Thesis (M.S.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / Source: Masters Abstracts International, Volume: 46-04, page: 2056. Adviser: Maureen Sanderson. Includes bibliographical references.

Neonatology is a branch of medicine which consists of the medical care not only of healthy newborn infants, but also of the ill or premature ones. The number of the premature born infants increases constantly worldwide. It might be caused by women postponing their pregnancies, and very likely also by the growing number of pregnancies achieved by the assisted reproductive technologies. Thanks to improvements in perinatal care of risk pregnancies, guiding preterm labour, and development of neonatal intensive care, it has become possible to save more infants born at the very margin of viability with an extremely low birth weight. The diagnostic, therapeutic and nursing techniques have been developing steadily. It's the methods providing maximum comfort for the child and ensuring the quality of their later life that have been put into forefront. They are a set of measures, which do not disturb the child's reflex behaviour; they support its physiological stability, and thus foster growth and development of the immature organism. The aim of this diploma work is to map the specific needs of the newborn infants with an extremely low birth weight, to find out how these needs are satisfied during the first days after birth, and to determine, how the nursing care supporting the development of the infants takes place in the real life. The theoretical part of the diploma work is based on the scientific papers and resources. The empirical part is based on an observation method, which was carried out at the Neonatal Intensive Care Unit of the University Hospital in Pilsen. The survey proved that the infants' needs are not only on the biological level, but also on the emotional level, and they need appropriate sensomotoric stimulation. The outcomes of the observation show that the greatest problem of the newborn infants with an extremely low birth weight is to satisfy the biological needs i.e. breathing, feeding and defecation. The need of safety and stimulation was satisfied only partly. Based on the information collected by observing the nursing staff, it was possible to lay out areas with a potential to improve the individualized care of the newborns with an extremely low birth weight. These are, above all, the increased level of noise at the unit and thus the sense of sleep and wakefulness of the infants. Furthermore, it's the stimulation of the children and the communication with the parents. The outcomes of the empirical part of this diploma work will be presented at the seminar of the perinatal centre.

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Submitted by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-10-11T13:39:02Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO DANIELLE LATGE.pdf: 794878 bytes, checksum: 5cca76d4644dc8468ea35e9fb8e4dc67 (MD5) / Approved for entry into archive by Ana Lúcia Torres (bfmhuap@gmail.com) on 2017-10-11T13:39:16Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO DANIELLE LATGE.pdf: 794878 bytes, checksum: 5cca76d4644dc8468ea35e9fb8e4dc67 (MD5) / Made available in DSpace on 2017-10-11T13:39:16Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) DISSERTAÇAO DANIELLE LATGE.pdf: 794878 bytes, checksum: 5cca76d4644dc8468ea35e9fb8e4dc67 (MD5) Previous issue date: 2015 / Universidade Federal Fluminense. Hospital Universitário Antonio Pedro / Corpo de Bombeiros Militar do Estado do Rio de Janeiro / Atualmente, pode-se perceber um crescente aprimoramento na atenção prestada aos recém-nascidos de maneira geral e, de modo particular, aos recém-nascidos prematuros. É nítido o aumento da sobrevida de recém-nascidos, cada vez mais prematuros, em diversos lugares do mundo, incluindo o Brasil, o qual leva a diminuição dos limites de viabilidade. Diante de um cenário incerto, da possibilidade de graves sequelas e de sofrimento para o recém-nascido e sua família, a reanimação na sala de parto de um recém-nascido no limite de viabilidade envolve inúmeras questões bioéticas. Este estudo consistiu numa pesquisa qualitativa, na qual foram realizadas entrevistas semiestruturadas (em anexo) com os médicos da UTI neonatal de um Hospital de Ensino na Região Metropolitana do Rio de Janeiro que realizam salas de parto. Foram analisados aspectos relacionados à prática da assistência neonatal em sala de parto aos recém-nascidos extremamente prematuros, objetivando compreender os fatores associados à conduta médica diante destes recém-nascidos sob a ótica da bioética. O propósito deste trabalho é o de conhecer e analisar os valores éticos e/ou argumentos morais que embasavam a conduta médica ante ao nascimento de um recém-nascido no limite de viabilidade / Currently, it can be seen a growing improvement in the care provided to newborns in general and, particularly, to premature infants. It is clearly increased newborn survival of increasingly premature, in various parts of the world, including Brazil, which leads to decreased viability limit. Faced of an uncertain scenario, the possibility of serious consequences and suffering for the newborn and his/ her family, resuscitation in the delivery room of a newborn in the limit of viability involves numerous ethical issues. This study was a qualitative research in which semi-structured interviews with the doctors at the neonatal ICU of the University Hospital in a Metropolitan Region of Rio de Janeiro, who perform delivery rooms, were realized. There were analyzed practices related to aspects of neonatal care in the delivery room to extremely premature newborn, aiming at understanding the factors associated to medical management before these newborns from a bioethics perspective. The purpose of this work is to understand and analyze the ethical values and / or moral arguments which were based on a medical management before the birth of a newborn in the limit of viability

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-12-15T14:26:56Z No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-12-15T14:39:16Z (GMT) No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) / Made available in DSpace on 2016-12-15T14:39:16Z (GMT). No. of bitstreams: 1 hericasilvadutra.pdf: 3223242 bytes, checksum: 250a7a107719f5970fd463ae5025faf6 (MD5) Previous issue date: 2010-03-19 / Um aumento na sobrevida de recém-nascidos cada vez mais imaturos tem sido observado em consequência dos avanços em neonatologia. Crianças de muito baixo peso ao nascer (MBPN) e extremo baixo peso ao nascer (EBPN) podem apresentar como desfechos complicações a curto e longo prazo devido à assistência intensiva no período neonatal, o que pode determinar alterações em sua qualidade de vida (QV). Os objetivos foram avaliar a QV de crianças nascidas MBPN e EBPN a partir da utilização de questionário validado; descrever domínios incluídos no instrumento e estabelecer um perfil de satisfação da criança a partir do autorrelato e da perspectiva de seus responsáveis. Foram avaliadas 40 crianças e 45 responsáveis selecionados a partir dos dados do serviço de follow-up do HU-UFJF. A QV foi avaliada a partir do AUQUEI. Outros dados de interesse foram obtidos a partir de avaliação dos prontuários e inquérito direto ao responsável pela criança. A idade das crianças variou de 3 a 7 anos. O peso médio, ao nascer, foi 1173,13 (± 222,84). A idade gestacional variou de 24 a 33 semanas (29,40 ± 2,08). A QV média na avaliação das crianças foi de 49,75 (± 5,973) e na avaliação dos responsáveis 49,24 (± 6,675). A correlação entre os escores totais de crianças e responsáveis obteve intensidade de nível razoável (Correlação de Pearson = 0,391 / p = 0,013). Entretanto, a classificação final da QV (prejudicada x satisfatória), obteve concordância pobre (índice de Kappa = 0,143 / p = 0,457). A QV de crianças nascidas MBPN e EBPN foi considerada satisfatória na perspectiva delas mesmas e de seus responsáveis. A concordância entre os escores das crianças e seus pais foi alta. Entretanto a classificação em QV satisfatória e prejudicada teve concordância pobre, o que reforça a importância de valorizar o auto-relato de crianças e adicionar a perspectiva dos pais na avaliação da QV. O domínio lazer foi considerado o componente mais importante da QV na infância pelas crianças e responsáveis. / An increase in the number of more immature newborn survivors has been observed due to neonatology advances. Children born very low birth weight (VLBW) and extremity low birth weight (ELBW) can present as outcomes complications at short and long time, due to intensive care assistance in the neonatal period, what can determine alterations in their quality of life (QoL). This study aims: to evaluate the QoL of children born VLBW and ELBW using a validated questionnaire; to describe domains included in the instrument and to establish a satisfaction profile of the child using self-report and parent proxy-report. 40 children and 45 parents were selected from data at the follow-up service of the HU-UFJF. The QoL was evaluated using the AUQUEI. Other interest data had been collected from follow-up records and direct inquiry to the responsible one for the child. The age of the children varied from 3 to 7 years. The average birth weight was 1173,13g (± 222,84). The gestacional age varied from 24 to 33 weeks (29,40 ± 2,08). The QoL score in the self-report was 49,75 (± 5,973) and in the proxy-report was 49,24 (± 6,675). The correlation between the total scores of children and parents has got intensity of reasonable level (Correlation of Pearson = 0,391 / p = 0,013). However, the QoL final classification (damaged x satisfactory), got poor agreement between them (index of Kappa = 0,143 / p = 0,457). The QoL of children born VLBW and ELBW was considered satisfactory in the self-report and proxy-report. The total scores agreement between them were high, however the classification in satisfactory / damged QoL had poor agreement, what strengthens the importance to evaluate the self-report and to add the proxyreport of the QoL. The domain leisure was considered the most important component of the QoL in childhood by self and proxy-report.

Ensemble models have proved effective in a variety of classification tasks. These models combine the predictions of several base models to achieve higher out-of-sample classification accuracy than the base models. Base models are typically trained using different subsets of training examples and input features. Ensemble classifiers are particularly effective when their constituent base models are diverse in terms of their prediction accuracy in different regions of the feature space. This dissertation investigated methods for combining ensemble models, treating them as base models. The goal is to develop a strategy for combining ensemble classifiers that results in higher classification accuracy than the constituent ensemble models. Three of the best performing tree-based ensemble methods – random forest, extremely randomized tree, and eXtreme gradient boosting model – were used to generate a set of base models. Outputs from classifiers generated by these methods were then combined to create an ensemble classifier. This dissertation systematically investigated methods for (1) selecting a set of diverse base models, and (2) combining the selected base models. The methods were evaluated using public domain data sets which have been extensively used for benchmarking classification models. The research established that applying random forest as the final ensemble method to integrate selected base models and factor scores of multiple correspondence analysis turned out to be the best ensemble approach.

Thesis (M.Med. (Paediatrics and Child Health)) -- University of Limpopo, 2019 / Objectives To determine the prevalence and survival rate; and to assess the maternal risk factors as well as complications of prematurity, associated with the mortality of very low and extremely low birth weight infants in the Neonatal Intensive Care Unit (NICU) of Mankweng Hospital. Materials and Methods A retrospective descriptive study was conducted at the NICU of Mankweng Hospital for a 7-month period from 1st January to 31st July 2015. The patient medical records and the Perinatal Problem Identification Programme (PPIP) data were used for the study. Results Prevalence of prematurity was 23%, Infants weighing between 500g-1499g represented 6.3% of the total live births and 25% of the admissions to the NICU; of which 4.9% were classified as extremely low birth weight (ELBW). Overall 77% of the study population survived until discharge. From the medical records, the survival to discharge of infants with weight 500g - 999g was 52%; and 84% for those with weight 1000g-1499g. Multivariable analysis found that improved survival was associated with an increase in gestational age (p <0.001), as well as birth weight (p <0.001) and prolonged length of stay. Variables associated with poor survival were spontaneous preterm labour (p = 0.031), low Apgar score at 1 and 5 minutes (p <0.001), sepsis (p = 0.001), respiratory distress syndrome (p <0.001), pulmonary hemorrhage (p <0.001), hypothermia (P = 0.005), resuscitation at birth (p = 0.002) and necrotising enterocolitis (p =0.044). Antenatal steroids were not associated with survival (p =0.111), however this was not documented in 53%(134/252) of the records, so the non-significance to outcome in this study may not be a true reflection. The use of NCPAP or SiPAP only was associated with improved survival of up to 69% and high mortality rates were recorded in babies who required invasive ventilator support. Multi-organ immaturity was found to be the most common cause of death, followed by sepsis. Conclusion: The prevalence and survival rates of very low and extremely low birth weight, found in this study are comparable to those found in other tertiary hospitals in South Africa. The survival rate of ELBW babies is low and must be improved. Reliable data and further research should address effective steps to prevent preterm labour, extreme prematurity and hypothermia. The documentation and provision of antenatal steroids is encouraged. KEY CONCEPTS: Prematurity, Extremely low and Very low birth weight, Risk factors, Prevalence, Survival, Neonatal mortality rate.

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