No description available.

The observed physiological dynamics of an infant receiving intensive care contain a great deal of information about factors which cannot be examined directly, including the state of health of the infant and the operation of the monitoring equipment. This type of data tends to contain both common, recognisable patterns (e.g. as caused by certain clinical operations or artifacts) and some which are rare and harder to interpret. The problem of identifying the presence of these patterns using prior knowledge is clinically significant, and one which is naturally described in terms of statistical machine learning. In this thesis I develop probabilistic dynamical models which are capable of making useful inferences from neonatal intensive care unit monitoring data. The Factorial Switching Kalman Filter (FSKF) in particular is adopted as a suitable framework for monitoring the condition of an infant. The main contributions are as follows: (1) the application of the FSKF for inferring common factors in physiological monitoring data, which includes finding parameterisations of linear dynamical models to represent common physiological and artifactual conditions, and adapting parameter estimation and inference techniques for the purpose; (2) the formulation of a model for novel physiological dynamics, used to infer the times in which something is happening which is not described by any of the known patterns. EM updates are derived for the latter model in order to estimate parameters. Experimental results are given which show the developed methods to be effective on genuine monitoring data.

No description available.

This descriptive study explored the congruency between the Prepared Childbirth couple's planned antenatal coaching support style and the observed coaching support style and the couple's postpartal perceptions of the coaching support style. Also explored were the relationship of coach's support style and the degree of the couple's postpartal satisfaction with the childbirth experience. A rrodified version of Campbell's Antenatal Questionnaire and Postpartal Questionnaire (1980) and Standley and Anderson's Naturalistic Observation Fonn were utilized for this study and administered to 10 Prepared Childbirth couples for labor observation and detennination of coaches' support styles. The researcher was not able to observe two of the couples in the sample during labor to determine the coach's style. Data collected from these two couples could only be used to answer twu of the four hypotheses, resulting in 16 subjects in the sample for these instead of 20. Only five of 16 subjects accurately predicted the coaching style that was observed. Six of the 16 subjects' postpartal perceptions of the coaching style agreed with the observer's classification. TWelve out of 20 subjects had congruent antepartal expectations and postpartal perceptions even though the coach may have demonstrated a different support style than planned. Based on the findings of the study, the majority of the subjects were not able to predict the support style that the individual coach would derronstrate during his wife's labor. This had little effect on postpartal satisfaction. The wives of coaches who utilized the "interactive through instrumentation" support style had the lowest rating of satisfaction with the childbirth a-perience. These wives also reported more complications occurring in labor during their postpartal interview.

Introducción: La ictericia neonatal es una patología altamente prevalente en el recién nacido. Se define como la coloración amarillenta de mucosas, piel y escleras, debido al aumento de valores sanguíneos de bilirrubina por sobre los estándares normales para las semanas de gestación previas del neonato y sus horas de vida. Objetivo: Determinar los factores asociados al uso de fototerapia como tratamiento para ictericia neonatal en el Hospital Nacional “Luis N. Sáenz” PNP Julio 2013 a Julio 2016. Material y Métodos: Fue un estudio de tipo observacional, retrospectivo y analítico. La población estudiada fueron 305 recién nacidos con diagnóstico de ictericia neonatal. Se recogió la información de las historias clínicas en una ficha de recolección de datos, de los cuales se seleccionaron 267 neonatos que cumplieron los criterios de exclusión e inclusión. Resultados: Los resultados obtenidos sobre el nivel de asociación fueron: Incompatibilidad ABO OR=1.88, Lactancia Materna Insuficiente OR= 4. 5, Horas de vida al momento del diagnóstico de ictericia neonatal OR=0.5. Conclusiones: Incompatibilidad ABO, Lactancia Materna Insuficiente y Horas de Vida al momento del diagnóstico de ictericia neonatal se asociaron al uso de fototerapia como tratamiento de ictericia neonatal.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Mothers of neonates admitted to neonatal intensive care units appear to suffer stress which may be related to the illness and treatments the neonate is undergoing, separation from the neonate and social and relationship issues. Nursing professionals employed in the neonatal intensive care unit (NICU) need specific preparation in order to assist mothers to cope with the experience of their neonate being admitted to the NICU. Research is required in order to adequately describe the nature of the stress and whether it changes over a period of time and to provide nursing professionals with information relating to the subject of stress suffered by mothers in this situation. A quantitative, longitudinal study of stress experienced by mothers of the neonate NICU patient was undertaken using the Neonatal Unit Parental Stress (NUPS) Scale (Reid, Bramwell, Booth & Weindling, 2007) (Reid et al., 2007). Mothers who met inclusion criteria were recruited to participate in the study. They were asked to complete the NUPS questionnaire at two time points. Correlations were examined between data obtained on the NUPS questionnaire and the mother and infant demographic data. The results of this study have shown that mothers experience the greatest stress as a result of neonatal suffering and their inability to perform functions of the mother role as a result of separation from the neonate. These findings have been used to make recommendations for the preparation of nursing professionals who work in the NICU.

Considerando-se que as experiências não dolorosas também causam desequilíbrio em recém nascidos pré-termo (RNPT) e eventos físicos, psicológicos e sociais que resultam em reações excessivas e dificuldade de enfrentamento, são geradores de estresse, fazazendo-se necessário estudar as reações dos prematuros a essas situações não dolorosas e habituais em Unidade de Terapia Intensiva Neonatal (UTIN). O estudo teve como objetivo: Avaliar a reatividade do RNPT aos cuidados de rotina em uma UTIN. Trata-se de estudo observacional, descritivo, exploratório. A amostra foi constituída por 17 RNPT, internados na UTIN, de um hospital do interior paulista, cujas mães ou responsável aceitaram a participação dos mesmos na pesquisa. Após a aprovação pelos Comitês de Ética em Pesquisa iniciou-se a coleta de dados, sendo os dados de caracterizações maternas e neonatais coletados dos prontuários e os relacionados aos procedimentos de rotina (banho, cuidado agrupado para a higiene e conforto e exame físico médico) e reatividade dos RNPT, coletados a partir das filmagens para posterior análise. Os parâmetros fisiológicos (FC e SatO²) foram registrados minuto a minuto, durante os períodos: basal, manipulação e recuperação. A mímica facial, foi avaliada nos períodos: basal, recuperação 1 e 2 e as Atividades Corporais e Estados de Sono e vigília, nos períodos: basal, de manipulação e recuperação. Para as FC e SatO², foi utilizado o teste estatístico de Wilcoxon para comparar se houve variação significativa entre os períodos, com nível de significância de 5%. A reatividade comportamental dos RNPT foi avaliada através das proporções das atividades faciais e através da distribuição de frequência e de porcentagem dos estados de sono e vigília e movimentação corporal, possibilitando a descrição das mais frequentes em cada um dos períodos avaliados nos diferentes cuidados de rotina dos RNPT. No Banho as medianas das FC variaram entre os períodos: basal, manipulação e recuperação, sendo respectivamente de: 151,5, 152,9 e 149,2 bpm. Os valores medianos para a SatO² foram: 97,2% 98,1% e 97,9% na mesma sequência. Não houve diferença estatística entre os períodos avaliados para estas variáveis. No cuidado agrupado as medianas das FC variaram entre os períodos sendo: 159,1, 158 e 157,5 respectivamente. Houve diferença estatisticamente significante para a FC entre os períodos basal e de recuperação, com p<0,05 (0,047). Para a SatO², os valores medianos foram: 97%; 97% e 97,1% respectivamente. Não houve diferença estatística entre os períodos analisados para esta variável. No exame físico médico as medianas das FC variaram entre: 153,5, 153,8 e 153,8 bpm nos períodos. Os valores medianos para a SatO² foram: 98,4%, 98% e 97,8%, na mesma sequência. Não houve diferença estatística entre os períodos avaliados para estas variáveis. No banho os valores proporcionais medianos da mímica facial variaram entre: 16,7%, 20%, e zero respectivamente nos períodos basal, Recuperação 1 e 2. No cuidado agrupado os valores foram: zero, 20% e 10%. Zero, 2,5% e zero, foram os valores nos respectivos períodos no exame físico médico. Não houve muita variação na freqüência das atividades Corporais nem nas freqüências dos estados de Sono e Vigília entre os períodos avaliados nos diferentes cuidados avaliados, sendo que prevaleceram movimentos regulares, pequenos, relaxado (AC1) e o estado de sono ativo, exceto no período de manipulação no banho, que prevaleceu o choro. Embora as avaliações tenham se dado nos cuidados de rotina, houve presença de 5,9% de aspiração de VAS, considerada por alguns autores como um procedimento doloroso. Os resultados apontaram ainda o uso da sacarose em 3 (17,6%) cuidados agrupados para a higiene e conforto. Mostrase necessária a revisão da aplicação protocolo do uso dessa solução na instituição para que esta não seja oferecida indiscriminadamente em situações que não envolvam procedimentos dolorosos. Sinalizamos a necessidade de rever alguns procedimentos de rotina aplicados nos RNPT, visando à diminuição do estresse por eles vivenciado / Considering that non-painful experiences also cause imbalance in preterm newborns (PTNB) and that physical, psychological and social events which result in excessive reactions and difficulty in coping are also stressing factors for them, it is necessary to study the reactions of premature infants to these non-painful and habitual situations in Neonatal Intensive Care Unit (NICU). This study aimed to: evaluate the PTNB reactions to routine care in a NICU. This is an observational, descriptive, exploratory study. The sample consisted of 17 PTNB infants admitted to the NICU of a hospital in the interior of São Paulo, whose mothers or guardians accepted their participation in the study. This study was approved by Research Ethics Committees for data collection. Maternal and neonatal characterization data were collected from the medical records and those related to routine procedures (bathing, grouped care for hygiene and comfort, and medical physical examination) and PTNB reactions by filming for later analysis. Physiological parameters (HR and SatO2) were recorded minute by minute, during the periods: basal, manipulation and recovery. Facial mimetic was evaluated in the periods: basal, recovery 1 and 2 and body activities and asleep and awake states, in the periods: basal, manipulation and recovery. For HR and SatO2, the Wilcoxon statistical test was used to compare if there was a significant variation between the periods, with a significance level of 5%. The behavioral reactivity of the PTNBs was evaluated through the proportions of the facial activities and through the frequency and percentage distributions of the asleep and awake states and body movement. This procedure allowed the description of the most frequent behavioral reactivities in each of the periods evaluated in the different steps of routine care of the PTNBs. During bath, the HR medians varied between the periods: basal, manipulation and recovery, being respectively: 151.5, 152.9 and 149.2 bpm. The median values for SatO2 were: 97.2% 98.1% and 97.9% respectively. There was no statistical difference between the periods evaluated for these variables. In grouped care the median HR varied between the periods, as given: 159.1, 158 and 157.5 respectively. There was a statistically significant difference for HR between the basal and recovery periods, with p <0.05 (0.047). For SatO², the median values were: 97%; 97% and 97.1%, respectively. There was no statistical difference between the periods analyzed for this variable. For medical physical examination the median HR varied between: 153.5, 153.8 and 153.8 bpm in the mentioned periods. The median values for SatO² were: 98.4%, 98% and 97.8%, respectively. There was no statistical difference between the periods evaluated for these variables. During bath, the median values of facial mime ranged from: 16.7%, 20%, and zero respectively in the basal periods, recovery 1 and 2. In grouped care the values were: zero, 20% and 10%. Zero, 2.5% and zero, were the values considering the same periods in the medical physical examination. There was not statistically significant variation either in the frequency of body activities or in the frequencies of asleep and awake states between the periods established in the different caring types evaluated, prevailing regular, small, relaxed movements (AC1) and active asleep state, except in the manipulation during bath, for which crying prevailed. Although evaluations have taken place in routine care, there was a 5.9% of aspiration of VAS, considered by some authors as a painful procedure. The results also indicated the use of sucrose in 3 (17.6%) grouped care for hygiene and comfort. It is necessary to reevaluate the protocol for application of the use of this solution in the institution so that it is not offered indiscriminately in situations which do not involve painful procedures. We highlight the need to review some routine procedures applied to PTNBs, aiming to reduce the stress experienced by them

Introdução: O conhecimento de parâmetros respiratórios em recém-nascidos a termo saudáveis pode contribuir para a construção de critérios poligráficos utilizados no diagnóstico da Apneia do Sono Central do Lactente. No período neonatal tais critérios não se encontram bem estabelecidos. Método: Foi realizado estudo descritivo de 60 poligrafias de recém-nascidos a termo saudáveis, entre 37 e 44 semanas de idade pósconcepcional, entre os anos de 2017 e 2018, com controle de variáveis maternas, do recém-nascido e variáveis ambientais durante a aquisição de exames. Eventos respiratórios foram identificados conforme critérios do Manual para estadiamento do sono e dos eventos associados da Academia Americana de Medicina do Sono. Foram adicionalmente contabilizados apneias centrais com durações >= 3 segundos, >= 10 segundos, >= 15 segundos, >= 20 segundos; episódios de dessaturação < 90% e 85%; bradicardia < 100 e < 80 batimentos por minuto (bpm). Resultados: A frequência cardíaca (FC) em sono variou entre 82 e 199 bpm, com média de 120,3 ± 10,6 bpm. Antecedente positivo para tabagismo materno prévio foi associado a menores valores de frequência cardíaca mínima, em relação ao antecedente negativo (94 ± 8,4 bpm x 104,9 ± 10,5 bpm). Não foram registrados eventos de bradicardia com FC < 80 bpm. A saturação de oxigênio (SatO2) em sono variou entre 85% e 100%, com média de 97,6% ± 1,5. Não houve episódio de dessaturação com SatO2 < 85%. O percentil 90 para o índice de apneias e hipopneias foi 41,4/hora, e para o índice de apneias centrais foi 10,8/hora. A maioria (90%) dos recém-nascidos apresentou respiração periódica ausente ou presente em < 3% do tempo total de sono. Indivíduos com menores perímetros cefálicos apresentaram maiores índices totais de apneias, e indivíduos com menores perímetros torácicos apresentaram maiores índices de apneias e hipopneias. Conclusões: Não houve episódio de dessaturação com SatO2 < 85% ou eventos de bradicardia com FC< 80 bpm em recém-nascidos a termo saudáveis, e eventos prolongados de apneia foram raros. O percentil 90 para o índice de apneias e hipopneias foi 41,4/hora, e para o índice de apneias centrais foi 10,8/hora. Respiração periódica esteve geralmente ausente ou ocupando menos que 3% do tempo total de sono. Menores perímetros cefálicos e menores perímetros torácicos estiveram associados a maiores índices de eventos respiratórios. / Introduction: The knowledge of respiratory parameters in healthy term newborns can contribute to construction of diagnostic polygraphic criteria in Central Sleep Apnea of Infancy. In the neonatal period these criteria are not well established. Methods: A descriptive study of 60 polygraphic recordings of healthy term newborns (37-44 weeks of postconceptional age) was carried out between 2017 and 2018, with control of maternal, newborn and environmental variables during exams acquisition. Respiratory events were identified according to the American Academy of Sleep Medicine criteria. Central apneas >= 3 seconds, >= 10 seconds, >= 15 seconds, >= 20 seconds were analyzed as well as desaturation <90% and 85%; bradycardia <100 and <80 beats per minute (bpm). Results: The heart rate in sleep ranged from 82 to 199 bpm, with an average of 120.3 ± 10.6 bpm. Previous maternal smoking was associated with lower values in minimum heart rate, as compared to negative antecedent (94 ± 8.4 bpm x 104.9 ± 10.5 bpm). No bradycardia of <80 bpm events was recorded. Oxygen saturation in sleep ranged from 85% to 100%, with an average of 97.6% ± 1.5. There was no episode of desaturation <85%. Central apneas longer than 10 seconds were rare. The 90th percentile for apnea and hypopnea index was 41.4/hour, and for central apnea index was 10.8/hour. The majority (90%) of the newborns did not experience periodic breathing or presented it in <3% of total sleep time. Lower cephalic perimeters were associated with higher total apnea indices, and lower thoracic perimeters with higher apnea and hypopnea indices. Conclusions: There were no episodes of desaturation <85% or bradycardia < 80 bpm in healthy term newborns and prolonged apneas were rare. The 90th percentile for apnea and hypopnea index was 41.4/hour, and for central apnea index was 10.8/hour. Periodic breathing was usually absent in normal term newborns occupying less than 3% of total sleep time. Lower cephalic perimeters and lower thoracic perimeters were associated with higher rates of respiratory events.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01