O presente estudo teve por objetivo examinar os indicadores de temperamento e comportamento de crianças nascidas pré-termo em comparação a crianças nascidas a termo, assim como nos subgrupos de crianças nascidas pré-termo extremo, muito pré-termo, pré-termo moderado e tardio, na fase de 18 a 36 meses de idade cronológica. Além disso, examinou-se o efeito preditor da prematuridade, dos fatores do temperamento e das variáveis da criança e ambientais no comportamento das crianças. A amostra foi composta por 100 crianças, sendo 50 nascidas pré-termo (PT) que passaram por internação em Unidade de Tratamento Intensivo Neonatal e 50 nascidas a termo (AT), e suas mães. A amostra dos subgrupos de crianças nascidas pré-termo foi composta por 14 crianças nascidas pré-termo extremo (PTE) e 36 crianças nascidas muito pré-termo, pré-termo moderado e tardio (PTM/Mo/Ta). Em ambos os grupos as crianças estavam na faixa de 18-36 meses de idade cronológica. Os dados foram coletados em uma única sessão de entrevista face a face com as mães das crianças PT e de forma autoadministrada com as mães das crianças AT. Aplicou-se as versões brasileiras do Early Childhood Behavior Questionnaire (ECBQ), para avaliação do temperamento, e do Child Behavior Checklist (CBCL 1 ½ -5), para avaliação de problemas de comportamento das crianças. Além disso, foram aplicados questionários de caracterização da amostra e utilizado o Critério de Classificação Econômica Brasil da Associação Brasileira de Empresas e Pesquisa. Foram processadas as análises estatísticas descritivas e inferenciais. Para a comparação entre grupos (PTvs.AT e PTEvs.PTM/Mo/Ta) foram utilizados os testes t-independente de Student e Qui-quadrado. Utilizou-se os testes ANOVA e MANOVA para examinar as potenciais diferenças entre os grupos relacionadas ao temperamento e comportamento das crianças, controlando-se idade da criança, frequência à escola, sexo e nível socioeconômico. Foram realizadas análises de regressão linear múltiplas a fim de encontrar o melhor modelo explicativo das variáveis preditas (problemas de comportamento Totais, Externalizantes e Internalizantes). O nível de significância adotado no estudo foi de p <= 0,05. Em relação ao temperamento, o grupo PT apresentou maior escore nos fatores Afeto Negativo e Extroversão, assim como nas dimensões antecipação positiva, desconforto, sensibilidade perceptual, prazer de baixa intensidade e transferência de atenção, quando comparado ao grupo AT. O grupo PTE apresentou mais sensibilidade perceptual em comparação ao grupo PTM/Mo/Ta. Observou-se que, quanto maior a idade da criança, mais Controle com Esforço, assim como mais aconchego, controle inibitório, medo e antecipação positiva, e menos ativação motora. Quanto ao comportamento das crianças, o padrão de comportamento foi predominantemente normal, em ambos os grupos e subgrupos. Os problemas de comportamento Totais, Externalizantes e Internalizantes foram preditos por mais Afeto Negativo, moderado por menor idade gestacional, e menos Controle com Esforço. Esses achados contribuem para a compreensão do impacto dos riscos do nascimento prematuro nos indicadores disposicionais do temperamento e na constituição dos problemas de comportamento no desenvolvimento das crianças. É importante que programas de follow-up de prematuros considerem as intervenções preventivas de orientações de pais a fim de mediar os processos regulatórios ao longo do desenvolvimento das crianças / The present study aimed to examine the temperament and behavior indicators of preterm toddlers compared to full-term counterparts, as well as in the subgroups of toddlers born extremely preterm and very preterm, moderate preterm and late preterm, in the phase of 18 to 36 months of chronological age. In addition, we examined the predictive effect of prematurity, temperament factors, and child and environmental variables on children\'s behavior. The sample consisted of 100 toddlers, of whom 50 were born preterm, who were hospitalized in a Neonatal Intensive Care Unit and 50 full-term (FT) counterparts enrolled in private schools. The sample of subgroups of preterm toddlers consisted of 14 toddlers born extremely preterm (PTE) and 36 toddlers born very preterm, moderate and late preterm (VPT/Mo/La). In both groups, the toddlers were in the range of 18-36 months of chronological age. Data were collected in a single face-to-face interview with the mothers of the PT toddlers and in a self-administered form with the mothers of the FT toddlers. The Brazilian versions of Early Childhood Behavior Questionnaire (ECBQ) and Achenbach\'s Child Behavior Checklist (CBCL 1 ½ -5) were used to assess children\'s temperament and behavioral problems. In addition, questionnaires were applied to characterize the sample and it used the Brazilian Economic Classification Criteria of the Brazilian Association of Companies and Research. Descriptive and inferential statistical analyzes were processed. For the comparison between groups of sociodemographic chacteristics (PTvs.FT and PTEvs.VPT/Mo/La), it was used the ANOVA and MANOVA tests to examine the potential differences between the groups related to temperament and behavior of the children controlling the child\'s age, school attendance, sex, and socioeconomic level. Multiple linear regression analyzes were calculated in order to find the best explanatory model of the predicted variables (Total, Externalizing, and Interalizing behaviors problem). The level of significance adopted in the study was p <= 0.05. Regarding temperament, the PT group presented a higher score in the Negative Affectivity and Surgency factors, as well as in the positive anticipation, discomfort, perceptual sensitivity, low intensity pleasure and attention shifting, than the FT group. The VPT group presented more perceptual sensitivity than the VPT/Mo/La group. It was observed that the greater the age of the child, the more Effortful Control, as well as more cuddliness, inhibitory control, fear and positive anticipation, and less motor activation. Regarding to the behavior of the children, the pattern of behavior was predominantly normal in both groups and subgroups. The Total, Externalizing, and Internalizing behavior problems were predicted by more Negative Affectivity, moderated by lower gestational age, and less Effortful Control. These findings contribute to the understanding of the impact of the risks of preterm birth on dispositional indicators of temperament and the constitution of behavioral problems throughout children´s development. It is important that follow-up programs for preterm infants consider preventive interventions in parental guidance in order to mediate regulatory processes throughout child development

Inflammation and oxidative stress are increasingly recognised as important independent mediators of preterm brain injury and have been implicated in the pathogenesis of cerebral palsy and cognitive impairment. Such exposures are common for the premature infant in whom infection and inflammatory morbidities occur in around 60%. Furthermore, many preterm infants require oxygen therapy and respiratory support due to lung immaturity. Epidemiological and experimental studies indicate that in addition to the independent effects of inflammation and extreme hyperoxia on the developing brain, inflammation preconditions the developing brain resulting in variable injury when exposed to subsequent hypoxia-ischaemia. However experimental studies employing exposure to more modest oxygen fluctuations are lacking. This thesis characterises a clinically relevant model of prematurity where the developing brain is exposed to low grade inflammation and oxygen fluctuation around a hyperoxic mean. We hypothesise that antenatal inflammation and postnatal oxygen fluctuation, both alone and in combination, have detrimental effects on developing white matter. Pregnant dams received intraperitoneal lipopolysaccharide (LPS) or saline on G18 and G19. Dams and their pups were then reared in room air or fluctuating hyperoxia (circa 10kPa) for seven days. We measured longitudinal brain and body growth in different experimental groups to 12 weeks. Whole brains were examined for mRNA expression of inflammatory cytokines (TNFα, IL-1β, IL-6 and IL-10) and markers of oxidative injury (iNOS, SOD2). To determine the effect of perinatal insults on developing white matter, we analysed the expression of myelin basic protein (MBP) and glial fibrillary acidic protein (GFAP) in the internal and external capsule. We also examined white matter tracts for differences in microglia (CD68), oligodendrocyte progenitor cells (NG2), oligodendroglial cells (Olig2) and cell death (cleaved caspase3). Behavioural studies (Morris Watermaze Test, Elevated Plus Test and Open Field Test) were undertaken at 12 weeks of age to detect any long-term functional difference between the groups. Antenatal inflammation reduces both brain and body growth at P7. This normalises by P14 unless this inflammatory insult has been followed by postnatal oxygen fluctuation, where brain and body growth restriction persists until P14. We defined our inflammatory response at P1 following antenatal inflammation and did not observe elevation of mRNA at P1. We demonstrated increased SOD2 at this time point, indicating a reparative process. At P7 we observed a significant reduction in the oxidative response following combined exposure to antenatal inflammation and postnatal oxygen fluctuation, indicating a potential limit to, or suppression of, the reparative process. In terms of white matter injury, antenatal inflammation reduces myelination at P7. There is no synergistic effect of inflammation and oxygen fluctuation on MBP immunohistochemistry at P7. However, MBP mRNA expression is increased in pups exposed to both insults compared to those exposed to inflammation alone suggesting that the oxygen fluctuation may stimulate MBP production in response to oxidative injury. MBP mRNA levels and protein expression have all normalised by P14. We observed a reduction in total cell number in the external capsule and corpus callosum in the dual insult group, without an increase in caspase. In keeping with other studies we detected no effect of our perinatal insults on NG2+ve oligodendrocytes. Olig2+ve cell numbers were also consistent between experimental groups. In further characterisation of the cellular response, antenatal inflammation followed by postnatal oxygen fluctuation resulted in a decrease in GFAP mRNA at P7, an effect which was reversed and significantly increased by P14 suggesting delayed activation of the innate immune system. No difference was observed in microglial numbers between experimental groups. There was however, increased microglial cell death (CD68 + caspase) in the group exposed to antenatal inflammation. When this insult was combined with postnatal oxygen fluctuation there was a comparative decrease in microglial cell death, which may reflect an earlier peak of microglial cell death, due to an increased and sustained inflammatory stimulus. Morris Watermaze testing demonstrated that pups exposed to both insults took longer than controls to locate the hidden platform on day 1, which is a measure of spatial learning. The Elevated Plus Test and Open Field Test demonstrated that pups exposed to both insults were less anxious and took more risks than pups exposed to single insults. In conclusion, within a clinically relevant preterm model, antenatal inflammation transiently disrupts both brain and body growth and myelination of the motor tracts of the developing brain. Moreover, when combined with postnatal oxygen fluctuation, detrimental effects on growth are amplified and sustained. Decreased cell numbers are also observed within white matter tracts. In terms of long term functionality, these pups display disinhibition of behaviour as young adults. Collectively, this thesis demonstrates that synergistic actions of common low-grade perinatal insults may alter normal neurodevelopment, and that this may carry a risk of neurodevelopmental sequelae for preterm infants.

La neuro-inflammation induite par l'inflammation systémique ou générée en réponse à une lésion cérébrale aiguë a des conséquences cliniques néfastes : elle est mise en cause dans l'aggravation des lésions cérébrales aiguës chez l'homme, aussi bien chez l'adulte que chez l'enfant. La microglie est l'effecteur cérébral principal de cette réponse inflammatoire, et peut présenter selon les situations un profil neurotoxique ou, au contraire, anti-inflammatoire et régulateur. La compréhension des mécanismes d'activation microgliale et de leurs conséquences est capitale pour une meilleure prise en charge des malades. La première partie de ce travail de thèse s'intéresse aux conséquences de l'inflammation néonatale associée à la prématurité sur la réponse microgliale à l'âge adulte, face à de nouvelles agressions cérébrales que sont l'inflammation systémique et les lésions cérébrales aiguës. Dans un modèle murin d'inflammation néonatale, nous avons mis en évidence d'importantes modifications du transcriptome microglial une fois ces souris adultes. De plus, un stimulus inflammatoire à l'âge adulte modifie le profil d'activation microgliale, le pic des marqueurs pro-inflammatoires et immuno-régulateurs survenant plus précocement et intensément, démontrant l'existence d'une mémoire du système immunitaire inné cérébral. Ces modifications dans le profil d'activation microgliale s'accompagnent dans un modèle de lésion cérébrale excitotoxique d'une majoration de la taille des lésions de la substance blanche. Un traitement par mélatonine des souriceaux prévient cette aggravation. La deuxième partie de ce travail a consisté à caractériser in vitro le profil d'activation microgliale en réponse à une stimulation par HMGB1, une alarmine relarguée lors de la mort cellulaire et donc présente en cas de lésion cérébrale aiguë mais aussi de lésions extra-crâniennes associées. Nous avons montré que le profil d'activation microgliale dépend du type d'HMGB1 utilisé. Les microglies exposées à la forme recombinante de chez Sigma présentent un profil transcriptomique proinflammatoire mais une baisse des taux de cytokines sécrétées dans le milieu. Ces résultats mettent en évidence l'importance de l'inflammation et de l'activation microgliale dans le pronostic des lésions cérébrales et offrent la possibilité de mettre en place des stratégies neuroprotectrices innovantes / Neuroinflammation induced by systemic inflammation or generated in response to acute brain injury has adverse clinical consequences: it is implicated in exacerbation of acute brain injury in humans, for adults as well as for children. Microglia is the main effector of this cerebral inflammatory response, and may present, depending on the situation, a neurotoxic or - on the opposite - anti-inflammatory and regulating profile. To decipher the mechanisms of microglial activation and their consequences is essential for better management of patients.The first part of this thesis focuses on the consequences of neonatal inflammation associated with prematurity on the microglial response in adulthood, in case of new cerebral aggressions such as systemic inflammation or acute brain injury. Relying on a mouse model of inflammation of the preterm infant, we have demonstrated drastic modifications of the microglial transcriptome once these mice are adults. Moreover, when an inflammatory stimulus occurs in adulthood, the microglial activation profile is altered, the peak of pro-inflammatory and immuno-regulatory markers occurring earlier, demonstrating the existence of a memory of the cerebral innate immune system. These changes in the microglial activation profile are accompanied in a model of excitotoxic brain injury by an increase of the white matter lesion size. Melatonin treatment of mice prevents the happening of this worse outcome. In the second part of this thesis, we characterized the microglial activation profile in vitro, in response to stimulation by HMGB1, a damage associated molecular pattern released during cell death and therefore present in acute brain injuries but also in associated extra-cranial injuries. We have shown that the microglial activation profile depends of the kind of HMGB1 used. Microglia exposed to Sigma recombinant form have a proinflammatory transcriptomic profile but a lower release of cytokines in the culture medium. These results highlight the importance of inflammation and microglial activation in the prognosis of brain injuries and offer the opportunity to implement innovative neuroprotective strategies

Due to a steady increase in the number of babies born prematurely over the past 20 years, prematurity (a birth occurring before 37 weeks gestation) has emerged as an important public health concern. Even with improved survival of these infants, they remain at risk for many unfavorable health outcomes. Most of those risks include cognitive and behavioral deficits that show up later in life, highlighting the importance of studying the development of the brain, in particular. The current study investigates brain development outcomes in the first years of life using: (1) structural magnetic resonance imaging (MRI) to study brain structure, and (2) three novel cognitive assessments of visual working memory, attention, and speed of processing information. Healthy 12-month-old infants were recruited through University of Iowa’s Neonatal Admissions Registry. An MRI imaging acquisition protocol was developed in order to scan infants during their naptime without sedation. Additionally, a new automatic approach to classifying areas of the brain was developed at the University of Iowa Department of Radiology for 12-month-old brain images. These novel cognitive assessments are based on infant eye movements (including how long it takes for an infant to react to certain stimuli and the direction of their looking). Results from this study support the use of these cognitive tasks to detect specific functional changes in performance based on gestational age. Therefore, these tasks may be potential early markers of risk in preterm populations, but continued investigations are necessary to fully elucidate early brain outcomes during this critical period of development.

Maintaining adequate and stable blood oxygen level is important for preterm babies to avoid the risk of brain, lung and retinal injury such as retinopathy of prematurity (ROP). However, wide disparities in policies and practices of oxygenation in preterm babies exist among neonatal care providers as it is still unclear which best method of monitoring and what features of oxygen measurements are important to clinician’s interpretations for assessing preterm babies at risk of developing severe ROP or unstable health condition. This thesis consists of two projects: NZ-ROP that examines multiple factors of severe ROP including summary statistics (mean, standard deviation (SD), coefficient of variation (CV) and desaturation) for oxygen saturation (OS) features in very extreme preterm babies, and NZ-LP that investigates the efficacy of some of these statistics for health monitoring of late preterm babies. The OS data in NZ-ROP were recorded using modified oximeters that have offsets and inherent software artefact, both of which mask the actual saturation for certain OS ranges and may complicate the choice of methods in the analyses. Therefore, novel algorithms involving linear and quadratic interpolations are developed, implemented on the New Zealand data, and validated using the data of a UK preterm baby, as recorded from offsets and non-offsets oximeters. For all data sets, the algorithms produced saturation distributions that were very close to those obtained from the non-offset oximeter. The algorithms perform within the recommended standards of commercial oximeters currently used in the clinical practice. ROP is a multifactorial disease, with oxygenation fluctuations as one of the key contributors. The all-subsets logistic regression, robust and generalised additive statistical modelling, along with a model averaging approach, are applied in NZ-ROP to determine the relationship of variability and level of OS with severe ROP, and the extent of contribution of various clinical predictors to the severity of this eye disease. Desaturation, as a measure of OS variability, has the strongest association with severe ROP among all OS statistics, in particular, the risk of severe ROP is almost three times higher in babies that exhibit greater occurrences of desaturation episodes. Additionally, this study identifies longer periods of ventilation support, frequent desaturation events, extreme prematurity and low birth weight as the most important factors that substantially exacerbate the severity of ROP, and therefore signify babies’ underlying condition of being severely ill. Persistent cardiorespiratory instabilities prior to hospital discharge may expose preterm babies to a greater risk of neuro-developmental impairments. In NZ-LP, the statistical summaries of mean, SD and CV are computed from the OS measurements of healthy stable and unstable babies, and the performance of these statistics in detecting the unstable babies is evaluated using an extremeness index for outlying data and a hierarchical clustering technique. With SD and CV, the clinically unstable babies were very well separated from the group of stable babies, wherein, the separation was even more apparent with the use of CV. These suggest that measures of variability could be better than saturation level for highlighting babies’ underlying instability due to immature physiological systems, but the combination of variability and level through the CV are believed to be even better. Identification and summarisation of useful OS features quantitatively hold great promise for improved monitoring of oxygenation instability and diagnosis of severe ROP for preterm babies.

No description available.

Caffeine has calciuric and osteoclasteogenesis effects. Objectives: To examine the association of caffeine cumulative dose and duration of therapy and the Osteopenia of prematurity (OP) Study design: A retrospective observational cohort study included premature infants less than 31 weeks and birth weight less than 1500 grams. OP was evaluated using chest X-rays on biweekly basis over 12 weeks hospital stay. Caffeine cumulative dose and duration of therapy, steroid dose and diuretic dose along with other maternal and neonatal risk factors were collected to examine their impact on OP. Results: The cohort included 109 infants. 51% had OP and 8% had spontaneous rib fractures. Using the generalized mixed model, Caffeine dose and duration of caffeine displayed strong association with OP. Steroids and vitamin D had significant correlation with OP while diuretic use did not show statistical significant effect. Conclusion: Caffeine cumulative dose and duration of therapy are associated with OP.

Submitted by DANIELLE MARINHO VIEGAS EMÍLIO (dannibtu13@gmail.com) on 2018-06-18T18:46:40Z No. of bitstreams: 1 texto finalizado Danielle.pdf: 1603168 bytes, checksum: 648168cbee10718cdc6a07a6f3c406e5 (MD5) / Rejected by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br), reason: Solicitamos que realize uma nova submissão seguindo as orientações abaixo: problema 1: A ficha deve ser inserida no arquivo PDF logo após a folha de rosto do seu trabalho. No arquivo que você submeteu a ficha está após a Folha de aprovação. Assim que tiver efetuado essa correção submeta o arquivo, em PDF, novamente. Agradecemos a compreensão. on 2018-06-21T12:42:00Z (GMT) / Submitted by DANIELLE MARINHO VIEGAS EMÍLIO (dannibtu13@gmail.com) on 2018-06-24T20:39:51Z No. of bitstreams: 1 texto finalizado Danielle.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) / Approved for entry into archive by ROSANGELA APARECIDA LOBO null (rosangelalobo@btu.unesp.br) on 2018-06-26T12:07:06Z (GMT) No. of bitstreams: 1 emilio_dmv_me_bot.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) / Made available in DSpace on 2018-06-26T12:07:06Z (GMT). No. of bitstreams: 1 emilio_dmv_me_bot.pdf: 1605296 bytes, checksum: e99ee16335a4b4affabc6ba03da33363 (MD5) Previous issue date: 2018-05-03 / Introdução: O aleitamento materno, além das propriedades nutritivas e imunológicas, propicia momentos essenciais de interação mãe-bebê. Quando o recém-nascido, especialmente o prematuro, é separado da mãe devido à sua internação em uma Unidade Neonatal, diversos fatores podem prejudicar o início do aleitamento materno e sua duração. Pesquisas com crianças nascidas a termo mostram que dentre vários fatores, a percepção de autoeficácia materna está associada com maior tempo de amamentação exclusiva e desmame mais tardio; entretanto, pouco se sabe sobre o papel da autoeficácia em mães de prematuros. Objetivos: Avaliar a percepção de autoeficácia em mães de prematuros durante a internação e após a alta e sua associação com a manutenção do aleitamento materno e desmame. Método: Trata-se de um estudo longitudinal, com 47 mães de prematuros cujos dados sociodemográficos e clínicos foram obtidos a partir de entrevista realizada até o terceiro dia após o nascimento e dos prontuários médicos do bebê. Entre três e sete dias após início da amamentação foram aplicados dois questionários para avaliação de autoeficácia: a) com relação aos cuidados (Perceived Maternal Parenting Self-Efficacy – PMP); b) com relação à amamentação (Brastfeeding Self-Efficacy Scale – Short-Form – BSE - SF). No primeiro retorno após a alta hospitalar do bebê, o BSES – SF foi reaplicado, e 60 dias após o nascimento foi verificado no prontuário, ou por contato telefônico se os bebês continuavam sendo amamentados. Resultados: A mediana da idade gestacional foi de 32 semanas e o tempo médio de internação foi de 20 dias. Na alta 85% dos prematuros estavam em aleitamento materno exclusivo, e até 60 dias após o nascimento 31,7% continuaram em aleitamento materno exclusivo. Nenhuma mãe pontuou para baixa autoeficácia, e altos índices de autoeficácia foram predominantes em mães com maior idade, multíparas e cujo recém-nascido teve melhor vitalidade ao nascer. A autoeficácia não se associou com tempo de amamentação, mas nascer pequeno para a idade gestacional foi fator de proteção e maior idade materna foi fator de risco para o desmame. Conclusão: A alta autoeficácia na amamentação não se associou com risco de desmame. As taxas de aleitamento materno foram elevadas na alta hospitalar mas caíram drasticamente 60 dias após o nascimento, o que sinaliza para a necessidade de retornos mais frequentes aos serviços de saúde após a alta para continuar encorajando o aleitamento materno, dando orientações técnicas ajustadas às necessidades individuais de cada mãe, visando aumentar seu empoderamento, sua percepção de autoeficácia e confiança em sua capacidade de amamentar. / Introduction: Breastfeeding propitiates not only nutritional and immunological advantages, but also essential moments of mother-baby interaction. According to the literature, when a newborn, especially if premature, is separated from the mother to be admitted into a Neonatal Unit, several factors can impair breastfeeding and its duration. Research with infants born at full-term shows that among several factors maternal perception of self-efficacy is associated with exclusively breastfeeding for a longer period and weaning at a later date. However, little is known about the role of self-efficacy in mothers of premature babies. Objectives: Evaluating the perception of self-efficacy in mothers of premature babies during hospitalization and after discharge and its association to breastfeeding and weaning. Methodology: A longitudinal study with 47 mothers of premature babies whose sociodemographic and clinical data were obtained through an on-site interview conducted up to three days after birth and from the baby’s medical charts. From three to seven days after they first started breastfeeding, two questionnaires were used to evaluate self-efficacy: a) the - Perceived Maternal Parenting Self-Efficacy (PMP-E); and b) the Breastfeeding Self-Efficacy Scale – Short-Form (BSES-SF). On the first consultation after discharge the BSES-SF questionnaire was applied once more and and 60 days after birth medical charts were consulted or by phone contact to check whether the mother was still breastfeeding. Results: Average gestational age was 32 weeks at birth and the children were admitted for an average of 20 days. 85.1% of the children were discharged on exclusive breastfeeding and up to 60 days after birth 31.7% continued on exclusive breastfeeding. No mother had a low score on self-efficacy and high levels of self-efficacy were predominant in older mothers who had given birth before and whose children had higher Apgar scores. No mother scored for low self-efficacy, and high self-efficacy rates were predominant in older mothers, multiparous, and whose newborn had better vitality at birth.Self-efficacy was not associated with breastfeeding time but being small for gestational age appeared as a protective factor and having an older mother a risk factor for weaning. Conclusion: The high self-efficacy in breastfeeding was not associated with risk of weaning. Breastfeeding rates were high at hospital discharge but dropped dramatically 60 days after birth, signaling the need for more frequent returns to post-discharge health services to continue encouraging breastfeeding, providing technical guidance tailored to individual needs of each mother, in order to increase their empowerment, their perception of self-efficacy and confidence in their ability to breastfeed.

Hyponatremia is common in preterm infants. The causes are usually related to the inability of the premature kidneys to excrete a given water load, excessive sodium losses, or inadequate sodium intake. Here, we present a case of severe hyponatremia in an extreme preterm infant, associated with the use of aminophylline. Aminophylline was administered intravenously on day 1 for the treatment of apnea of prematurity. On day 3, the patient developed hyponatremia which was not responsive to sodium replacement and fluid restriction. Due to concerns of aminophylline‑induced hyponatremia, aminophylline was discontinued on day 6, and within 48 h of discontinuation, serum sodium normalized without the need for sodium supplementation. The purpose of the case report is to present a rare complication associated with aminophylline use and to shed light on potential deleterious effects associated with drug shortages.

Background: Prematurity is a major risk factor for intraventricular haemorrhage (IVH). Premature infants often require respiratory support. There is little information on neonates with IVH who require respiratory support in low and middle income countries. Objective: To describe the characteristics and short-term outcomes of very low birth weight (VLBW) infants with IVH who required respiratory support in a tertiary neonatal unit with resource limitations. Methods: This was a matched retrospective observational study. The population included VLBW infants with IVH, who received positive pressure respiratory support between January 2014 and December 2016. Outcomes of infants with severe IVH was compared to those with mild IVH. Outcomes were further analysed according to mode of ventilation. Results: 150 infants were included in the study, 56 (37%) received continuous positive airway pressure (CPAP) only and 94 (63%) mechanical ventilation. Severe IVH was associated with surfactant therapy across both ventilation groups (p=0.03). Oxygen requirement at 28 days was more frequent in infants with severe IVH compared to mild IVH (79% vs 38%, p=0.01) (OR 6.11 (95% CI 1.19-31.34), p=0.03). Severe IVH and the presence of coagulopathy were the strongest predictors of death in both ventilation groups (p <0.0001). Pulmonary haemorrhage was the commonest cause of death in those with severe IVH and blood culture confirmed sepsis in those with mild IVH. Periventricular leukomalacia (PVL) was associated with severe IVH in those receiving invasive ventilation (OR 6.67 (95% CI 1.11-40.17)). Conclusion: Mechanical ventilation, coagulopathy and pulmonary haemorrhage were strongly associated with death in VLBW infants with severe IVH in a resource-limited setting. These prognostic factors may have a role in end of life decisions.