three different assay systems; red cell ⁸⁶Rb uptake canine kidney-Na⁺/K⁺-ATPase and red cell membrane-Na⁺/K⁺-ATPase. At least six fractions contained DLIS and inhibited Na⁺/K⁺-ATPase activity. Inhibition varied with the assay system used but none of the fractions inhibited ⁸⁶Rb uptake by erythocytes. One fraction (which eluted at 29 minutes) contained progesterone; 72% of the inhibitory activity present in this fraction was attributable to this steroid. Another inhibitory fraction co-eluted with dehydroepiandrosterone-sulfate (DHEAS-S). The only fractions found to inhibit both the red cell membrane and canine kidney Na⁺ /K⁺-ATPase enzymes eluted at 7 and 29 minutes. In summary, a number of digoxin-like immunoreactive substances were isolated from cord blood by HPLC fractionation and found to inhibit Na⁺/K⁺-ATPase activity. Inhibition varied with the assay system used. There was no apparent correlation between inhibition and digoxin immunoreactivity. Very large quantities (500 mL) of cord blood were extracted to demonstrate these properties. It remains to be determined whether or not DLIS isolated during the perinatal period is of physiological significance. / Medicine, Faculty of / Pathology and Laboratory Medicine, Department of / Graduate

M.Cur. / Please refer to full text to view abstract

Globally, nearly 40% of under-five deaths occur in the first 28 days after birth. Neonatal mortality is concentrated in sub-Saharan Africa and South Asia with an estimated 80% of all neonatal deaths occurring in the two regions. Low quality of care has been associated with poor health outcomes in low-and middle-income countries (LMICs). Low quality of intrapartum care has been shown to be strongly associated with poor newborn outcomes. Improving access to high-quality neonatal care for small and sick newborns is crucial to reducing preventable deaths in the immediate newborn period. Over the last two decades, significant advances have been made in measuring the coverage, quality and equity of maternal health services. However, few studies to-date have explored the quality of care for small and sick newborns in resource-constrained settings. Those studies conducted in low-and middle-income settings demonstrate that in-patient service readiness for small and sick newborns is low. While there have been increasing efforts to develop and standardize metrics for measuring facility readiness for this population, few studies to-date have explored the effective coverage – a term used to denote utilization adjusted for quality – of services for emergency newborn care in such settings. Recommendations for intervention packages for small and sick newborns have largely focused on secondary and tertiary levels of care, leaving the role of community and peripheral facilities under-explored. Central to the agenda of improving the coverage of high-quality services for small and sick newborns is also strengthening the capacity of health workforce that participate in their care. A plethora of training packages and supervision strategies have been tried and tested in LMICs for improving emergency obstetric care with the focus on emergency newborn limited to a few complications. These human resources initiatives have been criticized for being fragmented in implementation. Little is known about the quality of training and supervision for emergency newborn care competencies for the rural health workforce in under-resourced settings. This dissertation is presented in three papers to help evaluate specific components of quality and coverage for the small and sick newborn population in LMICs. Paper one identifies and describes the breadth of strategies used to successfully translate evidence-based community interventions for the management of newborns with possible serious bacterial infections (PSBI), enabling the generation of a common and consistent taxonomy for practitioners and researchers in this domain. Paper two uses quantitative methods to examine the service readiness and effective coverage of services for small and sick newborns at the sub-district and district levels in rural Ghana. Paper three, using a mixed-methods design, assesses health worker perceptions of the quality and gaps in training, supervision and tele-mentoring activities for emergency obstetric and newborn care in rural Ghana.

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Crying is the primary source of distal communication through which newborn and young infants’ needs are related to the caregiving environment and, as such, this social behavior is vital to the survival and development of the infant. Recently, a series of experimental studies has begun to isolate the effects of specific durational components of crying on adults’ perceptions of infant cries. These studies have found the duration of pauses within and between cries to be perceptually salient features, however, the point at which adults were able to detect changes in the duration of the pauses was not addressed. Seventy-five introductory psychology students participated in three experiments designed to determine Difference Thresholds for the point at which manipulations in the durations of pauses before and after the inspiration in infant cries were detectable by the adult listener. The Difference Threshold for the pause before the inspiration (PBI) with the duration of the pause after the inspiration (PAI) held constant was an increase of 354.18% in the duration of the PBI. Difference Thresholds for increases and decreases in the duration of the PAI were 58.53% and -61.91%, respectively. For increases and decreases in the duration of the PAI with a perceptibly longer PBI, Difference Thresholds were 39.82% and -57.6%, respectively. The Difference Threshold for an increase in the duration of the PBI with a perceptibly shorter duration of the PAI was 420.06% and the Difference Threshold for a decrease in the duration of the PBI with a perceptibly longer duration of the PAI was 485.61%. Results provided the first known experimental evidence of the point at which changes in the durations of pauses before and after the inspiration in infant crying are detectable by adult listeners. / Master of Science

An improved digital computer model of the neonatal respiratory system was developed. Using previous models as a basis, important improvements were made in order to accurately simulate infant blood gas chemistry and its effect on respiratory and circulatory control. The model is divided into five physiologic compartments: heart, brain, lungs, tissues, and cerebrospinal fluid compartment. Respiration is a function hydrogen ion concentration in the medulla and oxygen tension and hydrogen ion concentration in the aorta. Cardiac output is a function of oxygen and carbon dioxide tension in the brain and oxygen tension at the tissues. Major improvements in this model include an advanced carbon dioxide dissociation relationship and a complex blood buffer system. It also is able to simulate treatment of respiratory distressed infants with bicarbonate infusion and respirator therapy. In addition, it has a simplified variable time delay. In order to evaluate the model, an attempt was made to simulate an actual infant. Results indicate that while the model is an improvement over previous attempts, it is still deficient in some areas in its ability to simulate actual infants. More comparisons with actual data must be made to accurately evaluate the model. / Master of Science