Social cognition is a broad construct that refers to the fundamental abilities to perceive, store, analyze, process, categorize, reason with, and behave towards other conspecifics (Pelphrey & Carter, 2008). Two important aspects of social cognition are the ability to perceive and interpret body movements (biological motion perception) and the ability to infer the mental states of others (theory of mind reasoning) (Allison, Puce & McCarthy, 2000). In my thesis, these and other aspects of social cognition are explored in a group known to be at high risk for poor social outcomes, namely children born prematurely at very low birth weight (VLBW: < 1500 grams). Results showed that 8-11 year old VLBW children had difficulties processing both realistic and stylized life motion displays. These impairments were associated with increased evidence of autistic-like traits. Finally, poor performance on tests requiring life motion perception was linked to complications related to premature birth. These results could inform the development of screening, diagnostic, and intervention tools.

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The objectives of this study were to determine the current rates of immunization and identify variables associated with immunizations of NICU graduates who were 60 days of age or older at time of discharge. This is a descriptive pilot study utilizing retrospective paper chart review. The relationships between immunization status and study variables were examined using logistic regression. Of 43 infants discharged at least 60 days of age or older from the NICU, 74.4% were up to date for immunizations in accordance with AAP recommendations. Additional variables were not significant. Immunization needs to be a priority in order to give NICU infants every advantage regarding their future health status.

Preterm low birth weight infants remain at risk of impaired growth and developmental delay in childhood, compared with full-term babies. The main aim of the research project was to devise and test a preterm infant feeding strategy (PIFS) for the time from hospital discharge until one-year gestation corrected age (GCA). The strategy recommended the early onset of weaning, the use of foods with a higher energy and protein content than standard milk formula and recommended foods, which are rich sources of iron and zinc. To assess the effectiveness of the preterm infant feeding strategy, 68 preterm infants, mean birth weight 1.47 (SD 0.43) kg and mean gestational age 31.3 (SD 2.9) weeks, were randomised to either the PIFS group (n=37) or a current best practice control group (n=31), for one year. Energy, protein and mineral intakes at three points, zero months GCA, six months GCA and twelve months GCA, were determined from 7-day weighed records. The infants were assessed anthropometrically at the same ages, and blood sampled twice to discover any differences in growth or nutrient status between the groups, which could be a consequence of dietary intake. Analyses of dietary, growth and biochemical data showed the following significant differences between the PIFS intervention group compared with the control group. Improvements in haemoglobin and serum iron levels at six months GCA; increased intakes of energy, protein and carbohydrate at six months GCA and iron at twelve months GCA; enhanced length growth velocity between zero and twelve months GCA. A significant positive effect of treatment on standard deviation length scores and catch-up length growth was also observed. PIFS significantly influenced dietary intakes with consequent beneficial effects on length growth and iron status. This novel strategy should be adopted as the basis of feeding guidelines for preterm infants after hospital discharge.

Physiological inflammation occurs in the female reproductive tract, but pathological inflammation is implicated in reproductive pathologies such as preterm labour and endometrial cancer. Preterm labour (PTL, before 37 weeks of gestation) is the leading cause of preterm birth, neonatal mortality and perinatal morbidities. Endometrial cancer is the commonest gynaecological cancer, and its pathogenesis is characterised by chronic inflammation. The overall aims of this thesis were (i) to develop an in vitro model of myometrial-monocyte interactions to replicate the events occurring in the myometrium in preterm labour (ii) to determine the effects of potential therapeutics such as lipoxins, IL-10 and progesterone, on inflammation, and (iii) to characterise the lipoxin pathway in endometrial adenocarcinoma. Macrophages infiltrate the pregnant myometrium during labour; however the role of these cells is unclear. A myometrial-monocyte coculture model was developed either using non-pregnant primary myometrial smooth muscle cells (UtSMCs), or immortalised pregnant human myometrial cells (PHM1-41), with primary monocytes from term (38-41 weeks of gestation), non-labouring pregnant women. Cultures were stimulated with the toll-like receptor 4 agonist lipopolysaccharide (LPS), in the presence or absence of each of lipoxins, IL-10 and progesterone. A significant and synergistic increase in IL-6 and IL-8 secretion was found in the UtSMC/monocyte coculture after stimulation with LPS for 24 hours, compared to LPS-treated UtSMCs, or monocytes alone, but the increase in IL-6 and IL-8 secretion was not inhibited by lipoxin, epi-lipoxin or benzo-lipoxin. The PHM1-41/monocyte coculture both alone and in response to LPS treatment generated significantly increased IL-6 and IL-8 secretion, compared to vehicle treatment in the coculture and compared to the culture of either cell type alone. IL-1β and TNFα secretion were only detected from the PHM1/monocyte coculture, and monocytes alone. Use of a TNFα blocking antibody partially suppressed LPS-induced IL-6 and IL-8 secretion in the coculture. Coculture of PHM1/monocytes resulted in increased secretion of multiple mediators including pro-inflammatory cytokines, chemokines and growth factors compared to culture of either PHM1 cells or primary monocytes separately, both with vehicle and with LPS. IL-10 inhibited LPS-induced IL-6 and IL-8 secretion from the coculture, as did progesterone, which also inhibited GM-CSF, MCP-1 and CXCL5 secretion. Myocyte contraction, measured by PHM1-41 cells embedded in collagen was increased by primary monocyte treatment. This suggests that not only do infiltrating monocytes increase myometrial inflammation but they can induce myometrial smooth muscle contraction. In endometrial adenocarcinoma, the lipoxin synthesis enzymes, ALOX-5 and -15 and FPR2 mRNA expression were upregulated compared to proliferative phase endometrium, with FPR2, a reported lipoxin receptor, immunolocalised in endometrial adenocarcinoma tissue. Additionally, TNFα treatment of Ishikawa endometrial adenocarcinoma cells increased FPR2 mRNA expression, and upregulation of FPR2 mRNA also occurred in xenograft tumours from CD1 nude mice, compared to the Ishikawa cells from which they originated. These findings highlight FPR2 expression in endometrial adenocarcinoma, and suggest this receptor could mediate inflammatory signals, and lipoxins could be produced by ALOX-5 and ALOX-15. Collectively, these data describe the novel effects of monocytes in the regulation of myometrial smooth muscle cell inflammation, and demonstrate a mechanism by which myometrial inflammation during both term and preterm labour is triggered by infiltrating macrophages. This myocyte/monocyte inflammation is regulated in part by TNFα, and can be suppressed by both IL-10 and progesterone co-treatment. Components of the lipoxin pathway are present in endometrial adenocarcinoma, but their role in regulation of inflammation is still to be elucidated. Future research to clarify the processes, by which leukocyte recruitment is regulated at labour and the role of monocyte/macrophages in altering myocyte properties, could help to elucidate the mechanisms coupling inflammation to labour and provide more appropriate targets for the treatment of PTL.

MCur / Department of Advanced Nursing Science / Introduction: During the provision of care to preterm babies, midwives encounter many problems and challenges which may vary according to the gestational age of the women, condition of the foetus, availability of equipment and resources, and experience of the midwives. In addition, poor working conditions, feelings of insecurity, staff shortage, and lack of support from the management and having to deal with parents who do not comply with the hospital management plan for their babies; all contribute to the problems faced by midwives. The purpose of this study was to determine challenges encountered by midwives when providing care to preterm neonates at selected hospitals in the Mopani District of Limpopo Province, South Africa. Methods: Qualitative research in this study was conducted in a natural setting at the selected hospitals. The target population was the midwives who have been working in maternity wards for at least two years and were on duty during the period of data collection. Non-random purposive sampling was used to select the participants. Data were collected using unstructured interviews, which were tape recorded and transcribed. The six steps as described by Creswell were used for data analysis. Trustworthiness was ensured by using the model of Lincoln & Guba that included credibility, dependability, confirmability and transferability. Ethical principles, namely, permission to conduct the study, informed consent from participants, privacy, confidentiality, autonomy, anonymity and respect were observed. Results: When midwives provide care to preterm babies they often encounter multiple challenges which can be human or material resource related. In his study, midwives were found to perform their duties in the face of multiple challenges, including staff vi shortages, which resulted in exhaustion of the available midwives. Nursing a preterm baby is a challenge on its own as these babies are likely to develop clinical problems related to immaturity, e.g., hypoglycaemia, hypothermia, jaundice, sepsis and respiratory distress. Mothers may be traumatised and find it difficult to accept their babies as they are, this leads to lack of cooperation in the care of the neonate and it becomes a problem for the midwives who are directly providing such care. The aforementioned challenges are related to all the four major concepts of human caring as described by Jean Watson which are health, human being, nursing and environment. Recommendations: It is recommended that further research be conducted on the same topic, but in a different setting to generate more knowledge. Policy makers should work together with health care professionals who are directly involved in the care of preterm babies to improve the practice of the contents in the policies. / NRF

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