Neonatology is a field of medicine in which immense progress has been seen during the past two decades. As the frontiers of this area are shifting forwards, ethical problems and issues regarding the quality of life of the rescued infants and children grow in importance. Now it is clear that the development and health of children that were endangered in the perinatal period should continue to be followed up by healthcare professionals, sometimes for many years. Ideally, this care should seamlessly follow hospital care. It was the aim of this work to examine how this continuity of care of high-risk newborns is implemented in practice. This Thesis consists of 2 parts: theoretical and practical. The theoretical part analyses the differentiation of newborn care as outlined in the Bulletin of the Czech Ministry of Health; defines the categories of newborns; and explains the basic terms used in the specific domain of high-risk newborns. Foreign experience in the provision of medical care at hospitals as well as in the continuing care after discharging from the hospital for home care is outlined. The empirical part of the Thesis was compiled based on qualitative research survey, accomplished with 3 aims in mind. The first aim was to map what type of care is provided to high-risk newborns at the Intensive Care & Resuscitation Unit of the Plzeň Teaching Hospital and who provides it. The second aim was to ascertain how the parents perceived their role during in-patient care of their babies and how they were educated and engaged in providing the care. And the last aim was to ascertain how the parents appreciated and liked the follow-up system at the Developmental Care Centre. It was found by the survey that the responders (mothers) appreciated most the comprehensiveness of the care provided by the Centre. They found the care adequate, beneficial and motivating. In their view, the desired care continuity had been achieved. The results attained within the empirical part will be presented at a workshop of the perinatology centre.

Within the ABO system there are several blood subgroups: subgroup A, subgroup B and subgroup H, and the most frequently encountered in practice are the subgroups A1, A2, A1B and A2B. The cells of, approximately, 80% of adults in group A are A1. The remaining 20% are A2 or weaker subgroups. However, in newborns is very little literature about the frequency of the subgroups of A. At birth most of the blood group A infants seems to present itself as belonging to subgroup A2, since all the ABO antigens are not fully developed in this period. Since iron deficiency, widespread in this age group, often discussed by the scientific community is related to the disproportion between the expansion of erythroid mass and iron obtained from the diet. Around four months of age, iron stores are reduced by half, and the exogenous iron is required to maintain hemoglobin concentration during this phase of rapid growth, between four and 12 months. Our objectives were to determine the frequency of newborns belonging to subgroups A1 and A2, to identify the frequency of antigen expression A1, between six and 12 months of age, infants initially typed as belonging to subgroup A2 and check the hemoglobin levels for the detection of anemia in these children. The results showed that the frequency of newborn belonging to the A1 blood subgroup was 67% (319) and the A2 subgroup was 33% (152), from a total of 471 newborns belonging to blood group A. We found a great predominance of the A1 subgroup, contradicting the literature that reports the prevalence of subgroup A2 in newborn infants. Regarding the identification of the frequency of A1antigen expression, between six and 12 months of age (n = 40), the percentage of children who express the A1 antigen, after being with six months to one year of age was 67.5% (27), the rest remained as A2 (13). The verification of hemoglobin levels in these children (n = 71), by the method of cianometa-hemoglobin, resulting in 34% of anemic children, pointing to the presence of anemia in this age group. The rates found ranged from 6.56 g/dl to 10.8 g/dl. Thus, in relation to A1 antigen expression between six and 12 months of age further studies are needed, and for the prevalence of anemia is necessary to emphasize in public health programs, intervention measures and more effective control of this nutritional disorder. / Dentro do sistema ABO existem diversos subgrupos sanguíneos: subgrupos A, subgrupos B e subgrupo H, sendo que os mais frequentemente encontrados na prática são os subgrupos A1, A2, A1B e A2B. As células de, aproximadamente, 80% da população adulta do grupo A são A1. Os 20% restantes são A2 ou subgrupos mais fracos. Porém, em recém-nascidos é muito escassa a literatura a respeito de dados quanto à frequência dos subgrupos de A . A maioria dos lactentes do grupo sanguíneo A parece apresentar-se como pertencente ao subgrupo A2, no nascimento, já que todos os antígenos ABO não estão completamente desenvolvidos neste período. Já a carência de ferro, generalizada nesse grupo etário, muitas vezes discutida pela comunidade científica, é relacionada à desproporção entre a expansão da massa eritróide e o ferro obtido da dieta. Por volta dos quatro meses de idade, os estoques de ferro estão reduzidos pela metade, e o ferro exógeno é necessário para manter a concentração de hemoglobina durante esta fase de rápido crescimento, entre quatro e 12 meses. Os objetivos deste trabalho foram determinar a frequência de recém-nascidos pertencentes aos subgrupos A1 e A2; identificar a frequência da expressão do antígeno A1, no período entre seis e 12 meses de idade, em lactentes inicialmente tipados como pertencentes ao subgrupo A2 e verificar os níveis de hemoglobina para a detecção de anemia nestas crianças. Os resultados mostraram que a frequência de recém-nascidos pertencentes ao subgrupo sanguíneo A1 foi de 67% (319) e para o subgrupo A2 foi de 33% (152), de um total de 471 recém-nascidos pertencentes ao grupo sanguíneo A. Constatou-se uma grande predominância do subgrupo A1, contrariando a literatura que relata a prevalência de subgrupo A2 em recém-nascidos. Em relação à identificação da frequência da expressão do antígeno A1, no período entre seis e 12 meses de idade (n=40), a porcentagem de crianças que passaram a expressar o antígeno A1, depois de estarem com seis meses a um ano de idade foi de 67,5% (27), o restante permaneceu como A2 (13). A verificação dos níveis de hemoglobina nestas crianças (n=71), através do método da cianometa-hemoglobina, resultou em 34% de crianças anêmicas, apontando a presença de anemia para essa faixa etária. Os índices encontrados variaram de 6,56g/dl a 10,8g/dl. Assim, em relação à expressão do antígeno A1 entre seis e 12 meses de idade são necessários mais estudos; e, para a prevalência da anemia é necessário enfatizar, nos programas de saúde pública, medidas de intervenção mais eficazes e controle desse distúrbio nutricional.

Orientador: Maria Regina Bentlin / Resumo: INTRODUÇÃO: A incidência da sífilis congênita (SC) mais que dobrou na última década, sendo um importante problema de saúde pública e agravo de morbimortalidade perinatal. OBJETIVOS: Determinar a incidência de sífilis congênita e comparar dois períodos: 2011-2012 versus 2013-2014; Caracterizar o perfil dos recém-nascidos (RN) e suas mães; Determinar as principais formas de apresentação; Avaliar o seguimento dos expostos e estabelecer um fluxograma para o acompanhamento ambulatorial. METODOLOGIA: Estudo epidemiológico, retrospectivo, longitudinal, realizado no período de janeiro de 2011 a dezembro de 2014. Selecionados todos os casos notificados de mães com VDRL positivo e seus RN. Os dados foram coletados dos registros de notificação da Vigilância Epidemiológica e dos registros da Unidade Neonatal. Amostra de conveniência. Variáveis maternas: idade, pré-natal, uso de drogas, sorologia para sífilis, tratamento adequado, tratamento do parceiro e tipo de parto. Variáveis neonatais: peso ao nascer, idade gestacional, apgar, manifestações clínicas, sorologia para sífilis e exames complementares. Variáveis pós neonatais: líquor, avaliação auditiva, oftalmológica e sorologia aos 18 meses. Estatística descritiva com cálculo de proporções, testes não paramétricos com significancia se p<0.05. RESULTADOS: A incidência de SC foi de 21/1000 nascidos vivos (NV) aumentando entre os periodos de 18,5/1000 NV para 23,5 /1000 NV. A idade média materna foi de 24 anos (30% adolescentes), a maioria... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

Introdução: Adiponectina e leptina são produzidas no ambiente intrauterino, e estão envolvidas no crescimento fetal. Contudo, poucos estudos apresentaram dados de níveis de adiponectina e leptina comparando recém-nascidos (RN) pequenos e adequados para idade gestacional, prematuros de muito baixo peso e a termo. Objetivo: Comparar níveis de adiponectina e leptina em sangue de cordão umbilical de recém-nascidos prematuros muito baixo peso (MBP) e recém-nascidos a termo, e determinar sua relação com peso ao nascer (PN) e ser pequeno (PIG) ou adequado (AIG) para idade gestacional. Métodos: Estudo transversal com recém-nascidos prematuros de muito baixo peso (MBP), com idade gestacional <32 semanas e peso ao nascer <1500g, e recém-nascidos a termo com idade gestacional >37 semanas, nascidos em um hospital terciário, no período de Janeiro de 2010 à Maio de 2011. Critérios de exclusão: presença de malformações congênitas maiores, erros inatos do metabolismo, anomalias cromossômicas. Níveis de adiponectina e leptina em sangue de cordão umbilical foram determinados por enzimoimunoensaio com kit ELISA (R&D Systems). O estudo foi aprovado pelo comitê de ética e pesquisa da instituição sob número (09460). Empregados teste t de Student, Mann-Whitney e regressão linear, e aceito nível de significância p<0.05. Resultados: Ao todo foram estudados 127 recém-nascidos, 55 RNPTMBP e 72 a termo. Gênero, diabetes gestacional, infeção do trato urinário, idade e IMC maternos foram similares em ambos os grupos. Os níveis de adiponectina foram significativamente mais baixo nos recém-nascidos pré-termo do que nos recém-nascidos a termo: 1.57±0.74pg/mL versus 2.4±0.22pg/mL (p<0.001), respectivamente. Os níveis de leptina foram similares entre os grupos: 1.25±0.90pg/mL e 1.38±0.99pg/mL (p=0,481) nos recém-nascidos a termo e prematuros respectivamente. Independente de serem adequados ou pequenos para idade gestacional, RNPTMBP apresentaram níveis de adiponectina mais baixos (p<0,001). Os níveis de leptina e insulina foram similares em ambos os grupos, independentemente de serem AIG ou PIG. Na regressão linear com adiponectina como variável dependente, apenas prematuridade foi estatisticamente significativo. Conclusão: Prematuridade é o principal fator determinante para os baixos níveis de adiponectina em sangue de cordão umbilical em recém-nascidos. / Background: Adiponectin and leptin are produced in the intrauterine environment and are involved in fetal growth. However, few studies present data on adiponectin and leptin leves comparing adequate and small for gestational age very low birth weight preterm newborns. Aim: Compare the levels of adiponectin and leptin in cord blood of full term newborns and very low birth weight preterm, and determine its relation with birth weight and being small for gestational age. Methods: Cross sectional study with cord blood adipocytokines dosage in very low birth weight preterm (VLBW), with gestational age (GA) ≤32 weeks and birth weight ≤1500 grams, full term newborns, with GA ≥37 weeks, born at tertiary hospital between January 2010 and May 2011. Exclusion criteria were presence of major congenital malformation, metabolism innate errors, chromosomal anomalies. All includes newborn had a protocol filled with maternal and neonatal data. Adiponectin and leptin levels were determined by ELISA kits (R & D Systems). The study protocol was approved by the institutional review boards and hospital’s ethics committee under the number 09-460. Applied student T test, Mann- Whitney and linear regression. Accepted p <0,05 as significant level. Results: Included 127 newborns, being 55 VLBW preterm and 72 full term. There were no statistic difference regarding gender, maternal gestational diabetes, urinary tract infection, age and BMI. Adiponectin levels were significantly lower in preterm than in full term newborns (1.57±0.74 pg/mL versus 2.4±0.22pg/mL (p<0,001), respectively. Leptin levels were similar in both groups: 1.25 ±0.90pg/mL in full term infants and e 1.38±0.99pg/mL in preterm (p=0,481). When we evaluate adequacy for gestational age inside groups, despite being adequate or small for gestational age, VLBW preterm showed lower levels of adiponectin (p<0,001) and again, there was no statistically significant difference for leptin levels. In the linear regression, prematurity was the only independent variable associated to the low levels of adiponectin (p <0,001). Conclusion: our data suggests that been born prematurely is the main determinant factor for adiponectin levels in umbilical cord of newborns. It’s important to know perinatal factors that may interfere in the secretion of adipocytokines so that it’s possible to develop preventive strategies of metabolic syndrome, not only in adulthood but also in early childhood.

Trata-se de um estudo de seguimento, que reporta a prevalÃncia de perda auditiva em recÃm-nascidos de alto risco, realizado na Maternidade Escola Assis Chateaubriand, no perÃodo de janeiro de 1993 a junho de 1995. Foram incluÃdos na amostra 600 recÃm-nascidos de baixo peso, com um ou mais fatores de risco para perda auditiva. A distribuiÃÃo, de acordo com variÃveis sÃcio-demogrÃficas, revela alta proporÃÃo de mÃes jovens e com baixo nÃvel de escolaridade. Em relaÃÃo à histÃria familiar, registraram-se 43 casos de histÃria de deficiÃncia auditiva na famÃlia. Quanto Ãs caracterÃsticas gestacionais, 33,5% dos casos pesquisados eram recÃm-nascidos de primigestas. No que se refere a doenÃas e/ou intercorrÃncias gravÃdicas, foram detectados 13 (2,2%) casos de rubÃola. Em relaÃÃo a caracterÃsticas do parto e nascimento, 73,3.% dos casos eram prÃ-termo, com mÃdia de 34 semanas gestacionais. Com relaÃÃo Ãs caracterÃsticas de saÃde e morbidade durante o internamento, foram administrados antibiÃticos aminoglicosÃdeos a 360 crianÃas (60,0%); a hiperbilirrubinemia acometeu 257 crianÃas (42,8%), a anoxia severa esteve presente em 158 casos (263%), infecÃÃes congÃnitas perinatais foram registradas em 25 (4,2%) casos e meningite bacteriana em 7 (1,2%) casos. A avaliaÃÃo da audiÃÃo atravÃs do âScreening Instrumentalâ e imitanciometria, foi realizada em 403 crianÃas. Cento e noventa e sete (32,8%), ficaram sem diagnÃstico, pois abandonaram o acompanhamento. O restante, trezentas e sessenta e cinco crianÃas apresentaram audiÃÃo normal, 20 (5,0%) perda auditiva neurossensorial e 18 (4,5%) perda auditiva condutiva. / This study reports on the prevalence of hearing loss among 600 lowbirthweigth infants born between January 1993 and December 1994 in major obstetric hospital (Maternidade Escola Assis Chateaubriand) in Fortaleza, Ceara, Brazil. Neonates were recruited soon after birth and followed up to the age of six month. The majority of infantsâ mothers were young and had low level of education. About 7,2% of mothers had family history of hearing loss and 33,5% were first time pregnant. Thirteen percent of women did not attend antenatal consultations and 19,7% reported illnesses or complication during pregnancy including rubeola (2,2%). Most of newborns (73,3%) were premature and during the hospital stay, 60,0% were exposed to ototoxic drugs, 42,8% presented with hyperbilirubinemia, 26,3% had severe hypoxia and 1,2% were diagnosed bacterial meningitis. Screening and imitanciomatry tests were carried out in 403 children and 20 (5,0%) cases of sensorineural hearing loss and 18 (4,5%) cases of conductive hearing loss were identified.

Introdução: Adiponectina e leptina são produzidas no ambiente intrauterino, e estão envolvidas no crescimento fetal. Contudo, poucos estudos apresentaram dados de níveis de adiponectina e leptina comparando recém-nascidos (RN) pequenos e adequados para idade gestacional, prematuros de muito baixo peso e a termo. Objetivo: Comparar níveis de adiponectina e leptina em sangue de cordão umbilical de recém-nascidos prematuros muito baixo peso (MBP) e recém-nascidos a termo, e determinar sua relação com peso ao nascer (PN) e ser pequeno (PIG) ou adequado (AIG) para idade gestacional. Métodos: Estudo transversal com recém-nascidos prematuros de muito baixo peso (MBP), com idade gestacional <32 semanas e peso ao nascer <1500g, e recém-nascidos a termo com idade gestacional >37 semanas, nascidos em um hospital terciário, no período de Janeiro de 2010 à Maio de 2011. Critérios de exclusão: presença de malformações congênitas maiores, erros inatos do metabolismo, anomalias cromossômicas. Níveis de adiponectina e leptina em sangue de cordão umbilical foram determinados por enzimoimunoensaio com kit ELISA (R&D Systems). O estudo foi aprovado pelo comitê de ética e pesquisa da instituição sob número (09460). Empregados teste t de Student, Mann-Whitney e regressão linear, e aceito nível de significância p<0.05. Resultados: Ao todo foram estudados 127 recém-nascidos, 55 RNPTMBP e 72 a termo. Gênero, diabetes gestacional, infeção do trato urinário, idade e IMC maternos foram similares em ambos os grupos. Os níveis de adiponectina foram significativamente mais baixo nos recém-nascidos pré-termo do que nos recém-nascidos a termo: 1.57±0.74pg/mL versus 2.4±0.22pg/mL (p<0.001), respectivamente. Os níveis de leptina foram similares entre os grupos: 1.25±0.90pg/mL e 1.38±0.99pg/mL (p=0,481) nos recém-nascidos a termo e prematuros respectivamente. Independente de serem adequados ou pequenos para idade gestacional, RNPTMBP apresentaram níveis de adiponectina mais baixos (p<0,001). Os níveis de leptina e insulina foram similares em ambos os grupos, independentemente de serem AIG ou PIG. Na regressão linear com adiponectina como variável dependente, apenas prematuridade foi estatisticamente significativo. Conclusão: Prematuridade é o principal fator determinante para os baixos níveis de adiponectina em sangue de cordão umbilical em recém-nascidos. / Background: Adiponectin and leptin are produced in the intrauterine environment and are involved in fetal growth. However, few studies present data on adiponectin and leptin leves comparing adequate and small for gestational age very low birth weight preterm newborns. Aim: Compare the levels of adiponectin and leptin in cord blood of full term newborns and very low birth weight preterm, and determine its relation with birth weight and being small for gestational age. Methods: Cross sectional study with cord blood adipocytokines dosage in very low birth weight preterm (VLBW), with gestational age (GA) ≤32 weeks and birth weight ≤1500 grams, full term newborns, with GA ≥37 weeks, born at tertiary hospital between January 2010 and May 2011. Exclusion criteria were presence of major congenital malformation, metabolism innate errors, chromosomal anomalies. All includes newborn had a protocol filled with maternal and neonatal data. Adiponectin and leptin levels were determined by ELISA kits (R & D Systems). The study protocol was approved by the institutional review boards and hospital’s ethics committee under the number 09-460. Applied student T test, Mann- Whitney and linear regression. Accepted p <0,05 as significant level. Results: Included 127 newborns, being 55 VLBW preterm and 72 full term. There were no statistic difference regarding gender, maternal gestational diabetes, urinary tract infection, age and BMI. Adiponectin levels were significantly lower in preterm than in full term newborns (1.57±0.74 pg/mL versus 2.4±0.22pg/mL (p<0,001), respectively. Leptin levels were similar in both groups: 1.25 ±0.90pg/mL in full term infants and e 1.38±0.99pg/mL in preterm (p=0,481). When we evaluate adequacy for gestational age inside groups, despite being adequate or small for gestational age, VLBW preterm showed lower levels of adiponectin (p<0,001) and again, there was no statistically significant difference for leptin levels. In the linear regression, prematurity was the only independent variable associated to the low levels of adiponectin (p <0,001). Conclusion: our data suggests that been born prematurely is the main determinant factor for adiponectin levels in umbilical cord of newborns. It’s important to know perinatal factors that may interfere in the secretion of adipocytokines so that it’s possible to develop preventive strategies of metabolic syndrome, not only in adulthood but also in early childhood.

Orientador: Maria Cecilia Marconi Pinheiro Lima / Dissertação (mestrado) - Universidade Estadual de Campinas. Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-15T07:49:03Z (GMT). No. of bitstreams: 1 Loures_EdianaCristinaRoquette_M.pdf: 617893 bytes, checksum: b28556fb2b263ae6e97a8a40a7bf0509 (MD5) Previous issue date: 2009 / Resumo: O objetivo deste estudo foi descrever e analisar as ações de fonoaudiologia em um centro de referência em desenvolvimento infantil da Região Metropolitana de Campinas, no acompanhamento de lactentes egressos da Unidade de Terapia Intensiva Neonatal alimentados por mamadeira. Estudo de caso observacional, longitudinal, retrospectivo. Foram reunidas, descritas e analisadas as informações coletadas por meio de revisão de prontuário sobre as ações de Fonoaudiologia utilizadas na correção da técnica de alimentação por mamadeira para análise quantitativa do tipo descritiva e análise qualitativa. As variáveis estudadas foram: técnicas utilizadas pela mãe durante o aleitamento, tipos de recipientes de mamadeira para oferecer leite ao bebê, bico da mamadeira, avaliação da fonoaudiologia e condutas da fonoaudiologia no momento da consulta. Onze sujeitos completavam os critérios de inclusão: estavam em uso de mamadeira, as primeiras três consultas consecutivas de fonoaudiologia foram realizadas antes de o lactente completar 6 meses e 29 dias de idade cronológica e, posteriormente, tiveram alta do serviço. A análise estatística confirmou que as variáveis Avaliação e Conduta Fonoaudiológicas apresentaram nível de significância nos itens: utensílios (bico e mamadeira) e desconforto. Observou-se, nesta pesquisa, que a tomada de decisão em serviço sobre uso de mamadeira, adequação do bico e correção do posicionamento corporal do lactente durante e após as mamadas perdurou nas ações do fonoaudiólogo ao longo das consultas / Abstract: The objective of this study was to describe and analyze the actions of speech therapy in a reference center for child development in the Metropolitan Region of Campinas, which was part of monitoring bottle-fed infants who were discharged from the Newborn Intensive Care Unit. Observational, longitudinal, retrospective case study. We gathered, described and analyzed the information collected by means of a medical chart review that focused on speech therapy actions applied to correct the bottle-feeding technique and carried out both a quantitative analysis of the descriptive type, as well as a qualitative analysis. The variables studied included: techniques used by the mother during breast-feeding, types of bottles used to feed the baby, bottle nipple, speech therapy assessment and ways of conducting speech therapy during consultations. Eleven subjects met the inclusion criteria: they were bottle-fed, the first three consecutive speech therapy consultations had been held before the infant had reached the age of 6 months and 29 days, and they had been discharged from the service. Statistical analysis confirmed that the variables Evaluation and Speech Therapy Conduct showed a level of significance regarding the items: appliances (nozzle and bottle) and discomfort. In this research, we observed that the decisionmaking during service on bottle feeding, nipple adjustment, and infant body posture correction during and after the feedings persisted in the actions of the speech therapist throughout the consultations / Mestrado / Saude, Interdisciplinaridade e Reabilitação / Mestre em Saúde, Interdisciplinaridade e Reabilitação

Este estudo teve como objetivo descrever o perfil e o padrÃo de prÃticas assistenciais de recÃm-nascidos com distÃrbios respiratÃrios, internados nas unidades de terapia intensiva em Fortaleza e analisar fatores associados ao Ãbito em recÃm-nascidos de muito baixo peso com SÃndrome do Desconforto RespiratÃrio. Trata-se de um estudo de coorte prospectiva de base hospitalar, realizado em 773 recÃm-nascidos em cinco hospitais, de julho a dezembro de 2007. Foram duas etapas uma descritiva e a outra, analÃtica. A maioria era prÃ-termo (80,7%). Entre o primeiro e quinto minuto, houve queda no Apgar de 4-6 e melhora no Apgar maior do que 7. A SÃndrome do Desconforto RespiratÃrio foi a patologia mais freqÃente (73%). Dos recÃm-nascidos de muito baixo peso 62,7% estavam sob ventilaÃÃo mecÃnica, 53,7%, surfactante e 19,9% foram a Ãbito. Os fatores de risco para Ãbito identificados pela anÃlise bivariada e nÃvel de significÃncia de 5% foram a idade materna < 20 anos (p=0,008), Apgar de quinto minuto < 7 (p<0,001), o uso de ventilaÃÃo com pressÃo positiva na sala de parto (p< 0,001), intubaÃÃo na sala de parto (p< 0,001) e o uso de surfactante (p<0,001). O uso de corticÃide antenatal assim como o uso de surfactante foi baixo. Os recÃm-nascidos com peso menor que 1500g necessitaram de maior suporte terapÃutico e tiveram mais elevada taxa de Ãbito. Esse cenÃrio demonstra a necessidade de melhorias na assistÃncia prà e perinatal e particularmente aos recÃm-nascidos de muito baixo peso. / The objectives of this study was to describe the profile and the standards of medical care in newborns with respiratory disorders admitted to intensive care units as well as analyze the risk factors associated to the death in low birth weight newborn with respiratory distress syndrome. It is a prospective cohort study hospitalar-based realized in 773 newborns in five hospitals from July and December 2007. Was two phases a described and the other, analytical. The majotity were premature (80.7%). Between the first and the fifth minute, the number of newborns with Apgar less than 3 decreased and the ones with Apgar above or equal to 7 increased. Respiratory distress syndrome was the most frequent disease (73%). For the newborns with very low weight and respiratory distress syndrome, 62.7% used mechanical ventilation, 53.7% surfactant and 19.9% died. The risk factors for death according to the bivariate analysis were: mother`s age less than 20 years (p=0.008), Apgar less than 7 in the fifth minute (p<0.001), the use of positive pressure ventilation in the delivery room (p<0.001), intubation in the delivery room (p<0,001) and the use of surfactant (p<0.001).The use of antenatal corticosteroids and use of surfactant was low. The newborns weighing less than 1500g needed more medical assistance than others and still presented a high death rate. According to the study, the respiratory disorders of the newborns and the outcome are strongly related to the prenatal factors, to the assistance in the delivery room and to the intensive care.

The quantification of skeletal data is one way in which to demonstrate variation in human growth. In South Africa, few researchers have assessed patterns of growth in immature mandibles. The purpose of this study was to evaluate growth and sexual dimorphism in the mandible from the period of 31 gestational weeks to 36 months. A total of 74 mandibles were used, skeletal tissues were sourced from the Raymond A. Dart Collection (University of Witwatersrand), and cadaveric remains were obtained from the University of Pretoria and the University of Witwatersrand. The sources of cadaver materials (both bequeathment and unclaimed remains) included local provincial hospitals. The sample was divided into four groups, namely 31 to 40 gestational weeks (group1), 0 to 11 months (group 2), 12 to 24 months (group 3), and 25 to 36 months (group 4). Twenty-one osteological landmarks were digitized using a MicroScribe G2. Ten standard measurements were created and included: the longest length of mandible, mandibular body length and width, mandibular notch width and depth, mental foramen to inferior border of mandible, mandibular basilar widths bigonial and biantegonial, bigonial width of mental foramen and mental angle. Data were analyzed using PAST statistical software and Morphologika2 v2.5. For the linear measurements, no statistically significant difference between either the foetal and up to 12 month groups or the 2 to 3 years groups. However, statistically significant increases with age were noted between 12 and 24 months for nine variables. This can be associated with growth of the mandibular arch, development and eruption of the dentition and development of the masticatory structures. No evidence of sexual dimorphism was observed until age 3, where the mental angle and mandibular notch were significantly larger in females than males. In conclusion, the mandible develops and grows so as to accommodate development of the tongue, mastication and dental eruption. Future research that considers the influence of secular trends on mandibular growth is needed. AFRIKAANS : Die kwantifisering van skeletale data is ‘n betroubare metode om variasie in menslike groei aan te toon. Slegs enkele Suid-Afrikaanse navorsers, het groeipatrone in onvolwasse mandibulae nagevors. Die doel van hierdie studie was om groei en geslagsdimorfisme in die mandibula vanaf 31 gestasie weke tot 36 maande na geboorte te evalueer. ‘n Totaal van 74 mandibulae was gebruik. Skeletale weefsel uit die Raymond A. Dart Versameling (Universiteit van die Witwatersrand), en kadaweroorskot van die Universiteite van Pretoria en van die Witwatersrand was verkry. Die oorsprong van kadawermateriale (beide skenkings en onopgeëisde oorskot) het plaaslike provinsiale hospitale ingesluit. Die steekproef was verdeel in vier groepe, naamlik 31 to 40 gestasie weke (groep1), 0 tot 11 maande (groep 2), 12 tot 24 maande (groep 3), en 25 tot 36 maande (groep 4). MicroScribe, G2 is aangewend om 21 standaard antropometriese landmerke te digitiseer. Hieruit is 10 standaard antropometriese afmetings geskep o.a.: langste lengte van mandibula, lengte en breedte van corpus mandibula, afstand tussen foramen mentalis en inferior grens, basale wydte bigoniaal en biantegoniaal, bigoniale wydte van foramen mentalis asook mentale hoek. Inligting is d.m.v. PAST statistiese sagteware en Morphologika2 v2.5 ontleed. Volgens die Kruskal-Wallis-toets was die verskille tussen groepe 1 en 2, asook 3 en 4 statisties onbeduidend. Alle afmetings by groepe 2 en 3 het beduidende toenames getoon, behalwe dié van die afstand tussen foramen mentalis en inferior grens. Die veranderings mag die gevolg wees van die groei van die mandibula en koustrukture. Geslagsdimorfisme was aantoonbaar in groep 4, by die mentale hoeke (p=0.03) asook dimensies van die incisura mandibularis (p=0.0006), waar dié van vroulike individue groter was. Voor geboorte vergroot die arcus mandibularis om die ontwikkelende tong te huisves, terwyl dit na geboorte verander om die koustrukture te huisves. Gevolglik hermodelleer en groei die been as aanpassing vir die kouproses en om strukturele integreteit te behou. Geslagsdimorfisme word ook beïnvloed deur die kouproses. Die meeste veranderinge, veral dié van die koustrukture, was duideliker in vroulike individue. Toekomstige navorsing wat die invloed van sekulêre tendense op die groei van die mandibula oorweeg, is nodig. / Dissertation (MSc)--University of Pretoria, 2011. / Anatomy / unrestricted

La locomotion autonome est une étape clef du développement du nourrisson. Elle débute dans la majorité des cas par la marche quadrupède au deuxième semestre de vie. Cependant, dès la naissance, le nouveau-né est déjà capable de se propulser de manière autonome en position ventrale. Cette mobilité quadrupède précoce a été très peu étudiée, car considérée par la plupart des auteurs comme un simple réflexe de reptation, destiné à disparaître rapidement sous l'influence du développement cortical : cette reptation n'aurait aucun lien avec la marche mature, n'impliquerait pas les bras et aurait pour fonction principale de permettre au nouveau-né de se propulser jusqu'au sein maternel. Contrairement à ce point de vue, quelques auteurs ont observé que cette mobilité semblait complexe et pouvait éventuellement persister jusqu'à l'âge de 2-3 mois, dans un contexte adapté. Ces observations posent la question de savoir si cette mobilité primitive, loin d'être un simple réflexe, pourrait être en lien avec la marche quadrupède et bipède mature. L'objectif de cette thèse est d'étudier les différentes caractéristiques, en particulier cinématiques, de cette mobilité quadrupède depuis la naissance jusqu'au sixième mois. Dans ce but, un dispositif a été créé, le CrawliSkate, qui permet de libérer les bras et faciliter la propulsion. Trois études ont été menées et montrent que cette mobilité quadrupède est loin d'être un simple réflexe stéréotypé, qu'elle implique une coordination des jambes et des bras, qu'elle peut en partie être modifiée dès la naissance à un niveau supra spinal par la vision et enfin qu'elle persiste tout en se modifiant durant tout le premier semestre de la vie. / Self-produced locomotion is a key stage in infant development, which usually begins with hand and knees crawling in the second semester of life. Since the moment of birth, however, newborns are already capable of autonomous propulsion from a prone position. This precocious form of quadrupedalism remains largely unstudied due in part to the fact that most researchers consider these creeping movements to constitute a mere reflex, destined dissipate as cortical development progresses. Under such an interpretation, this creeping « reflex » would have no link with mature, bipedal walking, would not recruit the upper limbs and would serve mainly as a mechanism by which newborns could reach the maternal breast. Contrary to this point of view, a handful of authors have observed that these patterns of locomotion seem complex, and might persist in some form until the age of 2-3 months. These observations invite us to consider the possibility that such primitive locomotion might be directly involved in the emergence of quadrupedal and bipedal gait. The present thesis examines the various characteristics (particularly cinematic) of this prone mobility, from birth to about six months of age. To this end, we describe the creation of an experimental tool that frees the use of a newborn's limbs and facilitates the aforementioned form of propulsion: the CrawliSkate. We present three studies showing that neonatal prone mobility goes beyond simple reflexes, involves coordination between the upper and lower limbs, and can be partially modified at birth at a supra-spinal level through visual stimulation. Lastly, we demonstrate that this pattern of locomotion persists, albeit with heavy modification, throughout the first semester of life.