DISSERTATION SUBMITTED IN PARTIAL FULFILLMENT OF REQUIREMENTS FOR A MASTER OF MEDICINE DEGREE IN PAEDIATRICS AND CHILD HEALTH (MMED PAED) / Survival of extremely low birth weight (ELBW) infants in a resource limited public hospital setting is still low in South Africa. The study aimed at establishing the determinants of survival in this weight category of neonates who, due to limited intensive care facilities, were not mechanically ventilated.

Wong Pui On Raymond. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 105-120). / Abstracts in English and Chinese. / Contents --- p.i / Abstract --- p.vi / Statement of originality --- p.xii / Acknowledgments --- p.xiii / List of figures and tables --- p.xiv / Abbreviations --- p.xvii / Publications --- p.xx / Text / Chapter Chapter 1: --- Introduction and Objectives --- p.1 / Chapter 1.1 --- Neonatal Sepsis --- p.2 / Chapter 1.2 --- Markers of Infection --- p.4 / Chapter 1.2-1 --- Clinical markers for sepsis --- p.4 / Chapter 1.2-2 --- Cytokines as markers of sepsis --- p.7 / Chapter 1.2-3 --- Cell surface receptors as markers of sepsis --- p.8 / Chapter 1.3 --- The immune system in response to pathogen challenge --- p.10 / Chapter 1.3-1 --- Source of cytokines --- p.11 / Chapter 1.4 --- General outline of cytokines implicated in sepsis --- p.12 / Chapter 1.4-1 --- IL-2 --- p.13 / Chapter 1.4-2 --- IL-4 --- p.15 / Chapter 1.4-3 --- IL-5 --- p.16 / Chapter 1.4-4 --- IL-6 --- p.17 / Chapter 1.4-5 --- IL-10 --- p.18 / Chapter 1.4-6 --- IFN-γ --- p.19 / Chapter 1.4-7 --- TNF-α --- p.21 / Chapter 1.5 --- General outline of cell surface receptors implicated in sepsis --- p.23 / Chapter 1.5-1 --- CDllb --- p.23 / Chapter 1.5-2 --- CD64 --- p.24 / Chapter 1.5-3 --- CD45RO --- p.25 / Chapter 1.5-4 --- CD25 --- p.26 / Chapter 1.6 --- Aims of study --- p.27 / Chapter Chapter 2: --- Materials and methods --- p.31 / Chapter 2.1 --- Patients inclusion criteria and classification --- p.32 / Chapter 2.2 --- Sample collection and sepsis screening --- p.33 / Chapter 2.3 --- Quantitation of cell surface antigens --- p.35 / Chapter 2.3-1 --- Cell acquisition and calculation --- p.37 / Chapter 2.4 --- Quantitation of plasma cytokines --- p.38 / Chapter 2.4-1 --- Cytometric Beads Array assay --- p.40 / Chapter 2.5 --- Statistical Analysis --- p.41 / Chapter Chapter 3: --- "Cell surface and plasma cytokine markers for the diagnosis of late-onset sepsis in preterm, very low birthweight (VLBW) infants" --- p.51 / Chapter 3.1 --- Results --- p.52 / Chapter 3.1-1 --- Lymphocyte markers: CD25 and CD45RO --- p.52 / Chapter 3.1-2 --- Neutrophil markers --- p.53 / Chapter 3.1-2a --- CD64 --- p.54 / Chapter 3.1-2b --- CDllb --- p.55 / Chapter 3.1-3 --- Purified CDllb --- p.56 / Chapter 3.1-4 --- Comparison of cell surface markers --- p.56 / Chapter 3.1-5 --- Interluekin 6 (IL-6) and C-Reactive Protein (CRP) --- p.57 / Chapter 3.2 --- Combined analysis of diagnostic markers --- p.58 / Chapter 3.3 --- Discussion --- p.58 / Chapter Chapter 4: --- Proinflammatory and anti-inflammatory cytokine response in preterm very low birthweight infants (VLBW) with systemic infections --- p.82 / Chapter 4.1 --- Results --- p.83 / Chapter 4.1-1 --- Correlation of cytokine levels in infected patients --- p.84 / Chapter 4.2 --- Subgroup analysis --- p.85 / Chapter 4.2-1 --- Proinflammatory and anti-inflammatory cytokine ratios --- p.85 / Chapter 4.2.2 --- The deceased case --- p.86 / Chapter 4.3 --- Discussion --- p.87 / Chapter Chapter 5: --- General Discussion and Conclusions --- p.97 / Chapter 5.1 --- General Discussion --- p.98 / Chapter 5.1-1 --- Cell surface markers --- p.98 / Chapter 5.1-2 --- Infection markers with prognostic significance --- p.100 / Chapter 5.1-3 --- Limitations of infection markers in clinical applications --- p.100 / Chapter 5.2 --- Conclusions and future development --- p.102 / Chapter 5.2-1 --- Conclusions --- p.102 / Chapter 5.2-2 --- The future development --- p.102 / References --- p.105

Diss. (sammanfattning) Uppsala : Uppsala universitet, 2005. / Härtill 4 uppsatser.

The aims of the study were to examine postural development in very low birthweight and normal birthweight infants and to determine whether deviant postures were predictive of adverse neurodevelopmental outcome. In the first part of the study the 7 postural responses selected by Vojta to evaluate neuromotor development were applied to 69 very low birthweight (VLBW < 1 500 grams) infants and to 28 healthy full-term infants of normal birthweight (> 2500 grams). Of the 69 VLBW infants, 43 were small for gestational age and 26 appropriate for gestational age. All infants were examined at term and 4 months corrected age. They were all later assessed on the Griffiths Mental Development Scale at 12 and 18 months corrected age. There were significant differences in postural reactions between the 2 groups which confirmed the lower tone and greater extension previously described in VLBW infants. An important finding in the study was that poor head and trunk righting noted at 4 months corrected age in VLBW infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Development Scale. Thus, a delay in maturation in VLBW infants which was apparent from the assessment of postural responses was still identifiable on the locomotor sub-scales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants. In the second part of the study, the 5 useful Vojta responses were incorporated into the Infant Neurodevelopmental Assessment (INA) which was used to assess 76 high risk VLBW infants. The 76 infants consisted of 34 infants with intracranial lesions on ultrasound and 42 without intracranial lesions. All infants were assessed at term and 4 % months corrected age using the INA. At 12 months corrected age they were all assessed on the Griffiths Mental Development Scale. Six infants were diagnosed as having cerebral palsy, all of whom had intracranial lesions. Several clinical signs indicative of cerebral palsy were significant at 4 % months corrected age and will be useful in future studies to diagnose cerebral palsy early. The association between lack of head and trunk control at 4 % months corrected age and a lower locomotor score at 12 months corrected age proved to be significant again and reinforces the finding that early delay in maturation is identifiable on the locomotor scale at 12 months corrected age.

A research report submitted to Faculty of Health Sciences, as a requirement for completion of Masters of Medicine in Paediatrics, University of the Witwatersrand, Johannesburg, 2018 / Background. Candidemia is a significant cause of morbidity and mortality in infants. The mortality rate ranges between 21% and 76%. Non-albicans candida (NAC) is increasing in incidence and resistance to azoles. Very low birth weight (VLBW) infants have numerous risk factors which predispose them as a group to invasive candidemia. Methods. A retrospective case control study of candidemia in VLBW infants admitted to the neonatal unit at Charlotte Maxeke Johannesburg Hospital (CMJAH) between 01 January 2015 to 31 December 2017 was undertaken. Clinical and demographic characteristics of VLBW infants who developed candidemia, commonest Candida species, antifungal susceptibility profiles and outcomes defined as death were identified. 71 infants with confirmed positive blood cultures for candidemia from the NHLS database were selected and each case was allocated 3 controls; the final sample comprised 284 infants. Results. Bacterial sepsis, chronic lung disease (CLD), necrotising enterocolitis (NEC) and NEC surgery, other surgery, anaemia and ventilation, all showed a strong association with development of candidemia in the infants. The most common isolate was Candida parapsilosis (59.1%), followed by Candida albicans (30.9%). The cases of candidemia overall and NAC isolates increased over the study years. Resistance to azoles by NAC was demonstrated. Mortality was 31.2% and 28.2% in controls and cases respectively. The difference in death between the two groups was not statistically significant. 7 A research report submitted to Faculty of Health Sciences WITS, as a requirement for completion of Masters of Medicine; Paediatrics. Johannesburg, South Africa 2018. Conclusions. The study demonstrated a predominance of NAC isolates, increasing rate of candidemia and increased resistance to azoles. Stricter infection control measures and medical intervention strategies should be implemented / GR 2020

A Dissertation Submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg for the degree of Master of Medicine. / Disturbed mineral and bone metabolism is frequently found in very low-birth-weight infants fed breast-milk during the first three months of life. The study was designed to assess the prevalence of this disturbed mineral homeostasis in a very low-birth-weight populatiun at Baragwanath Hospital and to determine whether the addition of a preterm infant formula to the feeds reduced the prevalence and increased the rate of weight gain. Fifty three neonates weighing less than 1200g born at Baragwanath Hospital were monitored for weight gain, growth and for biochemical and radiological evidence of metabolic bone disease. The infants were randomized to receive either breast-milk only feeds or a combination of breast-milk and a premature formula in order to assess the effect of the different feeds on the development of bone disease. Weight gain and growth were similar in both groups. Calcium and phosphorus intakes were higher in the mixed feeding group. However, serum calcium and phosphorus values were similar in the two groups throughout the study. The breast-milk group had significantly higher alkaline phosphatase levels. Radiological rickets was uncommun in both groups, although periosteal reactions and osteopenia occurred frequently and with similar prevalence in both groups. Overt rickets is not a major problem in very-low birth- weight infants born at Baragwanath Hospital, although raised serum alkaline phosphatase values occur frequently. Feeding with breast-milk and a premature infant formula in equal proportions (as opposed to breast-milk only) does not appear to have any effect on weight gain and growth in very low-birth-weight infants, but does partially prevent the pathological rise in alkaline phosphatase levels. / Andrew Chakane 2019

Thesis (Ph. D.)--University of Washington, 2000. / Vita. Includes bibliographical references (leaves 70-78).

Diss. (sammanfattning) Linköping : Univ., 2001. / Härtill 6 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Orientador: Ana Maria Segall Correa / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-03T05:49:20Z (GMT). No. of bitstreams: 1 Patella_RoseineFortes_M.pdf: 21656384 bytes, checksum: a411b353da2b069b334fa693980d77d0 (MD5) Previous issue date: 2001 / Resumo: O objetivo deste estudo foi analisar o impacto da assistência oferecida pelo Programa de Vigilância para crianças nascidas sob risco (PRNR) sobre as intemações hospitalares e a mortalidade de crianças menores de um ano de idade em Santos/SP. Foi estudada uma coorte histórica retrospectiva de crianças expostas e não expostas ao Programa no período de 1"de Julho de 1997 até 30 de Junho de 1998. Dos 6554 bebês nascidos neste período, 1208 foram classificados como sob risco (RNRs). Foram então divididos em dois grupos: G.A. (acompanhados pelo PRNR = 675) e G.N.A. (não acompanhados pelo PRNR = 553). O seguimento foi delineado para controlar variáveis presumidas como fatores de confundimento como peso ao nascer, hospital de nascimento, localidade de residência e aleitamento ao seio além de outras variáveis psicossociais. Os RNRs do grupo G.A. foram então classificados em duas categorias de acordo com a assistência recebida. Foram considerados sob Assistência Adequada (ADEQ) os recém-nascidos que cumpriram três condições principais: - Ter realizado a primeira consulta médica e atividades de monitoramento em até 10 dias após o nascimento, ter recebido visita domiciliar (VD), e, pelo menos 7 consultas médicas durante o período de seguimento. Foram considerados sob Assistência Não Adequada (NADEQ) aqueles que não atingiram os critérios completos referidos. Foram encontrados 712 bebês no primeiro grupo e 496 no segundo. O risco relativo para intemação hospitalar considerando bebês não expostos ao programa (NADEQ) e os expostos (ADEQ) não foi estatisticamente significativo. Os Grupos GA e GNA foram diferentes ao considerar-se variáveis sociais. O primeiro (GA) mostrou freqüência mais alta de desemprego entre pais ou responsáveis e muitos moravam em localidades caracterizadas como as mais pobres na cidade. O risco relativo para intemação hospitalar no primeiro ano apontou para proteção para as crianças do G.N.A. O perfil de seguimento dos RNRs (G.A.) mostrou que 61,6% deles chegaram para a primeira consulta médica após dez dias; quase a metade (41,8%) compareceu a menos de sete consultas pediátricas; quase um terço deles (28,4%) nunca recebeu uma VD. Apesar da assistência oferecida pelo PRNR foram identificados 13 óbitos entre os RNRs da coorte estudada. Estudos adicionais seriam necessários para esclarecer melhor as características dos cuidados de saúde que deveriam ser oferecidos, em tais condições sociais, a recém-nascidos de alto risco no seu primeiro ano de vida / Abstract: The objective of this study was to analyze the impact of the assistance provided by the Surveillance Program for children bom at risk (PRNR) on hospital admissions and mortality of children under one year of age in Santos/SP. A historic retrospective cohort of children exposed and non-exposed to the program was studied from the 1st of July 1997 to the 30th of June 1998. From 6554 babies bom in this period, 1208 were classified as at risk (RNRs). They were then divided in two groups: G.A. (followed by the PRNR = 675) and G.N.A. (not followed by the PRNR = 553). The followup was designed to control for variables presumed to be confounders, like birth-weight, hospital of birth, neighborhood of residence, and breastfeeding, besides other mother's psychosocial variables. The RNRs of G.A. groups were then classified in two categories according to the assistance received. Adequate Assistance (ADEQ) was considered for those newboms who met tree main conditions: - first medical appointment and monitoring activity within 10 days afier birth, having received a home visit (VD), and, at least 7 medical consultations during the follow-up period. Non-Adequate Assistance (NADEQ) was assigned to those who did not meet the full ADEQ criteria. There were 712 babies in the first group and 496 in the second. The relative risk for hospital admission considering babies not exposed to the program (NADEQ) and those exposed (ADEQ) was not statistically significant. The GNA and GA groups were different considering social variables. This last group had higher frequency of unemployment among parents or family's responsible person and most of then were leaving in the neighborhood characterized as the poorest in the city. The relative risk for hospital admission in the first year of life pointed out to protection towards children of the G.N.A. The follow-up profile of the RNRs (G.A.) showed that 61,6% of them arrived after ten days at the 1st appointment, almost half (41,8%) attended less than seven pediatric consultations; almost a third of them (28,4%) never received a VD. Despite the assistance provided by the PRNR 13 deaths were acknowledged among RNRs in the study cohort. Further studies would be necessary to better clarify the characteristics of health care that should be offered, under such social conditions of the high-risk newbom in their first year of life / Mestrado / Saude Coletiva / Mestre em Saude Coletiva