Aim: The aim of the study was to compare knowledge and attitudes towards Kangaroo Mother Care (KMC) among neonatal unit staff at two neonatal units 2008 and 2010. Method: Members of staff from two neonatal units completed a questionnaire with 22 statements and an open-ended question in 2008 and 2010. The data were analysed with Mann-Whitney U test and content analysis. Results: There were significant differences between unit A and unit B in both the 2008 survey and the 2010 survey, showing better knowledge of KMC and a more positive attitude to KMC in unit A. Content analysis of responses to the open-ended question revealed concerns in unit B that its care environment was not suitable for KMC. Conclusions: Hypothetically, the fact that staff in unit A work in facilities designed to facilitate KMC, receive training in KMC and practice continuous KMC in intensive care as well as in intermediate care, has resulted in good knowledge of KMC and a general improvement of staff attitudes to KMC.

Objective: To describe the breastfeeding characteristics of late-preterm infants (LPIs) in a kangaroo mother care unit (KMC). Materials and methods: In a 20-bed KMC unit, the breastfeeding of 73 purposively-selected LPIs’ (mean gestational age: 34.8 weeks) was observed once-off, using the Preterm Infant Breastfeeding Behavior Scale. Participants’ mean age was 9.5 days, mean number of days in the unit was 3.1 days, and mean number of days breastfeeding was 7.5 days on observation. Results: Only 13.7% of participants were directly breastfeeding without supplementary tube-feeding/cupfeeding and 86.3% received supplementary cup-feeding of expressed breast milk. Most participants did not exhibit obvious rooting (83.5%) and although most latched-on (97.3%), those who did, latched shallowly (93%). The mean longest sucking burst was 18.8 (SD: 10.5) and approximately half the participants swallowed repeatedly (53.4%). The mean breastfeeding session duration was 17.8 minutes but most participants breastfed less than 10 minutes (76.7%). No statistically significant associations were found between chronological age and breastfeeding characteristics. A general trend towards more mature behaviors in participants breastfeeding for more days was present for many breastfeeding characteristics. More infants exhibited the most mature behavior for each breastfeeding characteristic when the environment was quiet, rather than noisy and disturbing, except for depth of latching (quiet: 0%, disturbance: 15.2%). Conclusion: LPIs in this sample presented with subtle, moderate breastfeeding difficulties, highlighting their need for breastfeeding support. Further research is required to examine the effect of KMC on breastfeeding in LPIs. / Dissertation (MA)- University of Pretoria, 2017. / Speech-Language Pathology and Audiology / MA / Unrestricted

Preterm birth (< 37 weeks gestation) is a major health burden for affected children. Although the risk of health problems increases as the gestational age decreases, research in the last decades has revealed that even late preterm infants born at 34-36 weeks gestational age have higher mortality and morbidity than term infants. Because late preterm infants constitute three fourths of preterm infants, they are important from both public health and health policy perspectives. This doctoral thesis sought to answer important knowledge gaps in health service utilization of late preterm infants via three studies. Study A, a systematic review and meta-analysis comparing health service utilizations of late preterm infants with those of term infants, found that late preterm infants had increased hospitalization compared with term infants that persisted from the neonatal period through adolescence. Study B is a cohort study evaluating the re-admissions and emergency department visits by late preterm and term singletons and twins for the first 5 years after birth. Study B demonstrated that late preterm infants had higher re-admission rates than term infants although differences in twins were less pronounced than in singletons. Study C is a population-based cohort study with cost analyses assessing the health care costs and resource utilization related to three different discharge timings of late preterm and term singletons: early (< 48 hours), late (48-71 hours), and very-late (72-95 hours) discharge after birth. Study C found that early discharge was not associated with the reduction of health care cost in late preterm infants, and instead was associated with an increase in the cost in term infants over the first year after birth. These findings are useful for parents, care providers, health policy makers, and guideline developers to provide optimal care for late preterm infants. / Thesis / Doctor of Philosophy (PhD)

Smooth tracking and efficient reaching for moving objects require the ability to predict the velocity and trajectory of the object. This skill is important to be able to perceive human action and object motion in the world. This thesis explores early visual motor development in full term and preterm infants. Study I showed that horizontal eye tracking develops ahead of vertical (full term infants at 5, 7 and 9 months of age). The vertical component is also more affected when a second dimension is added during circular pursuit. It is concluded that different mechanisms appear to underlie vertical and horizontal eye movements Study II-IV compared the development of the ability to visually track and reach for moving objects in very preterm infants born &lt;32 gestational weeks to healthy infants born at term. The development of horizontal smooth pursuit at 2 and 4 months of corrected age was delayed for the preterm group (Study II). Some infants were catching up whereas others were not improving at all. A question raised by the results was whether the delay was caused by specific injuries as a result of the prematurity. However, the delays persisted when all infants with known neonatal complications and infants born small for gestational age were excluded (Study III), indicating that they were caused by prematurity per se. At 8 months corrected age preterm and full term infants were equally good at aiming reaches and successfully catching a moving object. Nevertheless, the preterm group used a bimanual strategy more often and had a more jerky and circuitous path than the full term group (Study IV). In summary, preterm infants showed a delayed visual motor development compared to infants born at term. The results of these studies suggest that there is additional diffuse damage to the visual motor system that is not related to neonatal complications as diagnosed today. Measuring smooth pursuit could potentially be a new method for early non-invasive diagnosis of impaired visual function.

The UK currently has the highest number of premature births (babies born before 37 weeks gestation age and below 2.5kg) in Europe affecting around 70,000 babies and their caregivers each year. Consequently many interventions have been created to support the development of the preterm newborn and minimise the complications of prematurity. Many of the interventions developed have been predominantly tactile and have almost exclusively focused upon their effect upon the baby and not, for example considered the effect that this type of intervention might have upon the parents; specifically the mother, when they are the ones who perform the therapy. In fact there is a severe lack of systematic studies investigating the latter. Hence, the aim of this thesis was to search for research-based evidence on the benefits of environmental support to both babies (e.g. increased weight gain or awake periods) and their mothers (e.g. higher perceptions of themselves as a mother) during hospital confinement and within the context of Neonatal Health Psychology (NNHP). For this reason, the main hypothesis investigated whether mothers’ cognitions and emotions; specifically Maternal Self-Efficacy, Self-Esteem and Attachment, would be affected by environmental mediators in the form of structured or non-structured tactile sensory nurturing interventions. The empirical work reported in this thesis is divided into 3 distinct phases. Firstly, as their was no appropriate measure of maternal Self-Efficacy for mothers of hospitalised preterm neonates the main aim of Phase-1 was to develop and validate an appropriate measure. Using a prospective survey method and a mixed design (between/within and correlational) a total of 160 mother-preterm dyads (pooled from 2 cohorts; cohort 1, N=100; cohort 2, N=60) were recruited. The results demonstrated that the Perceived Maternal Parenting Self-Efficacy (PMPS-E) tool had good initial psychometric properties (including internal/external reliability and construct validity) for its use with mothers of relatively healthy hospitalised preterm neonates. Secondly, in order to investigate mothers’ perceived maternal parenting self-efficacy beliefs further Phase-2 examined whether the type of feeding a mother chose to give to her baby mediated her self-efficacy beliefs. The results suggested that breastfeeding a preterm neonate during hospital confinement may adversely affect mothers’ perceptions of their efficacy in all aspects of parenting. Finally, using an experimental method Phase-3 tested the main hypothesis of this thesis and used a randomised cluster control trial (RCCT) design to allocate 60 mothers and their preterms equally to one of three cluster groups; consisting of either structured (e.g. TAC-TIC therapy or Using a Toy) or non-structured (Placebo/Control) tactile sensory nurturing interventions. The main findings illustrate that tactile sensory nurturing interventions do mediate maternal cognitions and emotions, preterm weight gain and behavioural state. In particular, mothers who performed TAC-TIC demonstrated significantly higher self-reported perceptions in their self-efficacy, self-esteem and attachment, which was attributed to the fact that these babies spent increased amounts of time in an alert and responsive behavioural state, and gained more weight throughout the study period. Thus, the work presented throughout this thesis has implications for Neonatal Health Psychologists and other Health Care professionals’ practice within neonatal units, the use of Neonatal Health Psychology as a framework to study the preterm neonate and their family, and also the way in which both mothers and their hospitalised preterm neonates are supported during hospital confinement.

The experience of becoming a mother is a personal and social experience influenced by individual characteristics, friends and family, and the infant. The journey to become a mother encompasses concepts of maternal competence and responsiveness. The purpose of this study was to examine maternal competence and responsiveness to the infant in mothers of late preterm infants compared to mothers of full term infants. The conceptual model for this work was based on the work of Reva Rubin describing maternal identity and role development. Maternal competence and responsiveness are components of maternal role and are influenced by social support, maternal self-esteem, well-being, stress and mood. In addition, infant temperament and perception of infant vulnerability influence development of maternal competence and responsiveness. A non-experimental repeated measures design was used to compare maternal competence and responsiveness in two groups of postpartum mothers. One group consisted of mothers of late preterm infants 34-36, 6/7 weeks gestation. The second group consisted of mothers of term infants, >/=37 weeks gestation. Both primiparas and multiparas were included in the study. Data was collected in the initial postpartum period prior to discharge from the hospital and again at six-weeks postpartum. No statistically significant differences in development of maternal competence or responsiveness between mothers of LPIs and term infants were identified. This study adds to our knowledge concerning outcomes of mothers of late preterm infants and development of competence and responsiveness.

Submitted by Maria Aparecida (cidazen@gmail.com) on 2017-04-24T13:10:02Z No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) / Made available in DSpace on 2017-04-24T13:10:02Z (GMT). No. of bitstreams: 1 Marianne de Carvalho Rodrigues.pdf: 783432 bytes, checksum: 47b0cab16ad64cf53837adef47c49034 (MD5) Previous issue date: 2017-02-10 / FAPEMA / Breast milk (LM) is the best food for the child, especially in the first six months of life, because it contains fats, vitamins, minerals, immunoglobulins and other nutrients necessary for the maintenance, growth and development of the children. For preterm newborns (PTNBs), breastfeeding has also been the main food indication, both in the hospital setting and after discharge. Breastmilk supplementation has been highly recommended for the nutrition of PTNB and of very low birth weight, since it has been shown to be effective in providing calories and nutrients that may be below the needs of these children in their mothers' milk, for proper growth of the neonate. However, there is no consensus as to how best to feed these children after discharge. Given the conditions to which PTNBs are exposed and that breastmilk has components that can provide a better growth for the baby, this study intends to compare the growth among PTNBs and very low birth weight infants from the Neonatal Intensive Care Unit exclusively breastfed up to 6 Months of age with those not exclusively breastfed during this same period. Cohort study, conducted at the University Hospital of the Federal University of Maranhão, Unidade Materno Infantil, using data from the children followed up at the Follow-up service of Neonatology. For data collection, a form was constructed with the variables of interest, socio-demographic variables and growth variables of the children. The sample consisted of 174 individuals compared to the type of feeding and anthropometric measures of growth at six months of corrected gestational age. / O leite materno (LM) é o melhor alimento para a criança, principalmente nos seis primeiros meses de vida, por ter, em sua composição, gorduras, vitaminas, minerais, imunoglobulinas e demais nutrientes necessários à manutenção, crescimento e desenvolvimento desta. Para os recém-nascidos pré-termo (RNPT), o aleitamento materno também tem sido a principal indicação alimentar, tanto em ambiente hospitalar quanto após a alta. A suplementação do leite materno tem sido bastante recomendada para a nutrição dos RNPT e de muito baixo peso, pois tem se mostrado eficaz em prover calorias e nutrientes que podem estar aquém das necessidades destas crianças no leite de suas mães, contribuindo, desta forma, para o crescimento adequado do neonato. Porém, não se tem um consenso de qual a melhor forma de alimentar essas crianças após a alta hospitalar. Dadas as condições às quais os RNPT estão expostos e que o leite materno possui componentes que podem propiciar melhor crescimento ao bebê, este estudo pretende comparar o crescimento entre RNPT e de muito baixo peso egressos de Unidade de Terapia Intensiva Neonatal, amamentados exclusivamente até os seis meses de idade com aqueles não amamentados de forma exclusiva neste mesmo período. Estudo de coorte, realizado no Hospital Universitário da Universidade Federal do Maranhão, Unidade Materno Infantil, utilizando dados das crianças acompanhadas no Follow-up do Serviço de Neonatologia. Para coleta de dados foi construído um formulário com as variáveis de interesse, sócio demográficas e variáveis de crescimento das crianças. A amostra foi composta por 174 indivíduos comparados quanto ao tipo de alimentação e medidas antropométricas de crescimento aos seis meses de idade gestacional corrigida.

<p>The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. </p><p>For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. </p><p>The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV).</p><p>In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants. </p>

The overall aim of this thesis was to expand the knowledge and understanding of the processes of breastfeeding and becoming a mother in mothers of preterm infants. For this purpose, in-depth interviews were conducted with 25 mothers, whose very preterm infants had received care in seven neonatal units (NU) in Sweden, 1-12 months after discharge (I-II). In addition, prospective population-based register studies were performed of infants born 1993-2001; among 35 250 term and 2093 preterm infants (III), and a subpopulation of 225 very preterm infants (IV). Data were obtained from the Child Health Service registry of breastfeeding in Uppsala and Örebro, the Medical Birth Registry, and Statistics Sweden. The experiences of mother-infant separation, institutional authority, emotional exhaustion and disregard of breastfeeding as a relational interplay, comprised major hindrances to mothers’ experiences of breastfeeding as reciprocal and of a secure mother-infant relation, during and after the discharge from an NU (I-II). All studied socioeconomic factors, i.e. lower educational level, receiving unemployment benefit or social welfare or having a low equivalent disposable income, were individually adversely associated with breastfeeding up to six months of infants’ postnatal age, but were not found more decisive for weaning in mothers of preterm infants compared to those of term infants (III). Preterm infants were breastfed for a shorter time than term infants (III), but a long breastfeeding duration was evident. In addition, gestational age and neonatal disorders were not associated with breastfeeding duration in very preterm infants (IV). In conclusion, this thesis shows that improvements in the NU environment and the caring paradigm are called for. Furthermore, as socioeconomic status clearly has an impact on breastfeeding duration, increased equity in health care in accordance with the individuals’ needs must be sought, where resources are allocated to ensure fulfilment of needs in more vulnerable mothers and infants.

Feeding problems in preterm neonates stem from complications of early delivery. Attainment of independent feeding is a prerequisite for Neonatal Intensive Care Unit (NICU) discharges. Some quantitative studies of infant feeding involve excessive amounts of time for data processing. Multivariate spectral analysis was used to minimize time for investigation of variability in these rhythms. Auto and Cross-spectral parameters of the rhythms were correlated with Gestational Age (GA), Postmenstrual Age (PMA), Birthweight (BW), Days of Life (DOL), and Time Since First Nipple feeding (TSFN). Auto-spectral analysis showed 25.55% increase in Bandwidth of suck (bw-su) for a 2-week increase in GA (DOL fixed) and 8.99% increase in bw-su for a 10-day increase in DOL (GA fixed). Crossspectral analysis showed a decrease of 0.158Hz of Bandwidth of Suck-Swallow (bw-SS) for a 2-week increase in GA for GA later than 28 weeks. For GA earlier than 28 weeks, peak coherence decreased by 0.774 for a 2-week increase in GA (PMA fixed) and decreased by 0.126 for a 2-week increase in PMA (GA fixed). The method describes the progression of feeding rhythms through correlations with clinical indexes, thus providing clinicians with an understanding of the development of infant feeding and helps predict long-term developmental outcomes.