Thesis MSc.(Med)(Virology)-- University of Limpopo, 2011 / Background: Intraventricular hemorrhage (IVH) is a known complication occurring in the first week of life in premature neonates. The exact time of its occurrence and the ideal time to perform diagnostic imaging investigation remain controversial. Objectives: 1. To determine the incidence of intraventicular hemorrhage in premature babies at Dr George Mukhari Hospital, Pretoria. 2. To determine the timing at which bleeding occurs. 3. To determine if the rate of diagnosing intraventicular hemorrhage improves when performing ultrasound via the posterior fontanelle. 4. To determine the risk factors for intraventricular haemorrhage Materials and methods: The study included 60 premature babies of gestational age of less than 32 weeks that were admitted to our neonatal Intensive Care Unit over a two months period and screened for IVH. They were grouped into three categories according to their weight at birth, and according to their gestational age. All babies had a cranial ultrasound on day 1, 3 and 7. Results: We found that the overall incidence of IVH among premature babies was 28%. Although it did not reach statistical significance, the incidence was found to be inversely related to the birth weight and gestational age. The majority of the bleeds occurred within the first day of life and were mostly grade I and II according to Papile’s classification. The use of inotropes was found to be significantly associated with development of IVH. We also found that scanning through the posterior fontanelle did not significantly increase the rate of diagnosis for IVH.

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MSc Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, 2009. / As the medical world advances, there is an ever increasing survival rate of children that are born prematurely and of a low birth weight. For this reason more and more research is being done to investigate the consequences of being born pre-term and underweight. Research has shown that children who are born prematurely may show signs of developmental delay later on in life (Johnson, 2007). Motor development has been shown to be more affected by prematurity than any other causative factor of prematurity (Goyen and Lui, 2002). The main aim of the study was to establish the differences in global development between pre-term and full-term infants at eighteen months. The Bayley Scales of Infant Development II (BSID II) were used to determine performance in both the pre-term and the full-term group. These results were statistically analysed in greater detail in the mental and the motor section. The Mental and Psychomotor Developmental Indices (MDI and PDI) of the BSID II were used to determine the extent of the mental and motor delays in this sample. The Household Economic and Social Status Index (HESSI) was used in order to ascertain if the socioeconomic status of a family had any bearing on the development of the child in both the mental and the motor categories. This was statistically analysed. The socio-economic factors assessed in this study did not show any statistical significance but did confirm that these children come from similar backgrounds. The results of this study showed that there is a delay in the pre-term group when compared with the full-term group. The mean MDI for the full-term group was 105.25, this is compared with the pre-term group of 81.9, which is statistically significant (p<0.001). The PDI for the full-term group showed a mean score of 109.6. The mean score for the pre-term group was 86.8. This also showed a statistical significance (p<0.001). The pre-term infants in this study showed a significant delay both in the mental and the motor domains. The cognitive delays may be linked to an under-developed corpus callosum due to the premature birth. The motor delays may be caused due to a decreased motor control and developmental dyspraxia. Infants that are born prematurely are at a higher risk to suffer from developmental delays in the cognitive, language and the motor developmental domains. This study confirms what has been found in previous studies showing cognitive development to be the developmental domain most affected by prematurity. The results of this study are important as they support policy change to ensure that these children are followed-up to allow the at-risk children to reach their full potential.

MS(Med), Child Health: Neurodevelopment, Faculty of Health Sciences, University of the Witwatersrand / Background: ELBW preterm infants are at extremely high risk for adverse neurodevelopmental (ND) outcome. Systemic hypotension is an important peri-natal risk factor in neurodevelopmental outcome. Numerous other risk factors exist for adverse neurodevelopmental outcome. Aim: To assess whether early mean systemic blood pressure and other risk factors contribute to poor ND outcome in ELBW preterm infants managed at Panorama Medi-Clinic. Methods: A retrospective, analytical study using data obtained from 2003 to 2008. Data from the Vermont Oxford Network database of which Panorama Medi-Clinic is a member was used to select a cohort of inborn, surviving infants weighing ≤ 1000g or ≤ 30 weeks gestational age. Early mean systemic BP records were obtained from nursing records. ND data was obtained from the neurodevelopmental clinic or routine follow up clinics notes. Infants with major defects at birth were excluded. The cohort was classified according to their general developmental quotient and whether or not they had signs of cerebral palsy into a normal or abnormal neurodevelopmental group. All patients remained completely anonymous and ethical clearance was obtained from the ethics committee at Panorama Medi- Clinic. P a g e | VII Results: 82 infants were eligible. 78 were entered the study. 4 were lost to follow up. Average birth weight was 782.1g ± 148.23. Average gestational age was 27.06w ± 1.32. Normal neurodevelopmental outcome was found in 64(82%). An abnormal neurodevelopmental outcome was found in 14(18%). No statistically significant difference was found by logistical regression when mean systemic blood was compared between normal and abnormal neurodevelopmental groups. If a cut off BP of <30 mm Hg, or inotropic agents were administered, no statistical difference was found between the normal and abnormal groups. Severe grades of IVH, ROP, post-natal steroids, and chronic lung disease, and gastro-intestinal perforation, were identified as risk factor of adverse outcome

Thesis (MPH.) -- University of Limpopo, 2018 / Background: Pregnant women expect a normal pregnancy, a normal delivery and a healthy baby. Unfortunately, premature birth is a common occurrence; ithas some complications and causes death in developing countries. Mothers feel disappointed for not carrying their pregnancies to term and worry about the survival of their babies. Admission into neonatal intensive care unit increases chances of baby survival but has emotional impact on mothers, thus the need to explore their experiences. Objective: To explore the lived experiences of mothers regarding their first exposure to their premature babies admitted in neonatal intensive care unit. Methods: A qualitative and exploratory study using semi-structured interviews with purposively selected mothers was conducted. Interviews were conducted in English using an interview guide, audio recorded and continued until data saturation was reached, thus 8 mothers participated in the study. Field notes were collected. Voice recordings were transcribed verbatim and analysed thematically. An independent coder confirmed the findings. Results: Mothers experienced stress and anxiety, and felt neglected by health care workers. They felt the focus was on the baby alone and the mothers’ needs ignored, though others were happy that they were welcomed. Conclusions: Therefore, parents need support when their premature babies are admitted in neonatal an intensive care unit. Continuous update on conditions of their babies is also necessary. / AMREF Health Africa, and Limpopo Department of Health

Thesis (Ph.D.)--University of Western Australia, 2008.

Respiratory distress syndrome is the major cause of mortality in premature babies. Increasing numbers of neonates are now surviving the disease due to advances in techniques used in neonatal intensive care units. Mechanical ventilation is an essential part of the treatment for respiratory distress syndrome and is an area in which improvements and modifications are constantly being made. In the early 1980's a new infant ventilator was introduced involving ventilation by a distal jet. As yet, the mechanisms by which the distal jet ventilator enhances gas exchange are unknown. Original experiments are carried out to record the attenuation and speeds of the pressure wave produced by the distal jet ventilator. The observed changes in wave shape and the high wave speed imply that the ventilator produces waves operating within an acoustic regime. An understanding of the gas exchange mechanisms active in shock assisted ventilation is initiated by a comprehensive investigation of the transport properties of acoustic waves. The advection and diffusion that result from a linear concentration gradient in an acoustic flow are analysed, from the Eulerian and Lagrangian viewpoints. The Eulerian investigation shows that the total flux of tracer through a given pipe can be optimized by choosing the frequency appropriately. The Lagrangian transport is increased as both frequency and radius increase. For all values of parameters, Lagrangian streaming is observed, with a steady net flow in the pipe core away from the tube entrance and an opposing net flow near the tube walls.

As the capacity for saving smaller and smaller infants increases, the ethical dilemmas experienced by neonatal nurses who care for the smallest and most fragile of human beings will also increase. The current approaches to the resuscitation and management of extremely premature infants (24 weeks gestation and less) has resulted in the survival of infants with far less than optimal outcome. Neonatal nurses have begun to question saving the lives of extremely premature infants just because the technology exists to do so. This study explores the ethical issues faced by neonatal nurses caring for infants of 24 weeks gestation and less. The research question arose out of the need for neonatal nurses to articulate the ethical issues that they face in clinical practice when caring for extremely premature infants. The study design takes a dual approach to the research question, namely, a survey questionnaire and a qualitative analysis informed by phenomenology. Given the complexities of the issues within the topic, this combination of methods was deemed to be the most appropriate in gaining a convincing and authentic result. The results of this research are not generalisable to the experience of other nurses, or nurses caring for other groups of premature infants. In the first stage of the study neonatal nurses, members of the Australian Association of Neonatal Nurses (ANNA), were surveyed using a self-completion questionnaire. Then, in the qualitative component of this study fourteen (14) interviews with neonatal nurses were undertaken. These were either single or focus group interviews. In all, twenty four neonatal nurses from the state of New South Wales (NSW) and the Australian Capital Territory (ACT) were interviewed about their experiences of caring for infants of 24 weeks gestation and less. The questions asked during the interviews were based on findings from the questionnaire. The interview data was analysed using a qualitative approach informed by interpretative phenomenology. The qualitative analysis revealed that the ethical dilemmas faced by the nurses existed within four themes. The four themes are: • It’s all about this baby • Having a voice • Dealing with awfulness • Reflecting on the outcome. The qualitative description as given in the four themes reveals structures and meanings about what it is to be the neonatal nurse who experiences ethical dilemmas when caring for extremely premature infants. The study and its findings are a written account of the experiences of neonatal nurses and their ethical dilemmas in caring for infants of 24 weeks gestation and less. The meanings within the nurses’ experiences are offered and the final phenomenological description, Balancing hope with reality, is given. Hope has a buffering effect on the nurses. The nurses inspire and instil hope in themselves and a baby’s parents until the reality of a poor outcome dawns. Each time an extremely premature baby is born the nurses are hopeful for a good outcome, but the reality is that they have experienced many instances in which babies die or have a poor outcome. The neonatal nurses, affected by their experiences of ethical distress, attempted to find a pathway to achieve a balance between their emotions and caring for the baby. In doing so the nurses were able to remain productive the neonatal intensive care unit, and give high quality care to the baby and compassion to the parents. This study makes an important contribution to neonatal nursing knowledge and practice by exploring the ethical dilemmas and complexities associated with extremely premature infants. This study also makes a unique contribution to the body of literature on ethical dilemmas experienced by neonatal nurses.