No caso de um nascimento prematuro, uma vez que a gravidez é interrompida, o recém-nascido não corresponde ao bebê idealizado na gravidez e na maioria das vezes, não tem condições físicas de viver fora do útero sem ajuda da tecnologia médica. Os pais experimentam situações estressantes, o que afeta suas percepções e habilidades para interagir com a criança, dificultando o estabelecimento de um apego íntimo. Assim, é necessário que a mãe e a família tenham no hospital um ambiente acolhedor para poder receber e proteger seu bebê, amenizando os efeitos desta interrupção. Este estudo tem por objetivo compreender os significados atribuídos ao nascimento e internação de um bebê pré-termo e de muito baixo peso na perspectiva dos pais. Foram entrevistados cinco pais e cinco mães de bebês pré-termo de muito baixo peso que coabitavam o mesmo teto e que tinham, no momento das entrevistas realizadas, seus bebês internados. Foram realizadas duas entrevistas semi-dirigidas com cada um dos pais; uma logo após o nascimento e outra após um mês de internação. As entrevistas foram audiogravadas e transcritas na íntegra. Foram selecionadas as entrevistas de um casal para aprofundar a análise através do estudo de caso. O trabalho teve um enfoque qualitativo a partir do referencial psicanalítico de D. Winnicott. Na análise do caso foram abordados aspectos das condições emocionais da mãe e do pai em relação ao nascimento de uma bebê prematura, a relação que cada cuidador estabeleceu com a equipe do hospital, as fantasias em relação aos futuros cuidados à bebê e as vivências desenvolvidas como esposa e mãe; marido e pai. No presente estudo são apresentadas dificuldades dos pais que vão além do luto por estarem diante de seu filho que nasceu prematuro. Os pais são envolvidos por uma situação de muita ansiedade que faz brotar antigas feridas internas de suas histórias, além de outras nuances que só podem ser entendidas e vivenciadas se os profissionais estiverem abertos emocionalmente ao cuidado dos familiares para acolhê-los de forma integral. Destaca-se assim, a necessidade de se despir de olhares técnicos voltados para a racionalidade científica que não levam em conta a singularidade e a subjetividade presente em cada caso. Trata-se de um olhar mais atento às questões emocionais das relações pais-bebês, para que não se faça do atendimento uma escuta estereotipada baseada em conhecimento pré-estabelecidos que não permitem a fertilidade do contato com o novo e o desconhecido que surge a cada dia em um hospital. Acredita-se que este estudo possa em alguma medida estimular aqueles que pretendem repensar e desenvolver novos sentidos nas práticas do cuidado em saúde. / In the case of a premature birth, once the pregnancy is interrupted, the newly born does not correspond to the idealized baby during the pregnancy and, most of times, does not have physical conditions of living outside the womb without medical help. The parents experiment stressing situations, which affects their perceptions and skills to interact with the child, hindering the establishment of an intimate attachment. Therefore, it is necessary that the mother and the family have in the hospital a welcoming environment to be able to receive and protect their baby, softening the effects of this interruption. This study has by objective to comprehend the meanings assigned to birth and hospitalization of a preterm and very low birth weight baby on the perspective of the parents. It were interviewed five fathers and five mothers of preterm and very low birth weight babies, which cohabited the same roof and had, in the moment of the interviews, their babies hospitalized at a Neonatal Intensive Care Unit (NICU). It were conducted two semi-directed interviews with each parent; one right after the birth and the other one after a month of hospitalization. The interviews were audio recorded and transcribed in full. It were selected the interviews of a couple to deepen the analysis trough the study of case. The work had a qualitative approach from the psychoanalytical reference of D. Winnicott. In the analysis of the case were approached aspects of the mother\'s and the father\'s emotional conditions towards the the birth of a premature child, the relationship each caregiver had established with the hospital staff , the fantasies towards the future cares to the baby and the experiences developed as wife and mother; husband and father. In this study are presented parent\'s difficulties that go beyond the mourning by facing their child that was born premature. The parents are involved in a situation with lots of anxiety that brings back old internal wounds from their own histories, beyond other nuances that can only be understood and lived if the professionals were emotionally opened to family caring, to welcome them integrally. Stands out so the need of undress technical views directed to scientific rationality that does not consider the singularity and the subjectivity of each case. It is about a look more opened to the emotional issues of the parent-babies relationships, so as not to make the treatment a stereotyped hearing based on pre-established knowledge that does not permit the fertility of the contact with the new and the unknown that is brought each day at a Neonatal Intensive Care Unit. It is believed that this study may, somehow, stimulate those who intend to rethink and develop new meanings in health care practices.

Abstract Delivering a preterm baby who is admitted to a neonatal intensive care unit can be an enormous hardship for parents and families, and especially for mothers. The consequences of prematurity alter the parental role, affect their confidence in caring for the baby, and subsequently may impact infant outcomes. Adequately educating mothers of premature babies using an evidence-based practice approach may help them gain the confidence and skills needed to care for their infants. The purpose of this project was to create a tool kit to educate mothers of premature babies about the essential components of caring for their babies, establish content validity of the tool kit among clinical experts, and make recommendations about the use of the tool kit in the neonatal intensive care unit. Polit, Beck, and Owen’s framework was used to establish content validity. Neonatal intensive care nurses who were considered “experts” using Benner’s novice-to-expert theory (n = 7 reviewed the tools which were quantitatively computed and yielded an Item Content Validity Index value range of 0.86 to 1.00, and a Scale Content Validity Index of 0.97, reflecting that the content met the objectives of the toolbox. Positive social change can be realized through use of the tool kit in the neonatal intensive care unit to educate mothers in the care of their preterm babies, thus improving both maternal and infant outcomes.

<p>The aim of this literature review was primarily to describe how the nurse can involve the parents in the care for their premature baby, and secondly to describe the aim, design, method, population and quality of the reviewed studies. Searches have been made in different databases in order to find articles where the search words ”neonatal care”, ”neonatalvård”, ”premature infants” and ”nurse” were included. The literature review was based on 12 scientific articles. The results of the study were divided into six categories; The nursing staff’s relation to the parents, Support group, “Home-early program”, Decision-making, A work in progress and A safe and efficient method. It is the nurse’s task to create a trusting relationship to the parents. The parents’ relationship to the child is a determining factor in its development. Some of the studies described how support groups can be used to help families with premature children. The studies showed that parents want to be involved in making decisions about their baby, but they also find it frightening. There are a lot of ways for the nurse to involve parents in the care for their premature baby. It is very important that the parents get sufficient information, which will enable them to be active when decisions are made about their baby.</p>

The aim of this literature review was primarily to describe how the nurse can involve the parents in the care for their premature baby, and secondly to describe the aim, design, method, population and quality of the reviewed studies. Searches have been made in different databases in order to find articles where the search words ”neonatal care”, ”neonatalvård”, ”premature infants” and ”nurse” were included. The literature review was based on 12 scientific articles. The results of the study were divided into six categories; The nursing staff’s relation to the parents, Support group, “Home-early program”, Decision-making, A work in progress and A safe and efficient method. It is the nurse’s task to create a trusting relationship to the parents. The parents’ relationship to the child is a determining factor in its development. Some of the studies described how support groups can be used to help families with premature children. The studies showed that parents want to be involved in making decisions about their baby, but they also find it frightening. There are a lot of ways for the nurse to involve parents in the care for their premature baby. It is very important that the parents get sufficient information, which will enable them to be active when decisions are made about their baby.

[Truncated abstract] Mothers who deliver prematurely often have a delay in lactogenesis II and subsequent milk supply. Furthermore, due to the inability of their babies to breastfeed immediately after birth, these mothers are 'pump dependent' during both initiation and establishment of lactation. Apparently, there are no evidence based guidelines for the expression regime but some data suggesting that expression regimes for both breasts should be at least five times per day and at least 100 minutes expressing time per day. The project was set out to document the self selected current expression regimes of the preterm mothers from day 10 to 60 postpartum. It defined how various aspects of breast expression, such as frequency and interval, impact on the synthesis and production of milk. In addition, it determined the variations in the composition of preterm mother's milk. The collection of 24hr expression data and milk samples at each expression of each breast, each day, of 25 preterm mothers (<32 gestation age) from the neonatal intensive care unit in King Edward Memorial Hospital, Western Australia on day 10, 15-20, 30, 40, 50 and 60 postpartum showed that during the 'pump dependent' period (day 10 20), the frequency of expression for both breasts was 6, 6-7, 3-9 times per day (median, IQR, range) and total duration with the pump was 115, 80-160, 32-320 minute per day (median, IQR, range). Furthermore, during the 'transition from exclusively expressing to exclusively breastfeeding' period (day 30-60), frequency of expression/breastfeed and total duration of milk removal (both expressing and breastfeeding) for both breasts were 6, 5-7, 1-9 and 135, 75-170, 25-320, respectively (median, IQR, range). ... These nutrients make up the energy content of milk, thus the energy content of milk also varied greatly between mothers. Therefore, milk from individual preterm mothers varies greatly for individual values for fat, total protein, lactose and energy and this should be taken into account when calculating the level of fortification required for individual babies. The results suggest that when fortifying mother's milk, weekly measurement of fat and protein in milk would provide good estimates on which to base fortification requirements. The concentration of sIgA plus lactoferrin formed 32% of the total proteins in breastmilk. However there was large variations in the concentration of sIgA and lactoferrin (median, IQR, range: 0.82, 0.59-1.13, 0.05-2.93g/l and 2.41, 1.52-3.52, 0.04-8.82g/l, respectively) between mothers. Therefore the level of protection provided by these two proteins could differ greatly between babies. Further research on the relationship between the concentration of sIgA and lactoferrin in milk and the onset of infection would indicate the minimum amount of these proteins needed for the babies to benefit from the immune protection provided by their mother's milk. The hourly breast expression method and regression analysis of actual milk yield and interval since previous expression provides information that identifies the potential milk synthesis capacity of the breasts of the mothers and the impact of the interval between expressions on the milk production of the mothers. This information can be applied to individualize the interval between expression regimes to optimise milk production and minimize the demand on the mother. In addition, determining the changes in the milk composition of individual mothers would provide a more precise base to fortify their milk for their preterm babies.

No caso de um nascimento prematuro, uma vez que a gravidez é interrompida, o recém-nascido não corresponde ao bebê idealizado na gravidez e na maioria das vezes, não tem condições físicas de viver fora do útero sem ajuda da tecnologia médica. Os pais experimentam situações estressantes, o que afeta suas percepções e habilidades para interagir com a criança, dificultando o estabelecimento de um apego íntimo. Assim, é necessário que a mãe e a família tenham no hospital um ambiente acolhedor para poder receber e proteger seu bebê, amenizando os efeitos desta interrupção. Este estudo tem por objetivo compreender os significados atribuídos ao nascimento e internação de um bebê pré-termo e de muito baixo peso na perspectiva dos pais. Foram entrevistados cinco pais e cinco mães de bebês pré-termo de muito baixo peso que coabitavam o mesmo teto e que tinham, no momento das entrevistas realizadas, seus bebês internados. Foram realizadas duas entrevistas semi-dirigidas com cada um dos pais; uma logo após o nascimento e outra após um mês de internação. As entrevistas foram audiogravadas e transcritas na íntegra. Foram selecionadas as entrevistas de um casal para aprofundar a análise através do estudo de caso. O trabalho teve um enfoque qualitativo a partir do referencial psicanalítico de D. Winnicott. Na análise do caso foram abordados aspectos das condições emocionais da mãe e do pai em relação ao nascimento de uma bebê prematura, a relação que cada cuidador estabeleceu com a equipe do hospital, as fantasias em relação aos futuros cuidados à bebê e as vivências desenvolvidas como esposa e mãe; marido e pai. No presente estudo são apresentadas dificuldades dos pais que vão além do luto por estarem diante de seu filho que nasceu prematuro. Os pais são envolvidos por uma situação de muita ansiedade que faz brotar antigas feridas internas de suas histórias, além de outras nuances que só podem ser entendidas e vivenciadas se os profissionais estiverem abertos emocionalmente ao cuidado dos familiares para acolhê-los de forma integral. Destaca-se assim, a necessidade de se despir de olhares técnicos voltados para a racionalidade científica que não levam em conta a singularidade e a subjetividade presente em cada caso. Trata-se de um olhar mais atento às questões emocionais das relações pais-bebês, para que não se faça do atendimento uma escuta estereotipada baseada em conhecimento pré-estabelecidos que não permitem a fertilidade do contato com o novo e o desconhecido que surge a cada dia em um hospital. Acredita-se que este estudo possa em alguma medida estimular aqueles que pretendem repensar e desenvolver novos sentidos nas práticas do cuidado em saúde. / In the case of a premature birth, once the pregnancy is interrupted, the newly born does not correspond to the idealized baby during the pregnancy and, most of times, does not have physical conditions of living outside the womb without medical help. The parents experiment stressing situations, which affects their perceptions and skills to interact with the child, hindering the establishment of an intimate attachment. Therefore, it is necessary that the mother and the family have in the hospital a welcoming environment to be able to receive and protect their baby, softening the effects of this interruption. This study has by objective to comprehend the meanings assigned to birth and hospitalization of a preterm and very low birth weight baby on the perspective of the parents. It were interviewed five fathers and five mothers of preterm and very low birth weight babies, which cohabited the same roof and had, in the moment of the interviews, their babies hospitalized at a Neonatal Intensive Care Unit (NICU). It were conducted two semi-directed interviews with each parent; one right after the birth and the other one after a month of hospitalization. The interviews were audio recorded and transcribed in full. It were selected the interviews of a couple to deepen the analysis trough the study of case. The work had a qualitative approach from the psychoanalytical reference of D. Winnicott. In the analysis of the case were approached aspects of the mother\'s and the father\'s emotional conditions towards the the birth of a premature child, the relationship each caregiver had established with the hospital staff , the fantasies towards the future cares to the baby and the experiences developed as wife and mother; husband and father. In this study are presented parent\'s difficulties that go beyond the mourning by facing their child that was born premature. The parents are involved in a situation with lots of anxiety that brings back old internal wounds from their own histories, beyond other nuances that can only be understood and lived if the professionals were emotionally opened to family caring, to welcome them integrally. Stands out so the need of undress technical views directed to scientific rationality that does not consider the singularity and the subjectivity of each case. It is about a look more opened to the emotional issues of the parent-babies relationships, so as not to make the treatment a stereotyped hearing based on pre-established knowledge that does not permit the fertility of the contact with the new and the unknown that is brought each day at a Neonatal Intensive Care Unit. It is believed that this study may, somehow, stimulate those who intend to rethink and develop new meanings in health care practices.

Thesis (MOccTher (Interdisciplinary Health Sciences. Occupational Therapy))--University of Stellenbosch, 2010. / AFRIKAANSE OPSOMMING: AGTERGROND Dit is bekend dat vroeggebore babas met ʼn baie lae geboortemassa ʼn hoër insidensie van ontwikkelings-, gedrags- en mediese agterstande en verskeie leerprobleme toon teen die tyd dat hulle skoolgaande ouderdom bereik. Kommer bestaan ook oor die omgewingseffek van die neonatale intensiewe sorgeenheid op die sensoriese ontwikkeling van die vroeggebore baba en hoe dit tot bogenoemde agterstande kan bydra. Daar is verskillende benaderings wat daarop aanspraak maak dat hulle die probleem kan oplos, met kangaroemoedersorg (‘kangaroo mother care’) en ontwikkelingsorg (‘developmental care’) wat in die literatuur uitgesonder is as besonders belowend. Met die aanvang van hierdie studie was daar nog geen empiriese studies in die literatuur gerapporteer wat enige aansprake van hierdie benaderings bevestig het nie. Daar was dus ʼn behoefte vir ʼn empiries-nagevorsde program wat prakties in die neonatale intensiewe eenheid toegepas kon word met die oog op die vermindering van omgewingstressors ten opsigte van die vroeggebore baba se sensoriese sisteme. DOEL Die doel met die studie was om die invloed te bepaal van ʼn Sensoriese Ontwikkelingsorgprogram (‘Sensory Developmental Care Programme’), wat ʼn spesifieke kangaroemoedersorg- protokol insluit, op die sensoriese ontwikkeling van die vroeggebore baba met 'ʼn baie lae geboortemassa tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). METODOLOGIE ʼn Ewekansig-gekontroleerde studie is uitgevoer. Die studiesteekproef het bestaan uit 89 vroeggebore babas met ʼn baie lae geboortemassa wat in ʼn periode van 24 maande toegelaat is tot die neonatale eenheid van Tygerberg Hospitaal in Kaapstad, Suid-Afrika. Die babas is gewerf op grond van sekere kriteria en is dan daarna ewekansig aan een van twee groepe toegeken: 1) die intervensiegroep het sorg ontvang volgens die Sensoriese Ontwikkelingsorgprogram vir 10 dae; en 2) die kontrolegroep het ook vir 10 dae die standaardsorg van die eenheid ontvang. Die intervensiegroep het uit 45 babas bestaan, van wie 22 die studie voltooi het, terwyl die kontrolegroep uit 44 babas bestaan het van wie 20 die studie voltooi het. Beide studiegroepe is opgevolg op 6, 12 en 18 maande (gekorrigeerde ouderdom), by welke geleentheid die Sensoriese Funksietoets vir Babas (‘Test of Sensory Functions in Infants’) telkens toegepas is vir die assessering van sensoriese ontwikkeling. Op 18 maande (gekorrigeerde ouderdom) is ʼn assessering met die Griffiths Ontwikkelingskaal ook gedoen om funksies in die ander ontwikkelingsareas van die babas te bepaal. Toetsresultate is geanaliseer met behulp van herhaalde ANOVAmetings en die Bonferoni t-prosedure om die effek van die Sensoriese Ontwikkelingsorgprogram op die sensoriese ontwikkeling van die babas tot en met 18 maande (gekorrigeerde ouderdom) te bepaal. RESULTATE Die resultate van die vergelyking van die prestasie van beide groepe (groep-effek), gemeet met behulp van die Sensoriese Funksietoets vir Babas, is van groot belang vir hierdie studie. Die intervensiegroep het betekenisvol verskil op die totale telling (p<0.00), sowel as op die volgende vier van die vyf subtoets-tellings: respons op diepdruk (‘tactile deep pressure’) (p<0.03); motoriese aanpassingsreaksies (p<0.03); visuele tas-integrasie (p<0.00); en respons op vestibulêre stimulasie (p<0.01). GEVOLGTREKKING Die resultate van die studie dui aan dat die babas in die intervensiegroep baat gevind het by die Sensoriese Ontwikkelingsorgprogram met betrekking tot hul sensoriese funksies tot en met die ouderdom van 18 maande (gekorrigeerde ouderdom). Die Sensoriese Ontwikkelingsorgprogram het geblyk prakties sowel as suksesvol te wees met betrekking tot sy doel. Die Program sou daarom met vrug in ander neonatale intensiewe sorgeenhede aangewend kon word. / ENGLISH ABSTRACT: BACKGROUND Premature infants of very low birth weight are known to be inclined to developmental, medical, behavioural and various learning deficiencies by the time they reach schoolgoing age. Concerns have been raised about the effect of the neonatal intensive care unit environment on the sensory development of the premature infant and how this could contribute to these deficiencies. Various approaches claim to address this problem, of which kangaroo mother care and developmental care have in the literature been singled out as particularly promising. However, at the commencement of this study no empirical studies had been reported in the literature to confirm any of the claims of these approaches. Therefore, a need existed for an empirically researched programme that could be practically applied in the neonatal intensive care unit with a view to reducing environmental stressors regarding the sensory systems of the premature infant. AIM The aim of this study was to determine the influence of a Sensory Developmental Care Programme, which incorporated a specific kangaroo mother care protocol, on the sensory development of the very low birth weight premature infant, up to the age of 18 months (corrected age). METHODOLOGY A randomised controlled study was conducted. The study sample consisted of 89 very low birth weight premature infants, admitted during a 24-month period to the neonatal care unit at Tygerberg Hospital in Cape Town, South Africa. The infants were recruited by means of certain criteria and then randomly assigned to one of two groups: 1) the intervention group was cared for according to the Sensory Developmental Care Programme for ten recorded days; and 2) the control group that received the standard care of the unit, also for ten days. The intervention group consisted of 45 infants of whom 22 completed the study, while the control group consisted of 44 infants of whom 20 completed the study. Both study groups were followed up at six, 12 and 18 months (corrected age) when the Test of Sensory Functions in Infants was used to do a sensory developmental assessment. At 18 months (corrected age) a Griffiths Developmental Scale assessment was also conducted to determine function in other areas of development. Test results were analysed using repeated measures of ANOVA, and the Bonferoni t procedure to determine the effect that the Sensory Developmental Care Programme had on the sensory development of the infant up to 18 months (corrected age). RESULTS The results of the comparison of the performance of both groups (group effect), measured by the Test of Sensory Functions in Infants are of great importance to this study. The intervention group had a significant difference on the total score (p<0.00), as well as on the following four of the five sub-tests scores: reactivity to tactile deep pressure (p<0.03); adaptive motor functions (p<0.03); visual-tactile integration (p<0.00); and reactivity to vestibular stimulation (p<0.01). CONCLUSION The results of this study signify that the infants in the intervention group benefited from the Sensory Developmental Care Programme concerning their sensory functions up to the age of 18 months (corrected age). The Sensory Developmental Care Programme was demonstrated to be both practical and successful in terms of its aims. The Programme could therefore be fruitfully utilised in other neonatal intensive care units.

The aim of this study was to observe biofilm formation by Enterobacter sakazakii (E. Sakazakii) from different clinical, dairy and environmental origins on three infant feeding tubes made of different materials. Infant formula milk was selected as the medium for E. sakazakii growth. Seventeen isolates from different origins were retrieved and tested for purity, using a plating method and biochemical tests to eliminate the non E. sakazakii strains from this study. A method to rapidly and accurately detect viable cells of E. sakazakii on infant feeding tube surfaces using of the BacTrac® 4000 microbiological growth analyser was developed. The sources of errors such as from cleaning, operation and handling procedures were assessed prior to experimental runs. The strength of biofilm formation by different isolates of E. sakazakii on plastic surfaces was scrutinised using a microtiter plate assay. The results from the microtitre plate assay were based on the absorbance at 550 nm of crystal violet stained films and showed that all the clinical isolates were able to attach and form strong biofilms on the plate. Some environmental isolates formed strong or weak biofilms and some did not produce biofilm at all. However, dairy isolates formed both strong and weak biofilms in the microtitre plate when incubated in 10% reconstituted infant formula milk. The further studies were to quantify biofilm formation by three isolates of different origin on three different materials of infant feeding tubes using a batch system. Tubing pieces were incubated with infant formula milk inoculated with E. sakazakii cells at approximately 8 log CFU mL-1 and the biofilm formation was assessed at three time intervals: 4, 12 and 24 hours. Biofilm formation on the tubing by clinical isolates was also observed using epifluorescence microscopy and the scanning electron microscope. E. sakazakii from clinical, dairy and environmental isolates were able to form biofilm on three different materials of infant feeding tubes. The results showed that the initial attachment at 4 h on silicone tubing was low compared with the other two tubes. The scanning electron micrographs showed the surface characteristics of each tubing and the biofilm formation by E. sakazakii clinical isolates after 4, 12 and 24 hours. Silicone tubing appeared to be the best choice for premature babies that need feeding using feeding tubes, as it was slow to become colonised compared with the PVC and polyurethane tubing.