Syftet med litteraturstudien var att beskriva föräldrars upplevelser och behov på en neonatalavdelning. Data söktes ur databaserna PubMed och Cinahl och femton artiklar inkluderades i resultatet. Resultatet visade att kommunikation och information, delaktighet och närvaro, kunskap och förståelse, tillit och respekt, stress och oro samt trygghet var de allra viktigaste kärnfrågorna gällande föräldrars behov och upplevelser. Resultatet visade att en ärlig och förtroendeingivande kommunikation är av allra största vikt för att främja en god anknytning mellan föräldrarna och barnet. Det framkom att föräldrarna önskade vara delaktiga i barnets vård och att de ville bli uppmuntrade av vårdpersonalen att delta i denna. Det framgick tydligt att de flesta föräldrar hade ett stort behov av att tillgodogöra sig kunskap om såväl anatomi och fysiologi men även rörande medicinteknik. Föräldrarna uppgav att det var betydelsefullt att känna tillit till vårdpersonalen. De poängterade även hur viktigt det var att vårdpersonalen skapade en känsla av respekt och trygghet, både i yrkesrollen och som medmänniskor. Resultatet visade att brister i en eller flera av dessa sex kärnfrågor medförde känslor av stress och oro hos föräldrarna. En slutsats som kan dras är att vårdpersonalens bemötande och förmåga att engagera föräldrarna blir direkt avgörande för familjens totala helhetsupplevelse.

Bakgrund: En magnetkameraundersökning är en relativt säker diagnostisk metod då ingen joniserande strålning används, till skillnad från konventionell röntgen, vid framställandet av bilder. Trots detta finns ändå risker att ta hänsyn till, vissa gällande för alla patienter. För neonatala barn, prematura och fullgångna, skiljer sig dessa risker åt och därmed även neonatalpersonalens och röntgensjuksköterskans möjlighet att tillgodose barnets patientsäkerhet. Syfte: litteraturstudien syftar till att därför beskriva specifika riskfaktorer som påverkar patientsäkerheten vid undersökning med MR av fullgångna och prematura barn. Metod: vetenskapliga artiklar söktes i databaserna PubMed, Cinahl och Medline, varav åtta kvantitativa artiklar valdes ut efter kvalitetsgranskning. Resultat: Efter analys av dessa åtta artiklar utmärkte sig fyra kategorier som redovisades i resultatet; bildkvalitet, hypotermi, nedsatt saturation och narkosmedel. Resultatet visade även att användandet av en mr-kompatibel kuvös ytterligare påverkade patientsäkerheten positivt. Konklusion: Bildkvalitet, hypotermi, nedsatt saturation och narkosmedel är specifika riskfaktorer som visar sig viktiga att ta hänsyn till vid beaktande av patientsäkerheten för prematura och fullgångna neonatala barn. Nyckelord: MRI, magnetkamera, neonatal, patientsäkerhet, risker / Background: MRI is a relatively safe diagnostic method with non-ionizing radiation used, as is not the case in conventional radiography. Despite this there are still risks to take into account, some common to all patients. For neonates, premature and full-term, these risks differ, and thereby also affect the neonatal staff and the radiographer's ability to meet the child's special need of patient safety. Purpose: This study aims to describe specific risk factors that affect patient safety during examination with MRI, regarding the full term and preterm neonatal child. Method: scientific articles were searched in PubMed, Cinahl and Medline, eight quantitative articles were selected for quality review. Results: After analysis of these eight articles, four categories were recognized and distinguished; image quality, hypothermia, low oxygen saturation, and anesthetics. The results also showed that the use of an MR-compatible incubator further impacted patient safety positively. Conclusion: Image quality, hypothermia, low oxygen saturation and anesthetics are specific risk factors that need to take into account when considering the patient safety in preterm and full-term neonates. Keywords: magnetic resonance imaging, infant premature, patient safety

published_or_final_version / Surgery / Doctoral / Doctor of Philosophy

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Objectives: Interpregnancy interval (IPI), the time period between the end of one pregnancy and the conception of the next, can have a significant impact on maternal and infant outcomes. This study examines the relationship between interpregnancy interval and neonatal outcomes of low birth weight, preterm birth, and specific neonatal morbidities. Study Design: Retrospective cohort study comparing neonatal outcomes across 6 categories of IPI using data on 202,600 cases identified from Arizona birth certificates and the Newborn Intensive Care Program data. Comparisons between groups were made using odds ratios and 95% confidence intervals, and multivariable logisitic regression analysis. Results: Interpregnancy intervals of < 12 months and ≥ 60 months were associated with low birth weight, preterm birth, and small for gestational age births. The shortest and longest IPI categories were also associated with specific neonatal morbidities, including periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, apnea bradycardia, respiratory distress syndrome, transient tachypnea of the newborn, and suspected sepsis. Relationships between interpregnancy interval and specific neonatal morbidities did not remain significant when adjusted for birth weight and gestational age. Conclusions: Significant differences in neonatal outcomes (preterm birth, low birth weight, and small for gestational age) were observed between IPI categories. Consistent with previous research, interpregnancy intervals < 12 months and ≥ 60 months appear to be associated with increased risk of poor neonatal outcomes. Any difference in specific neonatal morbidities between IPI groups appears to be mediated through increased risk of low birth weight and preterm birth by IPI.

No description available.

Background: Thrombocytopenia is common in sick preterm babies in the first day of life. Despite this, platelet production in thrombocytopenic preterm babies has rarely been assessed. Methods: To address this problem I have developed miniaturised assays to study circulating megakaryocyte (MK) progenitors (BFU-MK and CFU-MK), total cultured MK precursors and mature MK, by culturing mononuclear cells purified from 0.5-1ml of preterm peripheral blood. MK lineage colonies and cells are identified by a MK specific anti-glycoprotein IIb/IIIa antibody (CD61) by APAAP. Results: i) Normal values for these cells at birth were established in cord blood from healthy term and preterm babies. ii) Circulating BFU-MK/CFU-MK, total cultured MK precursors and mature MK were then prospectively studied in 63 preterm babies (gestational age 24-34 wks). iii) At birth 18 (69%) of the thromocytopenic babies were also neutropenic. Conclusion: These data indicate that the principal cause of the thrombocytopenia and neutropenia in the preterm babies studied was <I>reduced platelet</I> <I>and neutrophil production</I> occurring as a consequence of reduced numbers of MK and neutrophil progenitors respectively. Taken together these data suggest the haematological abnormalities characteristic of new-born born to mothers with PIH or with IUGR (thrombocytopenia, neutropenia and polycythaemia) are a consequence of dysregulation of <I>fetal haemopoiesis</I> occurring proximal to committed MK and neutrophil progenitors, most likely at the level of the primitive multipotent haemopoietic stem cell (CFU-GEMM). Finally the value of miniaturised MK progenitor and precursor assays in evaluating rare or unusual cases of neonatal thrombocytopenia has been demonstrated. In the three examples investigated this approach provided unique insights into the pathogenesis of the thromocytopenia in each case.

Male circumcision is one of the most common paediatric surgeries. Most research has concentrated on assessing medical risks versus benefits, yet the majority of infant circumcisions are performed for social reasons. A few studies have surveyed reasons for circumcising/not circumcising. However, they have not revealed the decision-making process. Drawing upon embodiment theories, this study explored expectant parents’ decision-making about circumcision. Interviews were conducted with six individuals. Interpretative Phenomenological Analysis was utilized to identify themes. Findings revealed eight major themes, including ‘gender jurisdiction’ (whether fathers should have more decision-making power than mothers). Another centred on deciding whose body was the focus – the baby’s or the father’s. All participants perceived bias, both pro- and anti-circumcision, in the information they received from health professionals. They expressed a strong need for objective information and support. The findings may be helpful to obstetricians, paediatricians, and midwives – as well as individuals and families facing this decision.

No description available.

The neonatal intensive care unit (NICU) is frequently occupied by newborns who are marginally viable, or critically unwell, and could be considered terminally ill. It is a busy, highly technical environment with an arsenal of life-saving medical equipment at its disposal, and advances in technology used in this field stretch the boundaries of viability. Despite technological advances, increases in the margins of viability and highly skilled healthcare delivery, some newborns will still die in the NICU. In recent years, palliative care for the neonatal population has become increasingly topical and part of the lexicon of contemporary neonatal practice. Evidence-based protocols are available to inform this model of care, yet in reality, provision of palliative care to newborns is ad hoc. The reasons why implementing a palliative model of care have been problematic are unclear. The purpose of this study was to identify the barriers and facilitators to palliative care practice in neonatal nursing, and to develop policy recommendations to improve this area of practice. This exploratory research was conducted to answer two research questions: 1) What are the barriers and facilitators to palliative care practice in neonatal nursing? 2) How can the identified issues be addressed to inform policy and clinical guidelines in the practice environment? Phase one of this investigation developed, pilot tested, and administered an instrument to identify the barriers and facilitators to practice. Data analysis identified three subscales that indicated facilitators and barriers to palliative care practice. The second phase of this study used a translational research approach, utilizing interpretive methods to explore and contextualise the population study findings to inform policy development to improve palliative care practice in neonatal nursing. This research has identified that the facilitators that do exist for palliative care practice are subject to caveats that impinge markedly upon these facilitators. Furthermore, the barriers that were identified pose threats to the integration of a palliative model of care into Australian neonatal nursing practice. Thus, the overall results from this research have lead to a composite understanding of the barriers and facilitators to palliative care practice in Australian neonatal nursing, which may account for the gap between support of palliative care for marginally viable and critically ill newborns, and the application of this model of care in clinical practice. Translating the survey findings into policy directives that are applicable to the clinical environment has resulted in the development of recommendations that are aimed at improving palliative care practice in the NICU.

[Abstract]: This work involves the development of a lightweight, high efficiency, integrated Neonatal Retrieval System consistent with the requirements of medical personnel, with the capability to be loaded into ambulance vehicles without lifting.By studying the current systems in use and surveying the potential end users a basic specification is established. From this specification concepts are cultivated and, withregular input from end users, developed into a working prototype. This prototype is tested to the required standards and assessed by the end users. Following positivefeedback, a clinical trial is undertaken by medical personnel who confirm that the new system addresses many of the operational problems encountered with currentequipment.It is concluded that with further refinement and sufficient commercial backing, this new Neonatal Retrieval System would improve the process of neonatal retrieval inthis country and possibly internationally. This has the potential to improve outcomes for both patients and the medical personnel who conduct these retrievals.