Advances in neonatal nursing and medical interventions have made it possible for the very low birth weight (VLBW) infant to survive. However, it is now time to recognize the intangible costs, emotional stress, marital stress, grief, pain, sorrow, and the disruption of the role transition to parenthood. To facilitate progress in the area of neonatal nursing, systematic efforts were undertaken to examine and describe parental adaptation to the VLBW infant and potential risk for parenting problems after hospital discharge. The purpose of this study was to describe parents' method of adaptation to the problems of caring for a VLBW infant at home. Specifically this study was designed to identify: (1) What strategies parents employed during the adaptation process. (2) What resources parents combined with their strategies of adaptation. (3) What situations promoted or inhibited parental adaptation. The informants consisted of parents of VLBW infants (<1500 grams) following hospital discharge. The number of subjects for this study was 14. An exploratory design was used to conduct this study. Each subject was involved in three interview sessions, one months, three months, and five months following hospital discharge of their VLBW infant. Data were sampled theoretically, as guided by the emergent theory. The constant comparative method was used for data analysis. A basic social process, Creating Paths, was identified as the core category of the theory. Creating Paths is the continuous process experienced by parents living with a VLBW infant the first five months after hospital discharge. The process consists of three stages: Gathering, Emerging, and Affirming. Results of this investigation provide a beginning theoretical foundation for assessing the adaptation process of parents with VLBW infants the first five months at home. Neonatal nurses can utilize the model to provide anticipatory guidance and support to benefit parents and their VLBW infant.

A research report submitted to the Faculty of Medicine, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Masters of Science Degree in Occupational Therapy, by course work. Johannesburg, 1992. / The incidence of learning problems in a group of Normal and At-Risk preterm children was deterlined in this study. The children were allocated to Normal and At- Risk groups using the Neurodevelopmental Assessment Scale (NDS). The NOS was designed by Muriel Goodman for her thesis, "Evaluation of Physiotherapy on Preterm Infants", submitted to the Faculty of Medicine, University of he Witwatersrand, Johannesburg, in fulfilment of the requirements for the Degree of Doctor of Philosophy, 1987. [Abbreviated Abstract. Open document to view full version]

The purpose of this study was to determine the effect of posttraumatic stress disorder (PTSD), diagnosed prospectively during pregnancy, on the occurrence of low birthweight (<2500 grams) and preterm delivery (<37 weeks gestational age). A cohort of 1362 women was recruited from prenatal care visits and screened for depression, panic disorder, posttraumatic stress disorder, and substance use. Current episodes of PTSD were assessed using the MINI International Neuropsychiatric Interview. Pregnancy outcomes were abstracted from hospital records after delivery, and the data were analyzed using logistic regression. Two hundred sixty two women (33%) were lost to follow-up due to unavailable medical records, leaving 1100 women in the final analyses. Among these 1100 women, 31 (3%) were found to have PTSD during pregnancy. Substance use in pregnancy, panic disorder, major and minor depressive disorders, and prior preterm delivery were significantly associated with PTSD in the sample, while age, language spoken, and race were not. Low birthweight (LBW) was present in 6.5% of sampled women and was not significantly associated with a diagnosis of PTSD in pregnancy when adjusting for potential confounders. However, LBW was significantly associated with minor depressive disorder OR= 1.82 (CI=1.01, 3.29). Preterm delivery occurred in 7.0% of those without and 16.1% of those with PTSD (p=0.055). Because prior preterm delivery data were not available for 33% of women with PTSD, this variable was included only in secondary analyses. However, the association between PTSD and preterm delivery depended on this variable, with OR= 2.82 (0.95, 8.38) before controlling for prior preterm delivery and OR=3.35 (1.04, 10.85) after controlling for prior preterm delivery. These data suggest that a possible association of PTSD and preterm delivery was limited by the low rates of PTSD in this cohort and the inability to control for all confounders. Taken together, these findings provide limited support for the hypothesized association between PTSD and preterm delivery and no support for an association of PTSD with LBW.

Thesis (D.P.H.)--University of Alabama at Birmingham, 2007. / Title from PDF title page (viewed on Feb. 19, 2010). Includes bibliographical references.

Thesis (Ph. D.)--University of Alabama at Birmingham, 2008. / Title from first page of PDF file (viewed Feb. 19, 2009). Includes bibliographical references.

Thesis (D.P.H.)--University of Oklahoma. / Bibliography: leaves 71-75.

Introdução: A poluição atmosférica é um problema de saúde pública em todo o mundo. Os efeitos adversos produzidos pelos poluentes do ar estão fortemente associados com as doenças respiratórias e cardiovasculares e, com magnitude inferior, aos desfechos da gestação. Objetivo: estimar a relação entre os poluentes PM10 e O3 e o baixo peso ao nascer em crianças nascidas na cidade de Santo André. Casuística e métodos: este é um estudo de coorte histórica. Foram incluídos todos os bebês nascidos de mães que vivem no município de Santo André - São Paulo Brasil, entre 2000 e 2006 com declarações de nascimento de vivos concluído. A Companhia de Tecnologia de Saneamento Ambiental Cetesb forneceu dados diários do material particulado (PM10), ozônio (O3), temperatura e umidade. Foram realizadas análises descritivas e de regressão logística. Resultados: Dos 58.114 nascimentos ocorridos entre 2000 e 2006, 5,91 % dos bebês apresentaram baixo peso ao nascer. Houve uma relação dosedependente entre as concentrações de PM10 e o baixo peso ao nascer. Concentrações de PM10 no quarto quartil no terceiro trimestre aumentaram o risco de baixo peso ao nascer em 32% (Razão de Chance: 1,32; IC95%: 1,15 1,50) quando comparado com os valores do primeiro quartil. Comportamentos semelhantes foram observados nos demais trimestres. Não foram observados riscos para o O3. Conclusão: o aumento na concentração de PM10, na cidade de Santo André, no período estudado, produziu um aumento na chance de ocorrência de baixo peso ao nascer Este efeito foi observado mesmo não ocorrendo ultrapassagem dos padrões de qualidade do ar / Introduction: The atmospheric pollution is a public health problem worldwide. The adverse effects related to air pollutants are robustly associated with respiratory and cardiovascular diseases and, in a lesser extent, with pregnancy adverse outcomes. Objective: estimating the relationship between air pollutants PM10 and O3 and low birth weight of children were borne in the city of Santo André, São Paulo. Casuistic and methods: This is a crossectional study. We included in the study all newborns of mothers that were inhabitants of Santo André, São Paulo, Brazil, and that were born from 2000 to 2006. The São Paulo State Environmental Agency (CETESB) provided daily records of particulate matter (PM10), temperature, and humidity. We performed descriptive analysis and logistic regressions. Results: Among the 58,114 newborns it was observed a low birth weight rate of 5.9%. There was a dose-response relationship between PM10 concentrations and low birth weight. Particles concentrations in the highest quartile in the third trimester of pregnancy increased the risk of low birth weight in 32% ((Odds Ratio: 1,32; 95% CI: 1,15 1,50) when compared with the first quartile. The same pattern of effect was observed in the other trimesters. For the O3 not were detected risks. Conclusion: The increase in PM10 concentrations, in Santo André, during the studied period, lead to an increase in the odds of low birth weight. This effect was observed even though there was no surpassing of air quality standards

INTRODUÇÃO: O baixo peso ao nascer representa fator de risco importante para a morbidade e mortalidade neonatal e infantil, sendo acompanhado por prematuridade, retardo de crescimento intra-uterino, ou ambos os fatores. OBJETIVO: Estudar as características maternas, perinatais, ambientais, econômicas, evolução ponderoestatural e alimentação das crianças nascidas com baixo peso e sua interação no aumento da morbidade durante o primeiro ano de vida. MÉTODOS: Estudo de coorte retrospectivo realizado na cidade de Sobral, Ceará, no período de três anos (2005 a 2007) onde foram incluídas 261 crianças nascidas com baixo peso (BP) e acompanhadas pelo Programa de Saúde da Família. Foi utilizado a Base de Dados do Sistema de Informações de Nascidos Vivos e revisão de prontuários hospitalares e ambulatoriais destas crianças para coleta de dados, quantificação e causa das consultas e internações. Para análise das variáveis foram realizadas distribuições de freqüência, Odds Ratio (OR), respectivos intervalos de confiança (95%) e significância estatística das associações. A análise final de associação utilizou modelo de regressão multivariado para avaliar os fatores de risco relacionados com o aumento da morbidade. RESULTADOS: Entre as 261 crianças estudadas, a média da idade materna foi de 24 anos, sendo que 29,12% das mães eram adolescentes. Cerca de 41,76 % das mães eram solteiras e 31,42% casadas ou com união estável, e 24,14% eram sem escolaridade. Quanto às características perinatais, 52,11% das crianças nasceram de parto vaginal, 52,49% pré-termos; 55,56% eram do sexo feminino, 98,08% das crianças obtiveram Apgar de 5 minutos maior que 6. O peso médio de nascimento foi de 2140 g, sendo que 72,03% das crianças nasceram com peso entre 2000 e 2500 g. Houve incremento do escore-z de peso até os quatro meses de idade cronológica para crianças nascidas a termo e idade gestacional corrigida para os pré-termo em cerca de 87% das crianças e 45% do escore-z do comprimento. O índice de aleitamento materno exclusivo foi de 26,05% e 8,43% até os 4 e 6 meses de idade respectivamente. Observou-se que 13,97% das crianças residiam em casa de taipa, 36,49% dos domicílios utilizavam fogão a lenha e 36,11% viviam com renda familiar inferior a um salário mínimo. Quanto a morbidade, as 261 crianças nascidas com baixo peso realizaram 1103 consultas por motivo de doença no Programa de Saúde de Família, tendo como causa principal infecções respiratórias agudas. Ocorreram 469 consultas ocorreram em emergência pediátrica e 156 internações hospitalares, principalmente no período neonatal. Foram identificados como fatores de risco para maior morbidade: a) Interrupção do aleitamento materno exclusivo antes dos quatro meses o qual esteve associado a presença de consulta em emergência (OR 3,07; p<0,001); b) Idade gestacional e peso de nascimento baixos, com maior probabilidade de internação no período neonatal (OR 6,26; p<0,001); c) Prematuridade e a ausência de recuperação de peso até os 4 meses estiveram associados a internação por pneumonia, diarréia aguda e outros motivos (OR 5,15 e 0,65; p = 0,036 e 0,013, respectivamente). As demais variáveis não tiveram relação com a morbidade estudada. CONCLUSÃO: A prematuridade, a interrupção do aleitamento materno exclusivo antes dos quatro meses e a ausência do incremento de peso estiveram associadas a maior morbidade nas crianças de baixo peso ao nascer. Nesta população atendida pelo PSF, as características maternas, ambientais e econômicas não estiveram associadas à maior morbidade / BACKGROUND: Low birth weight represents an important risk factor for neonatal and infant morbidity and mortality, accompanied by prematurity, intrauterine growth restriction, or both. OBJECTIVE: To study maternal, perinatal, environmental, economic characteristics, growth and feeding of children with low birth weight and their interaction in the increased morbidity during the first year of life. METHODS: A retrospective cohort study conducted in the city of Sobral, Ceará, in the period of three years (2005-2007) which included 261 children with low birth weight (LBW) and followed by the Family Health Program. We used the database of the Sistema de Informação de Nascidos Vivos (SINASC) and review data collection of hospital and ambulatory records of these children, quantification and causes of emergency room visits and hospitalizations. For analysis of the variables, were used frequency distributions, odds ratio (OR), confidence intervals (95%) and statistical significance of associations. The final analysis of association used logistic regression analysis to assess the risk factors associated with increased morbidity. RESULTS: Among 261 children studied, the average maternal age was 24 years, and 29.12% of mothers were teenagers. Approximately 41.76% were single mothers and 31.42% were married or with a stable union, and 24.14% were uneducated. Regarding perinatal characteristics, 52.11% were born vaginally, 52.49% were preterm, 55.56% were female and 98.08% of the children had Apgar 5 minutes greater than 6. The average birth weight was 2140 g, and 72.03% of children born weighing between 2000 and 2500 g. There was catch up in weight to four months of chronological age for children born at term and corrected gestational age for preterm at around 87% and 45% in height. The rate of exclusive breastfeeding was 26.05% and 8.43% to 4 and 6 months of age respectively. It was observed that 13.97% of children lived in wattle and daub house, 36.49% of households used wood stoves, and 36.11% lived with less than one minimum wage. As for morbidity, the 261 children born with low birth weight were 1103 visits due to illness in the Family Health Program, with the main cause was acute respiratory infections. There were 469 emergency visits and 156 pediatric emergency hospital admissions, especially in the neonatal period. Were identified as risk factors for increased morbidity: a) interruption of exclusive breastfeeding before 4 months which was associated with the presence of emergency consultation (OR 3.07, p <0.001), b) low gestational age and birth weight, with a greater likelihood of hospitalization in the neonatal period (OR 6.26, p <0.001), c) Prematurity and the no catch up in weight at to 4 months of age were associated with hospitalization for pneumonia, diarrhea and other reasons (OR 5, 15 and 0.65, p = 0.036 and 0.013, respectively). The other variables were not associated with morbidity study. CONCLUSION: Prematurity, interruption of exclusive breastfeeding before four months and no catch up growth were associated with greater morbidity in children with low birthweight. In the population served by the PSF, maternal characteristics, environmental and economic were not associated with increased morbidity

INTRODUÇÃO: O baixo peso ao nascer representa fator de risco importante para a morbidade e mortalidade neonatal e infantil, sendo acompanhado por prematuridade, retardo de crescimento intra-uterino, ou ambos os fatores. OBJETIVO: Estudar as características maternas, perinatais, ambientais, econômicas, evolução ponderoestatural e alimentação das crianças nascidas com baixo peso e sua interação no aumento da morbidade durante o primeiro ano de vida. MÉTODOS: Estudo de coorte retrospectivo realizado na cidade de Sobral, Ceará, no período de três anos (2005 a 2007) onde foram incluídas 261 crianças nascidas com baixo peso (BP) e acompanhadas pelo Programa de Saúde da Família. Foi utilizado a Base de Dados do Sistema de Informações de Nascidos Vivos e revisão de prontuários hospitalares e ambulatoriais destas crianças para coleta de dados, quantificação e causa das consultas e internações. Para análise das variáveis foram realizadas distribuições de freqüência, Odds Ratio (OR), respectivos intervalos de confiança (95%) e significância estatística das associações. A análise final de associação utilizou modelo de regressão multivariado para avaliar os fatores de risco relacionados com o aumento da morbidade. RESULTADOS: Entre as 261 crianças estudadas, a média da idade materna foi de 24 anos, sendo que 29,12% das mães eram adolescentes. Cerca de 41,76 % das mães eram solteiras e 31,42% casadas ou com união estável, e 24,14% eram sem escolaridade. Quanto às características perinatais, 52,11% das crianças nasceram de parto vaginal, 52,49% pré-termos; 55,56% eram do sexo feminino, 98,08% das crianças obtiveram Apgar de 5 minutos maior que 6. O peso médio de nascimento foi de 2140 g, sendo que 72,03% das crianças nasceram com peso entre 2000 e 2500 g. Houve incremento do escore-z de peso até os quatro meses de idade cronológica para crianças nascidas a termo e idade gestacional corrigida para os pré-termo em cerca de 87% das crianças e 45% do escore-z do comprimento. O índice de aleitamento materno exclusivo foi de 26,05% e 8,43% até os 4 e 6 meses de idade respectivamente. Observou-se que 13,97% das crianças residiam em casa de taipa, 36,49% dos domicílios utilizavam fogão a lenha e 36,11% viviam com renda familiar inferior a um salário mínimo. Quanto a morbidade, as 261 crianças nascidas com baixo peso realizaram 1103 consultas por motivo de doença no Programa de Saúde de Família, tendo como causa principal infecções respiratórias agudas. Ocorreram 469 consultas ocorreram em emergência pediátrica e 156 internações hospitalares, principalmente no período neonatal. Foram identificados como fatores de risco para maior morbidade: a) Interrupção do aleitamento materno exclusivo antes dos quatro meses o qual esteve associado a presença de consulta em emergência (OR 3,07; p<0,001); b) Idade gestacional e peso de nascimento baixos, com maior probabilidade de internação no período neonatal (OR 6,26; p<0,001); c) Prematuridade e a ausência de recuperação de peso até os 4 meses estiveram associados a internação por pneumonia, diarréia aguda e outros motivos (OR 5,15 e 0,65; p = 0,036 e 0,013, respectivamente). As demais variáveis não tiveram relação com a morbidade estudada. CONCLUSÃO: A prematuridade, a interrupção do aleitamento materno exclusivo antes dos quatro meses e a ausência do incremento de peso estiveram associadas a maior morbidade nas crianças de baixo peso ao nascer. Nesta população atendida pelo PSF, as características maternas, ambientais e econômicas não estiveram associadas à maior morbidade / BACKGROUND: Low birth weight represents an important risk factor for neonatal and infant morbidity and mortality, accompanied by prematurity, intrauterine growth restriction, or both. OBJECTIVE: To study maternal, perinatal, environmental, economic characteristics, growth and feeding of children with low birth weight and their interaction in the increased morbidity during the first year of life. METHODS: A retrospective cohort study conducted in the city of Sobral, Ceará, in the period of three years (2005-2007) which included 261 children with low birth weight (LBW) and followed by the Family Health Program. We used the database of the Sistema de Informação de Nascidos Vivos (SINASC) and review data collection of hospital and ambulatory records of these children, quantification and causes of emergency room visits and hospitalizations. For analysis of the variables, were used frequency distributions, odds ratio (OR), confidence intervals (95%) and statistical significance of associations. The final analysis of association used logistic regression analysis to assess the risk factors associated with increased morbidity. RESULTS: Among 261 children studied, the average maternal age was 24 years, and 29.12% of mothers were teenagers. Approximately 41.76% were single mothers and 31.42% were married or with a stable union, and 24.14% were uneducated. Regarding perinatal characteristics, 52.11% were born vaginally, 52.49% were preterm, 55.56% were female and 98.08% of the children had Apgar 5 minutes greater than 6. The average birth weight was 2140 g, and 72.03% of children born weighing between 2000 and 2500 g. There was catch up in weight to four months of chronological age for children born at term and corrected gestational age for preterm at around 87% and 45% in height. The rate of exclusive breastfeeding was 26.05% and 8.43% to 4 and 6 months of age respectively. It was observed that 13.97% of children lived in wattle and daub house, 36.49% of households used wood stoves, and 36.11% lived with less than one minimum wage. As for morbidity, the 261 children born with low birth weight were 1103 visits due to illness in the Family Health Program, with the main cause was acute respiratory infections. There were 469 emergency visits and 156 pediatric emergency hospital admissions, especially in the neonatal period. Were identified as risk factors for increased morbidity: a) interruption of exclusive breastfeeding before 4 months which was associated with the presence of emergency consultation (OR 3.07, p <0.001), b) low gestational age and birth weight, with a greater likelihood of hospitalization in the neonatal period (OR 6.26, p <0.001), c) Prematurity and the no catch up in weight at to 4 months of age were associated with hospitalization for pneumonia, diarrhea and other reasons (OR 5, 15 and 0.65, p = 0.036 and 0.013, respectively). The other variables were not associated with morbidity study. CONCLUSION: Prematurity, interruption of exclusive breastfeeding before four months and no catch up growth were associated with greater morbidity in children with low birthweight. In the population served by the PSF, maternal characteristics, environmental and economic were not associated with increased morbidity

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2008. / LICL has E-Thesis 0038 ; please contact computer services.