Background: Extrauterine growth restriction (EUGR) is multifactorial in etiology and predisposes infants to multiple morbidities that can be significantly ameliorated by adequate nutrition and appropriate longitudinal growth. Current strategies to reduce the risk of EUGR include optimization of parental nutrition, varying schedules of feeding advances, and caloric supplementation. Very low birthweight (VLBW) preterm infants are particularly affected by EUGR, therefore ensuring adequate postnatal growth is an essential component in improving the long-term health outcomes for VLBW infants. The objectives of this observational study were to examine potential risk factors for growth failure among premature infants that did not respond to caloric and volume supplementation. Methods: We conducted a retrospective chart review of all infants born at the University of Massachusetts level III NICU from January 2016 to June 2020. Growth was tracked using PediTools electronic gestational age and growth calculators. (17) We reviewed the EMRs of infants who met the criteria for EUGR at the time of hospital discharge for a variety of potential factors affecting growth. Results: Overall, a total of 448 infants were screened with a final study cohort of 358 infants, of which 13% were discharge with EUGR. Analysis of demographic and clinical characteristics of infants with EUGR before and after nutritional intervention showed no statistically significant differences between the two cohorts. Pre-protocol, only weight percentiles and z-scores were statistically significant. Post-protocol, the change in z-score was also statistically significant. The only factor found to be statistically significantly different between was Necrotizing enterocolitis (NEC). Timing of EUGR in the pre-protocol groups occurred between 33-35 weeks, while in the post-protocol group EUGR occurred between 32 and 37 weeks (Figure 2). Conclusions: Our findings confirmed the presence of several factors that have been previously shown to increase risk for EUGR, including male sex, lower gestational age, lower birth weight, and the occurrence of NEC. It also identified an additional risk factor, that of being born “constitutionally small”. In the post-protocol cohort, the change in z-score was statistically significant in addition to birth weight percentile and z-score and discharge weight percentile in z-score. The window in which EUGR occurred as well as the interquartile range was significantly widened post-protocol. These data suggest that the volume supplementation protocol successfully addressed the causes of EUGR in some infants, but other mechanisms may have occurred in infants who were still discharged with EUGR post-protocol.

Background/Aims: This study aimed to analyze the effects of perinatal history on tear film properties and lid geometry in adults born preterm. Methods: The Gutenberg Prematurity Eye Study (GPES) is a German prospective examination of adults born preterm and term aged 18 to 52 years with Keratograph® 5M and Schirmer test I. Main outcome measures were first non-invasive tear film break-up time (F-NITBUT), bulbar redness (BR), Schirmer test, and nasal palpebral angle measurement. The associations with gestational age (GA), birth weight (BW), and BW percentile, retinopathy of prematurity (ROP), ROP treatment, and other perinatal factors were evaluated using regression analyses. Results: 489 eyes of 255 preterm and 277 eyes of 139 full-term individuals (aged 28.6 +/− 8.8 years, 220 females) were included. Of these, 33 participants (56 eyes) had a history of spontaneously regressed ROP and 9 participants (16 eyes) had a history of ROP treatment. After adjustment for age and sex, lower F-NITBUT (<20 s) was associated with ROP treatment (OR = 4.42; p = 0.025). Lower GA correlated with increased bulbar redness (B = −0.02; p = 0.011) and increased length of wetting in the Schirmer test (B = −0.69; p = 0.003). Furthermore, low GA was associated with narrowing of the nasal palpebral angle (B = 0.22; p = 0.011) adjusted for age and sex, but not when considering ROP in the multivariable model. Conclusion: Our analyses indicate that perinatal history affects ocular surface properties, tear production and lid geometry in adults born term and preterm. This might indicate that affected persons have a predisposition to diseases of the corneal surface such as the dry eye disease.

As medical advances are made in the area of neonatology, more and more premature babies are surviving at younger gestational ages and lower birth weights. Growth in the survival rates of preterm infants leads to questions regarding the long term developmental trajectory of these children. The current study sought to expand on research regarding dimensions of childhood functioning and to apply it to the problem of prematurity by (a) utilizing a new instrument: the Merrill Palmer Revised edition, (b) including children of preterm and full term birth statuses from as young as 2 months of age, and (c) collecting data from parental and clinician reports. In addition to attempts to clarify the relationship between birth status and childhood dysfunction, this study also sought to augment existing literature by exploring the correlation between parental report and clinician observation of childhood dysfunction. The results of this study did not support the hypothesis that children of preterm birth will demonstrate more problems in functioning when compared to full term peers. Although there were more significant differences between preterm and full term children in the older cohort group, those differences did not consistently reflect dysfunction by the preterm children. Additionally, this study considered dimensions of dysfunction as measured by parental report and clinician observations. Notably, a lack of agreement between parent and clinician observations emerged for the young age cohort group. However, the high level of agreement for the older children suggests that parental and clinician perspectives converge with older children. Contrary to the hypothesis, birth status, gender, ethnicity, and SES did not collectively form a specific risk index for dysfunction. However, these factors did interact with each other to predict functioning on several scales. In fact, there were no significant main effects. Instead, predictors of dysfunction were interactions of variables such as birth status, age, gender, and ethnicity. This general finding illustrates the importance of taking into consideration all aspects of the childs situation when making an assessment of functioning.

In New Zealand, approximately 10% of births are considered premature, that is less than 37 weeks gestation. With advances in medical technology, young infants are surviving gestation periods as few as 23 weeks. It is expected that many of these severely premature infants will demonstrate some problem in their academic, or cognitive function including language functioning. It is agreed that children who are born severely premature often present with language problems, the nature of the difficulties are not clear. Research examining language abilities that involve cognitive functions such as inference generation have demonstrated that children born prematurely exhibit difficulties with phonologic short-term memory and executive function. Language tasks such as inference understanding require children to integrate real-world knowledge with the linguistic information to generate and produce language that is more complex. The aim of this study was to discover if the language of children born severely premature differs from that of language-age matched peers. This study examined high-level language abilities of school-age children born severely prematurely, specifically, language tasks that involved executive functions including working memory, story inferencing, and recognising absurdities. Six children who were born less than 28 weeks gestation participated in this study. Their results on the above measures were compared to a language-aged matched comparison group, determined by performance on a standardised test. It was hypothesised that the children born severely premature would not differ from their language-age matched peers on measures of general language ability but differences would exist on measures of language processing and inferencing. The findings overall showed little difference between the preterm group and their language-age matched peers on measures except for the measure of chronological age. Although no group difference was found for the measure of working memory, a larger variance on this measure was observed in the preterm group.

O contexto da prematuridade traz para as mães muitas incertezas em relação ao desenvolvimento de seu bebê e às dificuldades específicas para a interação da díade pelas particularidades inerentes à condição do recém-nascido pré-termo (RNPT), envolvendo profunda adaptação da mãe a mudanças decorrentes da internação e da situação em que se encontra o recém- nascido. Diante da complexidade, a situação de prematuridade pode acarretar para a mãe um sofrimento que poderá desenvolver sentimentos desestruturantes em função das dificuldades acarretadas pela internação e prematuridade. Este estudo tem por objetivo geral analisar o acolhimento feito às mães de RNPTs hospitalizados em Unidade de Terapia Intensiva Neona- tal -UTIN, de um Hospital Amigo da Criança. Como objetivos específicos: Descrever os sentimentos vivenciados pela mãe do RNPT, na perspectiva do acolhimento em UTIN, no Método Canguru e na Casa da Gestante, no contexto de um Hospital Amigo da Criança em Passos- MG; Identificar estratégias de enfrentamento utilizadas pelas mães para lidar com situações causadoras de sentimentos e dificuldades no contexto de um Hospital Amigo da Criança em Passos-MG; Compreender como se dá a humanização de tal atenção, tendo em vista as inter-relações e também compreender de que forma os processos de acolhimento estabelecem relações com a humanização do cuidado nos diferentes ambientes da mãe, em tal contexto. Trata- se de um estudo exploratório e descritivo de abordagem qualitativa, pautado no conceito de humanização, para o processo analítico na modalidade de análise temática. Participaram da pesquisa mães de recém-nascidos pré-termo internados na UTIN de um Hospital Amigo da Criança, utilizando o critério de saturação teórica. Foi realizada, de forma individual, uma entrevista semiestruturada, gravada em áudio e, após a transcrição, foram identificadas três categorias de análise e subcategorias, a partir das verbalizações das participantes. 1- O impacto da separação súbita após o nascimento: A mãe diante do processo de internação: preocupando-se com o filho e A incerteza da sobrevida: apoiando-se na espiritualidade; 2- Vivenciando o Método Canguru: Permanecendo perto do filho na vivência do Método Canguru, Restrições na vivência do Método Canguru; Sentindo-se impotente e desamparada e tendo outros filhos; Permanecendo perto do filho na vivência do Método Canguru; 3- Casa da Gestante:Recebendo apoio e aprendizado: Conversando com outras mães: trocando experiências, Apoio do PROMAI e Tendo apoio da equipe de enfermagem. Conclui-se que, ainda que se esteja em um Hospital Amigo da Criança, munido de estratégias que visem à humanização do cui- dado, se faz premente a necessidade de um modelo que caracterize o acolhimento, centrado nos interesses das usuárias, e que vise à organização do trabalho, com vistas à escuta e à reso- lução de demandas em saúde / Prematurity context brings mothers a lot of uncertainties regarding her baby\'s development, specific difficulties for the interaction of the dyad by peculiarities inherent to the pre-term newborn babies (PTNB), involving a mother\'s real adaptation to changes due to the hospital admittance and the situation in which the newborn baby meets. Before the complexity, prema- turity may bring the mother a lot of suffering, which may develop dismantled feelings due to the difficulties brought by hospital admittance and prematurity. The study has the objective of analyzing the mothers\' embracement of hospitalized PTNB in a Neonatal Intensive Care Unit (NICU) of a Baby-Friendly Hospital. It has the specific objectives: Describe the mother\'s feelings when embracing at the NICU, in the Kangaroo Premature Baby Care Method and Pregnancy House in the context of a Baby-Friendly Hospital in Passos/MG, identify facing strategies used by mothers to deal with situations causing feelings and difficulties in the con- text of a Baby-Friendly Hospital in Passos/MG, understand how humanization occurs, con- sidering the inter-relations, and also understand how the embracing processes relate with care humanization in the different environments the mother is inserted. It is a descriptive explora- tory study with qualitative approach, based on the concept of humanization, for the analytic process in thematic analysis methodology. Using the theoretical saturation criterion, mothers of pre-term newborn babies admitted in the NICU of a Baby-Friendly Hospital participated in the survey. A semi-structured interview was conducted individually, recorded in audio and after transcribing it, three categories of analysis and subcategories were identified through the participations. 1. The impact of the sudden separation after birth: the mother regarding the admittance process, worrying about her child and the uncertainty of survival: having the spir- ituality as a support; 2. Experiencing the Kangaroo Premature Baby Care Method and staying near the child while the baby is experiencing it, restrictions about the experience with the Kangaroo Method, the mother feeling impotent and unprotected and having to care for other children; staying near the child experiencing the Kangaroo Premature Baby Care Method; 3. Pregnancy House: receiving support and learning: talking to other mothers: exchanging expe- riences. Support from the Mother-Infant Program (PROMAI) and from the nursing team. It is concluded that, even in a Baby-Friendly Hospital, provided with strategies aiming at care hu- manization, there is still the need for a model to characterize the embracement, centered at the users\' interests, with the objective of organizing the work, listening to and trying to solve the demands about health

Introduction: Preterm birth is increasing worldwide and is a major cause of neonatal death. Survivors are at increased risk of neurodisability, cognitive, social and psychiatric disorders in later life. Alterations to the white matter can be assessed using diffusion tensor imaging (DTI) MRI and are associated with poor neurodevelopmental outcome. The pathogenesis of white matter injury is multifactorial and several clinical risk and resilience factors have been identified. DNA methylation (DNAm) is an epigenetic process which links stressful early life experience to later life disease and is associated with normal brain development, neuronal processes and neurological disease. Several studies have shown DNAm is altered by the perinatal environment, however its role in preterm white mater injury is yet to be investigated. Aims: 1. To examine the relationship between preterm birth and white matter integrity 2. To investigate the effect of neuroprotective treatments and deleterious clinical states on white matter integrity in preterm infants 3. To assess the best DTI method of quantifying white matter integrity in a neonatal population 4. To investigate the effect of preterm birth on DNA methylation and 5. To determine the clinical and imaging factors that contribute to the variance in DNA Methylation caused by preterm birth Methods: DTI data was acquired from preterm infants (< 32 weeks' gestation or < 1500 grams at birth) at term equivalent age (TEA) and term controls (> 37 weeks' gestation at birth). Region-of-interests (ROI) and tract-averaged methods of DTI analysis were performed to obtain measurements of fractional anisotropy (FA) and mean diffusivity (MD) in the genu of corpus callosum, posterior limb of internal capsule and centrum semiovale. Clinical data was collected for all infants and the effect of prematurity, neuroprotective agents and clinical risk factors on white matter integrity were analysed. 8 major white matter tracts were segmented using probabilistic neighbourhood tractography (PNT), a tract-averaged technique which also allowed the calculation of tract shape. The two DTI techniques were compared to evaluate agreement between results. DNA was collected from preterm infants and term controls at TEA, and a genome-wide analysis of DNAm was performed. DTI parameters from probabilistic neighborhood tractography (PNT) methodology and clinical risk and resilience factors were used to inform a principal components analysis to investigate the contribution of white matter integrity and clinical variables to variance in DNAm. Results: FA and MD were significantly affected by preterm birth on ROI analysis. In addition, DTI parameters were affected by clinical factors that included antenatal magnesium sulphate, histological chorioamnionitis and bronchopulmonary dysplasia. Evaluation of DTI methodology revealed good accuracy in repeated ROI measurements but limited agreement with tract-averaged values. Differential methylation was found within 25 gene bodies and 58 promoters of protein-coding genes in preterm infants, compared with controls. 10 of these genes have a documented association with neural function or neurological disease. Differences detected in the array were validated with pyrosequencing which captured additional differentially methylated CpGs. Ninety-five percent of the variance in DNAm in preterm infants was explained by 23 principal components (PC); corticospinal tract shape associated with 6th PC, and gender and early nutritional exposure associated with the 7th PC. Conclusions: Preterm birth is associated with alterations in white matter integrity which is modifiable by clinical risk factors and neuroprotective agents. ROI analysis may not provide sufficient representation of white matter tracts in their entirety. Prematurity is related to alterations in the methylome at sites that influence neural development and function. Differential methylation analysis has identified several promising candidate genes for future work and contributed to the understanding of the pathogenesis of preterm brain injury.

A research report is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Sciences in Child Health Johannesburg, 2016 / Background: Leratong Hospital is a regional hospital in the West Rand of Johannesburg, South Africa. Statistics from maternity in 2008 showed high utilisation rates for delivery services at Leratong but a study on neonatal mortality was not yet done. It was therefore essential to measure and analyse the causes of new-born deaths so as to have policies to advance neonatal care. Objectives: To determine the neonatal mortality rate (NMR), the major neonatal causes of death and the occurrence of avoidable health factors. Methods: This was a prospective review of the clinical records of the 46 neonates who died within the 3 month period (15th April 2013 to the 15th July 2013). Data was obtained from neonatal admission and death registers. Information on the number oflive births was obtained from labour ward registers. Delegation books for nurses were checked to determine the number of nursing staff per shift as well as their allocation in different rooms. Neonate's age, birth weight, gender, race, place of origin, reason for admission and cause of death, were analysed. Health factors examined were access to high care services and to the neonatal ICU, number of staff on duty and the use of treatment guidelines. Questionnaires were used to collect information, and the consent to use clinical records was obtained from the mothers. Descriptive statistics were used to describe the frequencies and percentages of variables. Logistic regression of variables was applied to predict mortality. Results: The overall neonatal mortality rate at Leratong Hospital was lower than the rates found in South Africa and other studies in sub-Saharan Africa. Almost 37% of neonates died within 24 hours of admission. The three most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than sixty per cent of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low birth weight neonates. A critical staff shortage (nurse: neonate rati02.: 1:10) was the most common modifiable factor (63% of deaths). Thirty seven per cent of neonates were denied access to ICU. The significant predictors of neonatal death were being born preterm (OR: 3.1, 95% CI 1.7-6.0), extremely low birth weight (OR: 27.5,95% CI 8.2-92.6), very low birth weight (OR: 5.0, 95% CI 2.1-12.3) and birth by caesarean section (OR: 3.2, 95% CI 1.6-6.2). Conclusions: The study found the neonatal mortality rate at Leratong Hospital in 2013 to be lower than rates recorded in South Africa. Our results showed that the most common causes of neonatal mortality were similar to those in other hospitals in sub-Saharan Africa and in South Africa. A high number of neonatal deaths were avoidable by providing high care services (including NCP AP and surfactant) and adequate number of nurses trained in newborn care in the admission room, improving access to neonatal ICU, early detection of perinatal asphyxia and improved neonatal resuscitation, and the supervision of medical doctors. / AC2016

No description available.

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.

Children born prematurely are at higher risk for medical, learning and developmental concerns than children born full term. This study analysed the files of 73 pre-term children who completed an Assessment and Monitoring programme in New Zealand between 1998 and 2007. The participants were 39 boys and 34 girls with gestational ages ranging from 23 weeks to 32 weeks at birth and who attended the programme until they were 4 years chronological age. Analysis of the reports sent to paediatricians following the children’s monitoring visits at 8 months, 12 months, 18 months, 24 months and 36 months (corrected age) and at 48 months, chronological age indicated delays in achieving the expected developmental milestones in expressive language, cognition and gross motor skills for up to half of the cohort. Moreover, the findings further suggest that a ‘sleeper effect’ or ‘invisible prematurity’ emerged for up to half of the cohort at age 36 months. This ‘invisible prematurity’ and the developmental delay in cognition, expressive language and gross motor skills have implications for early childhood teachers as teachers need to develop an awareness of, and skills to identify and work effectively with these young children and their families. Practical teaching and learning strategies are presented for teachers.