Alloresponses to blood group antigens result from antigen mismatch between donor and recipient during blood transfusion or transplantation and between mother and fetus during pregnancy. During pregnancy, antigen mismatch can result in haemolytic disease of the newborn (HDN), a disease characterised by the development of potentially harmful alloantibodies, which cross the placenta and mediate the destruction of fetal erythrocytes. This project investigates examples of clinically important alloresponses to blood group antigens and, more specifically, characterises the ymphocytes that either drive or regulate these responses. The main aims or this project were to first map alioreactive T-helper cell epitopes and secondly to clone using a novel method, IL-10 secreting blood group specific regulatory cells. The work focussed on two major antigens, the kell (K) 1 and Rhesus (Rh) D antigens.

Class of 2012 Abstract / Specific Aims: The objective of this study is to evaluate and compare clinical outcomes and economic impact involved with the use of beractant (B) compared to poractant (P) for the treatment of respiratory distress syndrome (RDS) in premature neonates admitted to a neonatal intensive care unit. Methods: Patients were included if they were less than 35 weeks gestational age at birth, survived at least 48 hours, and admitted to the neonatal intensive care unit and treated with P or B for RDS. The primary outcome of this study is the change in the fraction of inspired oxygen (FiO2) over the first 48 hours after surfactant administration. Secondary outcomes were the change in oxygen saturation, time spent on mechanical ventilation and continuous positive airway pressure (CPAP), complication occurrence and mortality of the neonates. Main Results: There were a total of 40 neonates whose charts were reviewed (n= 13 and n=27 in the P and B groups respectively). The mean gestational age of the neonates were 29.2+/-2.9 and 28.8+/-2.9 weeks in the P and B groups respectively. The FiO2 was found to not be lower between the P and B groups (35.5+/-22.2 and 42.4+/-24.2, respectively; p=0.379), as well as the O2 saturation (94.6+/-4.6 and 92.3+/-6.1; p=0.194). Significance was also not found for the other clinical or economic outcomes assessed in this study. Conclusions: There was not a significant difference between poractant and beractant in FiO2, O2 saturation, or in the other clinical outcomes evaluated in this study.

Class of 2012 Abstract / Specific Aims: The goal of this project was to evaluate the use of a preparation of the brainstem and spinal cord of neonatal rats that has been widely used for observing and quantifying central nervous activity, as well as the response to pharmacological manipulation. To achieve this, we specifically aimed to remove the intact brainstem and spinal cord of newborn rats, and develop a preparation that would maintain physiological function and allow for recording of electrical activity. Methods: Multiple dissections were performed on neonatal rats. Conditions during the dissections were controlled to maintain physiological function. Once removed, the intact brainstem and spinal cord was placed in a preparation that allowed for manipulation and access to nerve rootlets. Finally, glass suction electrodes were used to record electrical activity directly from the nerve rootlets. Once recorded, the data were stored on a hard drive for further analysis. Main Results: We were successful in isolating the intact brainstem and spinal cord in neonatal rats while maintaining physiological conditions and nervous activity. The preparation allowed for easy access to nerve roots as well as customization for different experiments. We were also successful in recording nerve activity in the preparation and collection of data for use in future experiments Conclusions: We conclude that the brainstem spinal cord preparation described in this study is a valuable tool that allows for recording and analysis of nerve activity, and specifically for measurement of respiratory motor output. This is a preparation that can be used in a variety of experiments that attempt to observe or quantify the activity of central nerve cells and allows for pharmacological interventions that could be applied in various experiments.

Abstract According to Bowlby, infants have a universal need to seek close proximity with their caregiver when under distress or threatened. This study seeks to look at attachment in a population that is undergoing extreme distress as they suffer from opioid withdrawal within the first few weeks of life. It aims to explore the role touch (kangaroo care) can have in creating the secure base that attachment theorists describe as the basis for all future attachments, and in reducing the length of Neonatal Abstinence Syndrome. It is hypothesized that infants born with drug dependencies who receive increased touch and holding throughout their withdrawal will have a shorter duration of Neonatal Abstinence Syndrome and will be more securely attached at 18 months than those who do not receive increased touch. It is also hypothesized that infants whose caregivers reported high scores of bonding with their infants in the first year of life will be more securely attached than those with lower scores of bonding. Infants who were sent home with their birth parents after discharge are hypothesized to be more securely attached at 18 months with their caregiver than infants who were sent home to a foster family. The results of this study will contribute to attachment literature in a population where research is lacking, and will add to the knowledge on Neonatal Abstinence Syndrome treatment.

RESUMEN Introducción: Los recién nacidos con menos de 1,500 g de peso (RNMBP) son un problema de salud pública alrededor del mundo. Es necesario obtener información epidemiológica local para proponer cambios en el manejo de las mujeres gestantes y sus descendientes. Materiales y Métodos: Basados en una cohorte histórica de 1,265 nacimientos de RNMBP que ocurrieron en el Instituto Nacional Materno Perinatal de Lima entre los años 2,006 al 2,010 se determinó los factores perinatales asociados con la mortalidad neonatal. Se utilizó el Programa SPSS v.17 para un análisis de sobrevida con el método de Kaplan- Meier, un análisis bivariado utilizando el riesgo relativo y un análisis multivariado mediante la regresión de Cox y el cálculo de los hazard ratio. Resultados: Los RNMBP representaron 1.5% del total de recién nacidos vivos. Hubo una sobrevida global del 60%, observándose una relación directa entre la sobrevida y el peso nacer. Después del análisis multivariado, la preeclampsia, la rotura prematura de membranas, el parto vaginal, ser de género masculino y las patologías neonatales que incluyeron la depresión severa al nacer, la asfixia, la enfermedad de membrana hialina y la hemorragia intraventricular severa estuvieron asociadas significativamente con mayor riesgo de mortalidad neonatal. Discusiones y conclusiones: Deberían proponerse estrategias para que las gestantes reciban cuidados prenatales de calidad, buscando que sus fetos alcancen el mayor peso intrauterino especialmente en aquellas gestantes con diagnóstico de preeclampsia y rotura prematura de membranas. El parto por cesárea resultó ser un factor protector. Un número mayor de unidades de cuidados intensivos neonatales en nuestro medio son necesarias para mejorar la sobrevida de este grupo de recién nacidos. Es imprescindible el enfoque perinatológico para la mejora en la salud 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

MSc, Occupational Therapy, Faculty of the Health Sciences, University of the Witwatersrand / This study investigated the sensory processing of premature infants between 7-12 months of age at Chris Hani Baragwanath Hospital using the standardised Infant/Toddler Sensory Profile. The design of research that was primarily utilised in this study was quantitative, cross sectional, descriptive research. Results indicated that 50% of all the premature infants were found to be low threshold infants, and tended to be over responsive to auditory, visual and tactile sensory stimuli. The Sensory Profiles of infants who underwent different methods of neonatal care including kangaroo mother care (KMC), where mothers were involved in a fulltime twenty-four hour KMC programme, and those who received mainly conventional care (CC) were compared. The only score that differed significantly between infants receiving different types of care was tactile processing, with the CC infants having more typical tactile processing scores. These findings were contrary to other KMC research, which may have been affected by the reliability of using this measure with this study sample and the small sample size of infants who received CC.

Objetivos: A deficiência de glicose-6-fosfato desidrogenase (G6PD) está associada a um maior risco de encefalopatia bilirrubínica e de crise hemolítica aguda grave desencadeada por drogas como a primaquina e a dapsona. Conhecer a prevalência dessa deficiência enzimática em área onde a malária e a hanseníase ainda estão presentes e conhecer a prevalência das principais mutações traz subsídios para planejamento de estratégias com vistas à redução de riscos associados a esta deficiência enzimática. Métodos: Estudo descritivo transversal conduzido em uma região do centro-oeste do Brasil. Exame de triagem para deficiência de G6PD foi realizado em 3573 recémnascidos. Exame confirmatório foi necessário em 188 crianças triadas como possíveis portadores de deficiência. Nas crianças em que foi confirmada a deficiência de G6PD foi feita pesquisa das mutações G202A (G6PD A-) e C563T (G6PD Mediterrâneo) por PCR. Resultados: A deficiência de G6PD foi confirmada em 63 crianças, sendo 60 meninos (95,2%) e três meninas (4,8%). O percentual de exames falso-positivos na fase de triagem foi de 66,5%, estando o percentual de falso-positivos associado à temperatura e tempo de transporte das amostras. Entre as crianças que confirmaram deficiência de G6PD, foi mais frequente a história de anemia em familiares e de icterícia neonatal. Houve associação entre hematócrito baixo e deficiência enzimática, mas não com hemoglobina, contagem de reticulócitos ou neutrófilos. A prevalência da deficiência de G6PD (IC95%) foi de 1,76% (1,37; 2,24) entre os recém-nascidos triados e de 3,34% entre os meninos (2,58; 4,25). A mutação C563T não foi identificada em nenhuma criança, mas a mutação G202A estava presente em 58 crianças - 92,06% (IC95%: 83,29 - 97,03): 56/60 meninos e em 2/3 meninas homozigotas. Foi identificado um menino com Kernicterus portador da mutação G202A em hemizigose. Conclusão: O elevado percentual de falso-positivos na etapa de triagem, o tempo necessário entre coleta e confirmação da presença de deficiência enzimática, associado ao alto custo da triagem universal, não apoiam a inclusão da triagem de deficiência de G6PD no programa de triagem neonatal brasileiro. Na região avaliada, a prevalência observada em meninos indica que a triagem de deficiência de G6PD deva ser realizada antes do uso de drogas como a primaquina e a dapsona somente em meninos. Foi elevada a prevalência da mutação G202A, de classe III, sendo esta mutação associada a uma menor morbidade. A identificação de um menino com Kernicterus com deficiência de G6PD indica que há necessidade de se planejar estratégias para minimizar o risco dessa morbidade associada à deficiência enzimática / Objective: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with an increased risk of bilirubin encephalopathy in neonates and acute hemolytic crisis triggered by drugs such as primaquine and dapsone. In an area where malaria and Hansen\'s disease are still present, knowing the prevalence of this enzyme defect and determining the prevalence of major mutations is important for planning strategies for reducing the risks associated with this enzyme deficiency. Methods: Sectional study was conducted in a Midwestern region of Brazil. Screening for G6PD deficiency was performed in 3,573 neonates. Confirmatory tests were necessary for 188 positively screened children. After confirmation, PCR investigation was utilized to identify the mutations. Results: G6PD deficiency was confirmed in 63 children: 60 boys (95.2%) and 3 girls (4.8%). The percentage of false-positive cases in the screening phase, 66.5% and was associated with the temperature and transportation time of the samples. Family history of anemia and jaundice was more frequent among the children with confirmed G6PD deficiency. An association between a low hematocrit and enzyme deficiency was observed. However, there was no association with hemoglobin reticulocyte or neutrophils counts. The prevalence of G6PD deficiency (CI95%) was 1.76% (1.37; 2.24) among all screened neonates and 3.34% (2.58; 4.25) among male children. The C563T mutation was not identified in any child. The G202A mutation was present in 58 children - 92.06% (CI95%: 83.29 - 97.03), 56/60 boys and 2/3 homozygous girls. One boy with a hemizygous G202A mutation was identified as having Kernicterus. Conclusion: The high percentage of false-positive results when first screening for G6PD deficiency; the long delay time between the test and result; along with the high cost of the this screening test, are all factors that do not support adding this test to the already established Brazilian neonatal screening programs. The prevalence observed among boys does indicate that screening for G6PD deficiency should be performed in this region before the use of drugs such as primaquine and dapsone only in boys. This study found a high prevalence of the G202A mutation, a Class III variant associated with lower morbidity. The identification of a G6PD deficient boy with Kernicterus reinforces the necessity for strategies to abolish the morbidity associated with this enzyme deficiency

A triagem auditiva neonatal universal - TANU - tem sido recomendada no Brasil e no exterior como o principal instrumento para assegurar, nos primeiros anos de vida, o diagnóstico da deficiência auditiva. Nessa medida, o objetivo do presente estudo foi identificar o grau de preocupação e conhecimento a respeito desse procedimento por parte dos familiares, visando contribuir para o planejamento de ações que viabilizem estratégias ainda mais eficazes de orientações fonoaudiológicas. Também foi possível observar o quanto os pais sabem a respeito da audição do bebê, o que pode levar à criação de maneiras mais acolhedoras de acompanhamento e atenção às necessidades reais da família durante o diagnóstico audiológico. Para a pesquisa, foram então selecionadas, inicialmente, 42 famílias, das quais restaram trinta e oito cujos bebês não haviam passado no teste e reteste da TANU, realizados na maternidade Santa Isabel - Bauru/SP, pelo projeto \"Modelo de Saúde Auditiva no Recém-nascido\". A coleta de dados e o registro foram realizados na Clínica de Audiologia Infantil do Departamento de Fonoaudiologia da FOB-USP, Bauru/SP, por meio da aplicação de um instrumento integralmente adaptado, tomando por base dois questionários: o Rhode Island Hearing Screen Program Questionnarie, aplicado em Rhode Island Hearing Assesment Program; e o questionário aplicado por HERGILS; HERGILS17, 2000 na University Hospital, Linköping-Suécia. Foram incluídas, ainda, seis questões pelos juízes que validaram o instrumento. Os resultados foram: houve um aumento significativo do grau de preocupação materna entre o teste e reteste da TANU (p = 0.002); a maior parte das participantes (50%) soube da TANU após a alta hospitalar, 34% durante a internação e 16% antes da internação hospitalar; 55% informaram que não sabiam qual profissional havia realizado a TANU; 100% declararam ser favoráveis ao programa de TANU, sendo que, destas, 53% mostraram-se insatisfeitas com as informações recebidas, tanto sobre os objetivos como sobre as conseqüências da avaliação. O presente estudo confirmou os resultados de outras pesquisas que ressaltam a importância dos programas de Saúde Auditiva no sentido de assegurar que as famílias compreendam a necessidade da TANU, bem como a continuação do diagnóstico audiológico e intervenção precoce, quando necessários. / The universal newborn hearing screening - UNHS - has been recommended in Brazil and other foreign countries as the main instrument to assure, in the first years of life, the diagnosis of the auditory deficiency. In this measure, the goal of the current study was to identify the worry and knowledge degrees concerning to this procedure regarding the familiar people, aiming to contribute for the planning of actions that make possible audiologist guidance strategies even more efficient. It was also possible to observe how much the parents know about the baby hearing, and what can be taken to create more welcoming ways of attendance and attention to the real necessities of the family during the audiologist diagnosis. For the research, 42 families were initially selected, for those 38 remained, whose babies did not pass in the UNHS test and retest, which were held at the Maternity Saint Isabel - Bauru/SP, for the project \"Auditory Health Model in the Newborn\". Data and registers collecting were carried through the Audiologist Infantile Clinic of the Therapy Speech-Audiologist Department at FOBUSP, Bauru/SP, over the application of an integrally adapted instrument, based on two questionnaires: the Rhode Island Hearing Screen Program Questionnaire, applied in Rhode Island Hearing Assessment Program; and the questionnaire applied for HERGILS; HERGILS17, 2000 in the University Hospital, Linköping-Sweden. Six questions were included by the judges that validated the instrument. The results showed a significant increase of the maternal concern degree between the UNHS test and retest (p = 0,002); most of the participants (50%) was informed about UNHS procedures after the hospital discharge, 34% during hospital admission and 16% before the hospital admission; 55% informed that they did not know the professional name that performed the UNHS procedures; 100% declared to be for to the UNHS program. From all participants, 53% confirmed unsatisfied with the received information, not only on the objectives but also on the consequences of the evaluation. The recent study confirmed the results of other researches that point out the importance of the Auditory Health programs in order to assure that the families understand the necessity of the UNHS procedures, as well as the continuation of the audiologist diagnosis and previous intervention, when necessary.

Introdução: O Cateter Central de Inserção Periférica (CCIP) é um dispositivo vascular central inserido através de veias periféricas que permite a infusão de soluções hiperosmolares e medicações por tempo prolongado. Complicações mecânicas e infecciosas podem ocorrer com seu uso, resultando em remoção não eletiva do cateter. Um escore de risco para remoção não eletiva do CCIP que considere conjuntamente o valor prognóstico ponderado de diversos fatores de risco representa uma ferramenta valiosa para o planejamento do cuidado de enfermagem com enfoque na prevenção ou atenuação dos fatores identificados, e consequente melhoria da qualidade da assistência. Objetivo: Elaborar um escore de risco para remoção não eletiva do cateter central de inserção periférica em neonatos. Método: Estudo de coorte com coleta prospectiva de dados realizado no período de 31 de agosto de 2010 a 30 de agosto de 2012 com 436 recém-nascidos internados em uma unidade de terapia intensiva neonatal de um hospital terciário em São Paulo submetidos à instalação de 524 CCIPs. As variáveis relacionadas às características clínicas do neonato, à técnica de inserção do cateter e à terapia intravenosa que indicou a instalação do CCIP foram analisadas quanto ao seu potencial preditivo para remoção não eletiva do CCIP através de análise bivariada, e posterior regressão logística. O escore de risco ponderado foi construído baseado na razão de chances das variáveis preditoras e sua acurácia foi avaliada através da área sob a curva ROC (Receiver Operating Characteristic). Resultados: O escore de risco foi composto pelos seguintes fatores de risco: diagnóstico de transtorno transitório do metabolismo (hipoglicemia, hiperglicemia, distúrbios do cálcio, magnésio, sódio e potássio), inserção prévia do CCIP, uso do CCIP 2.0 French de poliuretano com dupla via, infusão de múltiplas soluções endovenosas através do CCIP 1.9 French de silicone com única via, e posição não central da ponta do CCIP. Sua acurácia foi de 0,76 [IC 95%: 0,73-0,78]. Sua aplicação permitiu classificar os recém-nascidos em três categorias de risco: baixo (0 a 3 pontos), moderado (4 a 8 pontos) e alto ( 9 pontos) risco para remoção não eletiva. Conclusão: Recomenda-se a adoção de estratégias preventivas da remoção não eletiva do CCIP baseadas em evidência de acordo com a classificação e fatores de risco do recém-nascido. Além disso, sugere-se evitar a inserção de múltiplos cateteres, a posição não central da ponta do CCIP, e a instalação de cateteres de silicone de única via para a administração de cinco ou mais classes de soluções endovenosas. / Background: Peripherally Inserted Central Catheter (PICC) is a central vascular access device inserted via cannulation of a peripheral vein that allows the infusion of hyperosmolar solutions and medications over a prolonged dwell time. Mechanical and infectious complications can result from its use leading to nonelective removal of the device. A risk score for nonelective removal of PICC-lines that considers jointly a weighted prognostic value of several risk factors can represent a valuable tool for planning the nursing care focused on preventing or modifying identified risk factors, and thereby improving the quality of care. Aim: To develop a risk score for nonelective removal of PICCs in infants. Methods: A cohort study with prospective data collection between August 31, 2010 and August 30, 2012 in 436 infants admitted to a tertiary-level neonatal intensive care unit in São Paulo and submitted to 524PICC insertions. Variables related to the clinical characteristics of the neonate, the technique of catheter insertion, and intravenous therapy that indicated PICC were analysed for their nonelective predictive potential through bivariate analysis, followed by a logistic regression. Predictors were weighted points proportional to their odds ratio in order to develop the risk score. The accuracy of the risk score model was examined by calculating the area under the receiver operating curve (AUC). Results: The risk score was composed of the following risk factors: diagnose of transitory metabolic disorders (hyperglycaemia, hypoglycaemia, disorders of calcium, magnesium, sodium or potassium), previous PICC line insertion, insertion of 2.0 French dual-lumen polyurethane PICC, noncentral tip position, and multiple intravenous solutions in a 1.9 French single-lumen silicone PICC. The accuracy of the risk score was of AUC=0.76 [IC 95%: 0.73-0.78]. Its application allowed classify newborns into three nonelective removal risk categories: a low-risk group (0-3 points), a moderate-risk group (4-8 points), and a high-risk group ( 9 points). Conclusion: It is recommended the adoption of evidence-based preventive measures according to the classification and risk factors of the newborn in order to avoid nonelective removal of PICC. The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of five or more intravenous solutions is suggested.