Thesis (M. Nurs.)--University of Hong Kong, 2005.

No description available.

In this thesis the use of real-time ultrasound in the assessment and management of preterm labour has been studied, with particular reference to the observation of fetal breathing movements, gross fetal body movements and the state of the uterine cervix. In addition, a longitudinal analysis of the trends in preterm labour in the John Radcliffe Hospital in Oxford between 1973 and 1981 has been performed. Finally, an attempt has been made to clarify the relationship between prostaglandin E2 and fetal breathing movements. The analysis of the trends in preterm labour in Oxford has shown that the incidence of preterm delivery remains unaltered. Of these patients, however, those eligible for tocolytic therapy (unexplained spontaneous preterm labour) form a small proportion. The incidence of extreme prematurity in this group is very low and the neonatal outcome is good. The presence or absence of Fetal Breathing Movements (FBM) by defined criteria is shown to be a highly sensitive index of whether the preterm labour is going to progress to delivery or not in singleton pregnancies with intact membranes. Its significance is lost when the membranes are ruptured and in multiple pregnancies. In pregnancies complicated by antepartum haemorrhage the presence or absence of Fetal Breathing Movements does not predict further haemorrhage leading to delivery. Fetal Breathing Movement status on admission bears no relationship to neonatal outcome and gives no indication of the presence of intrauterine infection. Silent chorioamnionitis has been highlighted as an important cause of "unexplained" preterm labour. Gross Fetal Body Movements (FM) are shown to give no early indication of impending preterm delivery. Evidence is presented to suggest that significant diminution in Fetal Movements is related to poor neonatal outcome. Ultrasonic measurement of the uterine cervix has been found to be technically feasible but of no benefit in the diagnosis of ongoing preterm labour. The relationship between prostaglandin E2 (PGE2) and the cessation of fetal breathing movement has been approached by elucidating the maternal absorption of PGE2 from a vaginal pessary. This then enabled me to sample fetal blood at the time of maximal maternal concentrations (the time we expect the fetal concentration to be greatest). This was performed by fetoscopy and demonstrated that a significant rise in fetal bicycleprostaglandin-E-metabolite (bicyclo-PGEM) occurs following maternal vaginal administration of PGE2. Using this information FBM has been assessed two and a half hours following the vaginal administration of PGE2. Although inconclusive, no reduction in FBM was demonstrated. as the bicyclo-PGE metabolite is used to assess PGE levels, this evidence decreases the probability that PGE mediates the reduction in FBM with the onset of labour.

Background: Screening for Retinopathy of Prematurity (ROP) is recommended to prevent possible blindness. Prior to 2016, resource limitations precluded routine ROP screening at Groote Schuur Hospital (GSH). Previous pilot studies at GSH did not detect ROP requiring treatment. However, improved survival of very low birth weight infants may affect the prevalence of ROP. Objectives: The study objectives were to: i) Determine the prevalence and severity of ROP in a prospective cohort of premature infants; ii) Describe the association with pre-specified potential risk factors; iii) Assess the feasibility of screening for ROP in our resource-limited setting. Methods Infants with a birth weight of < 1251 g or gestational age < 31 weeks admitted to the GSH neonatal unit from November 2012 to May 2013 were screened. A paediatric ophthalmologist examined the infants at 4 weeks chronological age or 32 weeks corrected gestational age, with follow-up examinations as indicated. Results: Screening was performed in 135 of 191 eligible infants. A total of 313 ROP examinations were performed; 38.5% of infants required a single examination and 16.3% required more than four. The mean gestational age and weight at birth were 30.1 ± 1.9 weeks and 1056 ± 172 g respectively. Seventy-four infants were female (54.8%). Only black (57.0%) and coloured (42.9%) infants were represented. ROP was diagnosed in 40 (29.6%) infants: Eight (5.9%) infants had clinically significant ROP. No infants had stage 4 or 5 ROP. No infants weighing more than 1250 g required treatment. Two infants received laser treatment. Infants with ROP had a lower mean gestational age and lower mean birth weight than those without ROP: 29.2 ± 1.6 vs. 30.5 ± 1.9 weeks (P < 0.002) and 988 ± 181 g vs. 1085 ± 160 g (P = 0.001) respectively. Infants with ROP were more likely to have received a blood transfusion (P < 0.002); to have late onset sepsis (P = 0.024); and to have receive d exclusive breast milk feeds (P = 0.005). There were no significant differences in the level of respiratory support, the need for oxygen therapy, the occurrence of apnoea, early sepsis or severe intraventricular haemorrhage in infants with ROP compared to no ROP. On multivariate analysis, only gestational age was independently associated with ROP was gestational age (RR 0.85; 95% CI 95% 0.740 - 0.988; p=0.03). When gestational age was excluded in post-hoc analysis, birth weight (RR 0.99; 95% CI 0.997 - 0.999; P=0.03) and blood transfusions (RR 1.71; 95% CI 1.0 27 - 2.859; P=0.03) were independently associated with ROP. Infants <1000 g had a 2.5 times higher risk of having ROP than their larger counterparts (95% CI 1.05 - 5.90, P=0.03). ROP screening was completed in 91.1% (123/135) of infants. Conclusion Clinically significant ROP was found in this study. In contrast to previous studies conducted in this setting, two patients received laser treatment. Extensive resources were required for successful screening. The strong association with birth weight and gestational age suggests that infants with lower birth weights and gestational ages should be prioritized for screening in our resource-limited setting.

The effects of perinatal risk and gestational age on sensory responsiveness and the ability to habituate were evaluated in three groups of preterm newborns designated as at high-, moderate-, and low-risk for developmental disability. Two major hypotheses were investigated: 1) that preterm infants have an elevated sensory threshold leaving them relatively unavailable to stimulation and 2) that once the preterm is stimulated sufficiently to respond, he/she is largely unable to habituate to repeated stimulus presentations. Additionally, the reliability of responsiveness and habituation over a 24-hour period was assessed.

Problem: Identifying the factors effecting birth transition success of late preterm infants may improve early recognition of newborn compromise. Multiple explanatory variables may be associated with birth transition success or failure. The purpose of the study was to determine the prevalence of, and clinical-epidemiological and demographic predictive factors for birth transition success of late preterm infants. Methods: A retrospective case-control chart review was used to compare the characteristics of successful and unsuccessful birth transition of 35 and 36 week gestational age late-preterm infants delivered in a large tertiary-care center during calendar year 2007. A mixture of categorical and numeric variables related to maternal, birth, and physiologic constructs were analyzed for their effects on birth transition as a binary outcome variable (success or failure). Results: Of 22 variables tested, four predictor variables were associated with birth transition failure: labor (OR = .42, p = .014), 5-minute Apgar score (OR = 1.79, p = .043), gender (OR = .47, p =.003), and respiratory rate (OR= 2.08, p = .001) as tested by logistic regression. The model was able to accurately assign transition failure and success at a rate of 66.7% and 74% respectively. The overall model was statistically significant (likelihood ratio chi square = 38.97(4), p

The purpose of this integrative research review is to provide a compilation and review of literature related to fetal fibronectin and cervical length relevant to the prediction of the patient at risk for preterm labor. This paper will synthesize and summarize the accumulated state of the science in this topic between the years of 1991- 1998. A general search using key terms was conducted, and yielded 79 prospective articles comprised of full articles, abstracts, letters, and literature reviews. Twenty-eight articles on fetal fibronectin were retained out of 49 that were found. The search for literature discussing cervical length produced 16 articles, of which 11 were found to be relevant to this project. Articles which addressed both fetal fibronectin and cervical length totaled 6, of which 5 were utilized. Seven of the total 44 articles retained were literature reviews and were used for citation and identification of additional information material to this topic. All of the studies on fFN consistently found the high negative predictive value to provide potential benefit in terms of improving the diagnosis of true preterm labor, thus increasing the accuracy of instituting appropriate interventions. Studies which examined cervical length found that a shortened cervical length and the presence of cervical funneling, correlated with a large cervical index was also consistent with preterm labor symptomology. The presence of fFN and cervical length as combined factors in the prediction of preterm delivery found that the incidence of preterm delivery when fFN is present correlated with confirmed shortening of the cervix was higher than in women negative for fFN and who enjoy normal cervical length.

The purpose of this study is to explore the differences in physiologic and financial outcomes among neonates delivered at 26, 28, 30, 32 and 34 gestational weeks. The Rosswurm-Larrabee model was selected as the theoretical framework for this research study. Prior to this study, an extensive review of the relevant literature failed to discover studies that encompass physiologic and financial outcomes at gestational-age specific groups. A descriptive, comparative design was utilized to determine physiologic and financial outcome among the five groups. A systematic retrospective chart review was used to select the sample from premature deliveries that occurred from January 1, 1999 to December 31, 1999 at a tertiary hospital in a metropolitan area in the Southeastern United States. The data analysis indicated a significant statistical difference in the financial outcomes among the groups. Additionally, there was a significant statistical difference in the majority of the physiologic outcomes including, respiratory distress, hyperbilirubinemia, necrotizing enterocolitis, sepsis, retinopathy, patent ductus arteriosus, intrauterine growth retardation, Apgar Scores at 1 and 5 minutes, and birth weight. Recommendations were made for further studies utilizing a larger, more diverse sample. In addition, a longitudinal study that encompasses long-term outcomes of neonates would be beneficial since many effects of prematurity are no evident until certain developmental milestones are or not achieved. A qualitative research study on how to better prepare parents for parenthood and to what extent the additional responsibilities and expectations might compromise the families parenting abilities was also recommended. Furthermore, the development of additional studies that focus on the use of critical pathways and outcomes should also be investigated. The devastating effects of prematurity on families and society provides the nurse with the unique opportunity for education and intervention with caring strategies. This research presents baseline data from which our society stands to benefit.

The purpose of this study was to assess if preterm infants receiving an intervention of intermittent human tactile contact would demonstrate clinical improvement over infants who did not receive the intervention. A quasi-experimental design was used with 26 infants between 28 and 32 weeks gestation. Hands were placed on the infants' heads and lower backs for a total of 36 minutes of tactile contact a day for 10 days. Findings indicated a significant gain in mean body weight for both groups between Day 0 and Day 10. Also, there was a significant decrease in mean hematocrit in the control group between Day 0 and Day 10. On Day 10, experimental infants had a significantly higher mean number of apneic and bradycardic episodes than control infants. There were no significant mean differences between the groups for body weight, body temperature stability, oxygen variance, or hematocrit. Data suggest that gentle human touch may be correlated with desireable outcomes. Further research is necessary.

Thesis (PhD. (Clinical Psychology)) --University of Limpopo, 2008 / Low-birth-weight/premature children seem to be vulnerable to psychiatric, neuropsychological and other deficiencies. Limited research is available in the South African context about these ever-increasing phenomena. The aim of this study was to investigate the magnitude and characteristics of internalising (Separation Anxiety, Overanxious and Major Depressive Disorders) and externalising symptoms (Attention-Deficit/Hyperactivity, Oppositional Defiant and Conduct Disorders) among low-birth-weight children in comparison with normal-birth-weight children, as well as to establish neuropsychological deficiencies (motor, visual-spatial, memory and executive functioning) between the birth weight groups, analysed as a function of gender and age. The sample (158 children) was selected from nine urban mainstream primary schools in the Tshwane North and South districts by means of stratified random sampling. Low-birth-weight children (weighing below 2 000 g) (N=79) were matched with normal-birth-weight children (above 3 000 g) (N=79) according to age, gender, language and socio-economic status. The neuropsychological test battery and self-reporting questionnaire were individually administered to the sample at the selected schools during school hours. Teachers and parents of selected participants were requested to complete a rating scale. As expected, low birth weight is associated with a tendency towards increased internalising and externalising psychological symptoms, as well as poorer neuropsychological functioning. This was particularly significant in the domains of internalising symptoms (depression), externalising symptoms (hyperactivity/impulsiveness, inattention, Oppositional Defiant Disorder and Conduct Disorder) and neuropsychological impairments (motor, visual-spatial/visual-motor, memory and executive functioning). The neuropsychological impairments observed in this study among the LBW children probably increase the risk of subsequent externalising (conduct and oppositional behavioural problems) and internalising (depressive) psychological symptoms. These impairments are possibly exacerbated by inattention and hyperactivity/ impulsiveness. Reciprocal interaction seems to take place between the psychological symptoms andneuropsychological functions. Only a few gender differences were observed. Neuropsychological deficits were observed both in the 6 to 9 and 10 to 13 age groups, indicating deficient resolution of impairments with increasing age. Increased pre-, peri- and postnatal complications in the low-birth-weight group may predispose these children biologically to neuropsychological deficiencies and subsequent internalising/externalising symptoms. These impairments most probably affect academic, emotional, social and other significant areas of functioning, increasing public health cost.