Background: Care of premature infants is challenging for health care professionals. When the preterm infant is separated from its mother the parent-child interaction is impeded. In the last few decades, there has been increasing interest in the effectiveness of massage as an intervention to counter the negative physiological, clinical and behavioral consequences of prematurity and the neonatal intensive care unit environment. Aims: To establish the effectiveness of moderate pressure massage from evidence in the literature and to then explore the cultural, organisational and contextual factors that may act as facilitators and/or barriers for its future implementation in Lebanon. Methods: This thesis utilizes a two-step approach. Two literature reviews were undertaken to establish recent evidence on moderate pressure massage. A qualitative exploratory investigation was adopted as no articles were found that elucidated the contextual barriers and facilitators for massage implementation in the neonatal intensive care unit. The normalization process theory was used as a sensitizing framework to understand implementation issues and address the observed difficulties in implementing new interventions in clinical settings. This study was also concerned with context and culture as moderate pressure massage is not practiced in the Lebanese neonatal intensive care units. A purposive sample of Lebanese health care professionals and parents were recruited from three university hospitals with data generated through focus group discussions and observational notes. Framework analysis was used for the analysis and interpretation of the findings. The study drew on the principles and practice of ethnographic approaches. Findings: The findings from the two literature reviews only revealed randomized control trials that observed mostly the short-term physiological and psychological effects of moderate pressure massage. There were no studies that examined the organizational and contextual issues that need to be understood before any trial could be designed in the neonatal intensive care unit setting. The evidence from this review suggested there is a need to explore the views of health care professionals and parents on the practice of massage in the neonatal intensive care units to provide insight into the subsequent design of an intervention study that would be culturally sensitive, appropriate, and acceptable in practice. The findings from the qualitative study then revealed that despite the participants’ interest in implementing massage intervention, parents’ participation in the neonatal intensive care unit is almost absent except for breastfeeding. Participants in both groups, parents and health care professionals, highlighted the parents’ fear and anxiety. In general, nurses are in charge and parents are passive observers. Transportation difficulties, unavailability of helpful staff, and fear were reported as major barriers to parent-implemented infant moderate pressure massage; health care professionals highlighted staff attitude and resistance, workload and time constraints. Communication, gradual implementation, encouragement and support were identified by parents as potential facilitators. In comparison, having extra staff and a protocol for teaching nurses, training parents and openness to innovation were the main potential facilitators of implementation identified by health care professionals. Conclusion: This study helped to reveal the potential challenges of applying such a complex intervention as moderate pressure massage by the parents in the neonatal intensive care unit. Adopting infant massage in the Lebanese neonatal intensive care unit without preparation of health care professionals and parents would be premature. Good communication between parents and health care providers is a key element to facilitate early bonding and parent-infant interaction. Missing the opportunity to involve parents in neonatal intensive care unit care puts the family in a difficult situation to adapt to the new challenges after discharge. The findings of this study will advance current knowledge in understanding the factors that determine applicability, acceptability and feasibility of massage implementation in the neonatal intensive care unit setting. It will also assist and inform the design of future randomized control trials. The noramalization process theory was a valuable lens to guide the process of inquiry and to make sense of the emergent findings from this exploratory qualitative study.

Bovine Neonatal Pancytopenia (BNP) is a disease of calves, characterised by peripheral blood and bone marrow depletion, which emerged in Europe in 2007. A strong epidemiological association between BNP and the administration of a particular inactivated Bovine Viral Diarrhoea (BVD) vaccine (Pregsure BVD, Pfizer Animal Health) to the dams of affected calves has been reported. Early studies suggested that BNP is mediated by the transfer of alloantibodies in colostrum and that these alloantibodies recognise major histocompatibility complex (MHC) class I molecules. This led to the hypothesis that Pregsure contains bovine MHC I molecules, originating from the MDBK line cell used in vaccine production, and that this is responsible for the generation of alloantibodies in particular cows injected with the vaccine. This project aimed to investigate the mechanisms by which BNP arises and develops. In particular to gain an understanding of the molecular basis of the syndrome and how this influences the number of cows and calves affected and the specificity of the pathology for the haematopoietic system. Haematological analysis of clinically normal calves born on a BNP-affected farm demonstrated that 15% of calves had profoundly abnormal haematology and could be described as affected by subclinical BNP. BNP was reproduced experimentally by feeding pooled colostrum to neonatal calves, confirming the role of colostrum in mediating the condition. Detailed analysis of serial haematology and bone marrow pathology from these calves demonstrated variable alloantibody damages to different haematopoietic lineages. In vitro cellular assays using a panel of MHC I-defined bovine leukocyte cell lines and mouse cells individually transfected with the MDBK-MHC I alleles demonstrated that Pregsure vaccinated cows have significantly higher titres of functionally active MHC I alloantibodies than BVDV unvaccinated cows or cows vaccinated with alternative BVDV vaccines. The alloantibody response was found to be heterogeneous in individual Pregsure vaccinated cows. MHC I expression levels on peripheral blood and bone marrow cells, assessed by flow cytometry, was shown to correlate with levels of in vitro and in vivo alloantibody damage. Overall, the results of this project demonstrate that the pathogenesis of BNP is mediated by the transfer of MHC I-specific alloantibodies via colostrum that cause rapid destruction of peripheral blood and bone marrow cells, and which is dependent on the titre of alloantibody produced by an individual cow, its specificity for the MHC I alleles present, and density of MHC I expression on the specific cells.

Made available in DSpace on 2014-06-11T19:31:01Z (GMT). No. of bitstreams: 0 Previous issue date: 2013-02-07Bitstream added on 2014-06-13T19:19:52Z : No. of bitstreams: 1 avila_lg_dr_araca.pdf: 752807 bytes, checksum: 7c3bb86701f5e8379de4c6d436c830bb (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo deste trabalho foi determinar e avaliar os parâmetros fisiológicos, a vitalidade, a glicemia, a concentração plasmática de lactato, os valores hemogasométricos e os perfis hematológico e bioquímico renal de cordeiros nascidos a termo e prematuros, do nascimento as 48 horas de vida. Foram constituídos quatros grupos experimentais: PN (cordeiros nascidos de parto normal, n=15, média de 146 dias); PNDEX (cordeiros nascidos de parto normal cujas mães receberam 16 mg de dexametasona aos 141 dias de gestação, n=8, média de 143 dias); PRE (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, n=10) e PREDEX (cordeiros prematuros nascidos de cesarianas aos 138 dias de gestação, cujas mães receberam 16 mg de dexametasona dois dias antes, n=9). As frequências cardíaca e respiratória foram mais altas nos grupos de partos normais; a temperatura retal diminuiu em todos os grupos entre 15 e 60 minutos de vida, sendo os menores valores encontrados nos cordeiros prematuros. O escore Apgar foi mais alto nos animais nascidos em tempo gestacional normal, o que também aconteceu em relação à glicemia. Contudo, a concentração plasmática de lactato foi mais alta nos animais prematuros, os quais apresentaram valores mais baixos de pH e bicarbonato, e mais altos de pCO2 e BE, indicando quadro mais grave de acidose respiratória e metabólica. Não houve variações expressivas no perfil hematológico, ao contrário do que foi evidenciado no perfil bioquímico renal, em que os cordeiros prematuros apresentaram concentrações séricas mais altas de creatinina / The aim of this study was to determine and evaluate the physiological parameters, vitality, blood glucose and plasma lactate concentrations, blood gas values and hematological and biochemical profiles of full-term and premature lambs from birth to 48 hours of life. Four experimental groups were formed: NDG (normal delivery group - lambs vaginally delivered, n=15, average of 146 days); NDEXG (normal delivery with dexamethasone group - lambs vaginally delivered whose mothers received 16 mg of dexamethasone at 141 days of gestation, n=8, average of 143 days), PRE (premature lambs born by cesarean section at 138 days of gestation, n=10) and PREDEX (premature lambs born by cesarean section at 138 days of gestation, whose mothers received 16 mg of dexamethasone two days before, n=9). Heart and respiratory rates were higher in the groups of normal deliveries; rectal temperature decreased in all groups between 15 and 60 minutes of life with the lowest values found in premature lambs. The Apgar score was higher in animals born at normal gestational time, which also occurred in relation to glucose. However, plasma lactate concentration was higher in premature lambs, which also showed lower values of pH and bicarbonate, and higher pCO2 and BE, indicating more severe metabolic and respiratory acidosis. There were no significant variations in the hematological profile, contrary to what was found in renal biochemical profile, where premature lambs had higher serum creatinine concentrations.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / Os recÃm-nascidos (RN) com malformaÃÃo congÃnita (MC) requerem dos profissionais de enfermagem atenÃÃo e cuidados especÃficos e individualizados. O estudo objetivou avaliar a prevalÃncia dos recÃm-nascidos com malformaÃÃes congÃnitas em instituiÃÃes pÃblicas e a assistÃncia de enfermagem prestada a essas crianÃas internadas na Unidade Neonatal (UN) nas primeiras 24 horas de vida. Estudo descritivo, transversal, quantitativo, realizado em trÃs Unidades Neonatais de instituiÃÃes hospitalares (A, B e C) de Fortaleza, Brasil. A amostra foi composta de 159 recÃm-nascidos, sendo 75 na instituiÃÃo A; 44 na B; e 40 na C. Os dados foram coletados em 2012, de janeiro a junho em A e B, e de marÃo a agosto em C. Investigou-se prontuÃrios e documentos nas unidades referidas e, posteriormente, eles foram registrados em formulÃrios prÃprios contendo variÃveis maternas e neonatais, apÃs a aprovaÃÃo pelos ComitÃs de Ãtica. Os resultados revelaram prevalÃncia de 3,3%, 2,1% e 3,6% de RN malformados nas instituiÃÃes, respectivamente. Da amostra, 53% eram masculinos, 57% com 37 a 41,6 semanas gestacionais, 52% pesando entre 2.500g e 3999g, 66% com estatura de 39 a 49 cm, Apgar no 1Â(60%) e 5Â(79%) minutos de sete a dez. Dentre as terapias implementadas ao RN, sobressaÃram-se oxigenoterapia sob Oxi-hood (42%); Dieta zero (37%); hidrataÃÃo venosa (36%); punÃÃo de acesso venoso central para infusÃes (44%); manuseio de trÃs em trÃs horas (89%) e nÃo realizaram cirurgias no perÃodo (75%). Dentre os curativos, o local destacado foi a regiÃo sacral (54%) e a cobertura com compressa estÃril (21%). As malformaÃÃes congÃnitas diagnosticadas foram categorizadas conforme classificaÃÃo do CID â 10, prevalecendo aquelas pertencentes ao Sistema Osteomuscular (30%) e Sistema Nervoso Central (SNC) (21,1%), ressaltando o PÃ torto congÃnito, Polidactilia, Hidrocefalia e Mielomeningocele. Destacaram-se as malformaÃÃes isoladas (61%) e os registros de cuidados de enfermagem envolvendo exames (24,4%) e oxigenoterapia (16,9%). Ocorreram associaÃÃes estatisticamente significantes entre as categorias de malformaÃÃes e algumas variÃveis especÃficas: (MC do SNC) x (IG, Terapia Medicamentosa); (MC do olho, ouvido, face, pescoÃo) x (IG, Uso de drogas e Escolaridade); (MC Aparelho CirculatÃrio) x (Uso de drogas e Terapia Medicamentosa); (MC Aparelho RespiratÃrio) x (Idade materna e Uso de drogas); (Fenda labial ou palatina) x (Idade materna e Uso de drogas); (Outras MC do Aparelho Digestivo) x (Modalidade VentilatÃria, Forma de NutriÃÃo e Cirurgia); (MC dos ÃrgÃos Genitais) x (Sexo, Renda familiar e Forma de NutriÃÃo); (MC Osteomuscular) x (NÃmero de GestaÃÃes e Modalidade VentilatÃria); (Outras MC) x (IG e Peso); e (Anomalias CromossÃmicas) x (Idade materna), todos com p<0,05. Concluiu-se que ainda se faz prevalente o nÃmero de MC em RN e que a equipe de enfermagem implementa cuidados de acordo com as condiÃÃes clÃnicas, da patologia e equilÃbrio hemodinÃmico de cada RN e nÃo especificamente para cada tipo de malformaÃÃo. / The newborns (NB) with congenital malformation (CM) requires from nursing professionals the performance of specific and individualized care. This study aimed at evaluating the prevalence of newborns with congenital malformation in public institutions and the nursing care provided to these children admitted to the Neonatal Unit (NU) in the first 24 hours of life. This is a descriptive, cross-sectional and quantitative study, which was conducted in three Neonatal Units of hospitals (A, B, C) from the city of Fortaleza-CE/Brazil. The sample was composed of 159 newborns; from which 75 belong to institution A; 44 to B; and 40 to C. The data were collected in 2012, from January to June in A and B, and from March to August in C. Records and documents were investigated in the aformentioned units and, subsequently, they were recorded in the proper forms containing maternal and neonatal variables, after approval by the Ethical Committee. Results showed prevalence of 3.3%, 2.1% and 3.6% of malformed newborns in the institutions, respectively. Of the sample, 53% were male, 57% with 37 to 41,6 gestation weeks, 52% weighing between 2,500 g and 3999g, 66% with height 39-49 cm, Apgar score at 1st (60%) and 5th (79%) minutes from seven to ten. Among the implemented therapies to the NB, it should be highlighted oxygenotherapy in Oxy-hood (42%); Zero diet (37%); intravenous hydration (36%); central venous access puncture for infusions (44%); handling for every three hours (89%) and did not undergo surgery throughout the period (75%). Among the dressings, the highlighted location was the sacral region (54%) and the coverage with sterile compress (21%). The diagnosed congenital malformations were categorized according to the classification of the ICD â 10, prevailing those ones belonging to the Musculoskeletal System (30%) and to the Central Nervous System (CNS) (21.1%) highlighting the Congenital clubfoot, Polydactyly, Hydrocephalus and Myelomeningocele. It should also be highlighted the isolated malformations (61%) and the nursing care records involving examinations (24.4%) and oxygenotherapy (16.9%). There were statistically significant associations between the malformations categories and some specific variables: (CM of the CNS) x (GI, Drug Therapy) (CM of the eye, ear, face, neck) x (GI, Drug use and Schooling); (CM of the Circulatory System) x (Maternal age and Drug use) (CM of the Respiratory System) x (Drug use and Drug therapy); (Cleft-lip and palate) x (Maternal age and Drug use); (Others CM of the Digestive System) x (Ventilation modality and Nutrition and Surgery forms); (CM of the Genitalia) x (Gender, Family Income and Nutrition form); (Musculoskeletal CM) x (Number of pregnancies and Ventilation modality); (Others CM) x (GI and weight), and (Chromosomal Abnormalities) x (Maternal age), all with p <0.05. We have concluded that the number of NB with CM it is still prevalent and the nursing staff implements the healthcare according to the clinical conditions, pathology and hemodynamic balance of each NB and not specifically for each type of malformation.

OBJETIVO: Identificar o perfil da clientela atendida na Unidade de Cuidados Intensivos Neonatal Externa (UCINE); observar possíveis diferenças entre recém-nascidos e família de mães adolescentes e de mães adultas, e verificar a participação das famílias nos programas de humanização da unidade. MÉTODO: Estudo de coorte transversal prospectivo de 284 recém-nascidos (RN) e seus familiares admitidos na Unidade de Cuidados Intensivos Neonatal do Instituto da Criança de maio de 2005 a dezembro de 2006. Os dados foram coletados com as mães seguindo o conteúdo do formulário construído especificamente para este estudo, que incluía informações socioeconômicas e demográ-ficas, história antenatal, tipo de parto, dados relacionados ao recém-nascido como idade gestacional e cronológica, pesos de nascimento e de admissão, tipo de aleitamento à internação e na alta, doenças que geraram a internação, número de altas, óbitos e transferências, trata-mentos utilizados e participação da família durante a internação. RESULTADOS: Evidenciou-se em relação às condições sociodemográ-ficas que a maioria dos 284 pacientes (66,2%) procedia da cidade de São Paulo, principalmente da Zona Oeste, ou dos municípios. O pré-natal foi realizado por 96,1% das mães, e 59% dos RN nasceram de parto cesa-riano, com peso entre 600 e 4780g, idade gestacional mediana de 37,6 semanas, e na maioria adequados para a idade gestacional (77,5%). A mediana da idade à internação foi de 7 dias de vida, associada princi-palmente a causas infecciosas (32,0%) e respiratórias (25,0%), sendo o peso nesta ocasião de 600 a 5810g. A taxa de mães adolescentes ( 19 anos de idade) foi de 21,0%, e neste grupo observou-se índices inferiores de escolaridade e de número de consultas de pré-natal e, maior inci-dência de prematuridade (47,5%). As mães adultas apresentaram maior número de intercorrências durante a gestação e maior incidência de parto cesariano (63,6%). Em relação às características dos RN, não houve diferenças estatísticas entre mães adolescentes e adultas, entre-tanto observou-se a necessidade de internação mais precoce dos RN de mães adolescentes na unidade, e pesos menores à admissão. A sobre-vida foi de 91,2% e, a evolução dos RN não foi influenciada pela idade materna, quando questionada a participação das famílias nos programas de humanização da unidade, observou-se participação ativa dos fami-liares de ambas as faixas etárias nos cuidados ao RN e aumento da porcentagem de RN em aleitamento na alta (69,3%) comparada à admissão (51,7%). CONCLUSÕES: O perfil da clientela mostra que o atendimento é na sua maior parte regionalizado, e constituído por pacientes com doenças complexas que necessitam de atendimento em Unidade de Cuidados Intensivos Neonatal de nível terciário. As mães adolescentes apresentaram intercorrências durante a gestação como hipertensão arterial e diabetes mellitus que, além da idade, predispõem ao nascimento de recém-nascidos prematuros. A participação das famílias nos cuidados aos seus filhos demonstrou-se relevante, no entanto são necessárias medidas que aumentem a adesão e integração dos familiares nos programas de humanização / OBJECTIVES: Identify the profile of the patients assisted in the Neonatal Intensive Care Unit (NICU); observe the possible differences between the newborns from families of adult mothers and families of teenage mothers, and also verify the participation of the families in the unit humanization programs. METHOD: Prospective transversal cohort of 284 newborns (NB) and their family members, who were admitted in the Neonatal Intensive Care Unit of the Instituto da Criança, between May 2005 and December 2006. The data was collected from the mothers according to the contents of the form that was specifically designed for this study, which included demographic, social and economical information; the antenatal history; type of delivery; data related to the newborn such as gestation age and chronological age; birth and admission weight; type of feeding at the time of admission and at the time of discharge; the diseases that caused the admission; number of discharges, deaths and transfers; the treatments used; and the participation of the family during the stay in the NICU. RESULTS: We found that, as far as the social and demographical conditions are concerned, the majority of the 284 patients (66.2%) were from the city of São Paulo, mainly from its West Part, or from the cities belonging to the greater São Paulo area. The prenatal exam was carried out by 96.1% of the mothers, and 59% of the NB were delivered by cesarean sections, having a body weight varying from 600 to 4780 grams, average gestation age of 37.6 weeks, and the majority were physically adequate for their gestation age (77.5%). Their average age upon admission was of 7 days, being the causes for admission mainly associated with infectious (32%) and respiratory (25%) diseases, and their weight at the time varied from 600 to 5810 grams. The percentage of teenage mothers ( than 19 years old) was 21%, and in this particular group we found inferior schooling levels and inferior prenatal exam figures, and also in this group we found a greater incidence of preterm births (47.5%). The adult mothers presented a greater number of complications during pregnancy and a greater number of surgically assisted deliveries (63.6%). As far as the NB\'s characteristics, there were no statistical differences between teenage and adult mothers, however we found an earlier admission age of the NB from teenage mothers in the Unit, and also less weight upon admission. The survival rate was 91.2% and the evolution of the NB was not influenced by maternal age. When we asked about the families\' participation in Unit humanization programs, we found an active participation of the families of either teenage or adult mothers in the care to the NB and an increase in the percentage of NB being breastfed at the moment of discharge (69.3%) compared to the moment of admission (51.7%). CONCLUSIONS: The profile of the patients show that the assistance is in most part regionalized, being constituted of patients with complex diseases that needed care in a Level III NICU. The teenage mothers presented complications during pregnancy such as high blood pressure and diabetes mellitus, which, along with their age, prearranged the preterm birth of newborns. The participation of the families in the care to their infants has shown to be relevant, however some measures are necessary in order to increase and improve the participation of the family members in the humanization programs

Entre os diversos procedimentos realizados na Unidade de Terapia Intensiva Neonatal (UTIN), está a Punção Venosa Periférica (PVP), considerada uma prática complexa, que representa 85% das atividades da equipe de enfermagem, sendo também a mais dolorosa. Os dispositivos utilizados em adultos têm sido adaptados para o uso em crianças e lactentes por não existir um material específico para assistência pediátrica. Entre estas práticas encontra-se a técnica broken needle, que tem sido considerada útil pelos profissionais que a utilizam por facilitar a coleta de amostras sanguíneas, apesar de alguns estudos atentarem para o risco de eventos adversos. O objetivo geral é avaliar as implicações da técnica broken needle sobre os parâmetros hemodinâmicos e comportamentais relacionados à dor durante a punção venosa periférica para coleta de sangue em neonatos prematuros e entender sua utilização na prática profissional. Especificamente objetivou descrever as características clínicas dos neonatos prematuros; avaliar as implicações da técnica broken needle na PVP em neonato prematuro nos seguintes parâmetros: nível de dor, comportamental e fisiológico; verificar a ocorrência de eventos adversos da utilização da técnica na PVP em neonatos prematuros; apreender a percepção dos profissionais de enfermagem e medicina que utilizam a técnica broken needle na PVP em neonatos prematuros. O estudo de método misto foi desenvolvido em duas etapas: na primeira foi realizado um estudo quantitativo, transversal e descritivo, em que a amostra foi composta por neonatos prematuros divididos em dois grupos – tratado e controle e foi realizada investigação retrospectiva dos prontuários. Na segunda etapa foi realizada uma pesquisa qualitativa com entrevistas semiestruturadas com cinco profissionais e os dados foram submetidos à Análise de Conteúdo de Bardin. Na caracterização dos neonatos há similaridade entre os dois grupos, sendo em sua maioria prematuros com idade gestacional entre 32 e 35,6 semanas, com diagnósticos relacionados a causas respiratórias, com peso maior de 1500g. Na análise documental não houve registro de sinais flogísticos ou lesões nos membros em que foi realizada a coleta de sangue. Os profissionais acreditam que a técnica broken needle seja mais eficaz por ser mais rápida do que as outras técnicas, o que não foi comprovado na análise do tempo de coleta nos neonatos. Não houve diferença estatística entre os grupos em relação ao comportamento da frequência cardíaca, padrão de sono e olhos espremidos durante a PVP. Em relação à saturação de oxigênio, sobrancelhas salientes e sulco nasolabial aprofundado houve diferença estatística entre os grupos. Apesar da tênue diferença entre os grupos no momento da punção, não há vantagens significativas de uma técnica em relação à outra. Evidenciou-se a importância do treinamento contínuo da equipe, pois os profissionais valorizam as informações passadas de um membro a outro. A transferência do conhecimento de um profissional ao outro favorece a incorporação da técnica. A equipe se preocupa em realizar técnicas que sejam menos agressivas ao neonato e realizam a técnica broken needle porque acreditam que a técnica seja mais vantajosa e benéfica e que não tenha efeitos adversos para o neonato. A técnica estudada parece não ter efeitos sobre os parâmetros relacionados com a dor neonatal, não demonstrando diminuir nem aumentar os escores de dor nos neonatos quando comparada com a técnica utilizando o canhão. Não foi encontrada relação da ocorrência de eventos adversos/complicações com a PVP. Ressalta-se que deve ser chamada a atenção para a segurança do paciente no procedimento de punção e a equipe deve revisar a tendência ao modelo mecanicista da assistência. Sugere-se a realização de outros estudos, inclusive com realização em escala nacional. / Among the several procedures performed in the Neonatal Intensive Care Unit (NICU), there is Peripheral Venous Puncture (PVP), considered a complex practice, which represents 85% of the activities of the nursing team, and is also the most painful. The devices used in adults have been adapted for use in infants and infants because there is no specific material for pediatric care. Among these practices is the broken needle technique, which has been considered useful by professionals who use it for facilitating the collection of blood samples, although some studies look at the risk of adverse events. The general objective is to evaluate the implications of the broken needle technique on hemodynamic and behavioral parameters related to pain during peripheral venous puncture for blood collection in preterm infants and to understand their use in professional practice. Specifically, it aimed to describe the clinical characteristics of preterm infants; to evaluate the implications of the broken needle technique in PVP in premature neonates in the following parameters: pain level, behavioral and physiological; to verify the occurrence of adverse events of the use of the technique in PVP in preterm infants; to apprehend the perception of nursing and medical professionals who use the broken needle technique in PVP in preterm infants. The mixed method study was developed in two stages: the first was a quantitative, cross - sectional and descriptive study, in which the sample consisted of preterm neonates divided into two groups - treated and control, and a retrospective study was carried out. In the second stage a qualitative research was conducted with semi-structured interviews with five professionals and the data were submitted to the Bardin Content Analysis. In the characterization of the neonates there is similarity between the two groups, being mostly premature with gestational age between 32 and 35.6 weeks, with diagnoses related to respiratory causes, weighing more than 1500g. In the documentary analysis there was no record of phlogistic signs or lesions in the members in which the blood collection was performed. The professionals believe that the broken needle technique is more effective because it is faster than the other techniques, which has not been proven in the analysis of the collection time in neonates. There was no statistically significant difference between groups in relation to heart rate, sleep pattern and eyes squeezed during PVP. In relation to oxygen saturation, protruding eyebrows and deep nasolabial sulcus, there was a statistical difference between the groups. Despite the slight difference between the groups at the time of puncture, there are no significant advantages of one technique over the other. The importance of continuous training of the team was evidenced, since professionals value the information passed from one member to another. The transfer of knowledge from one professional to another favors the incorporation of the technique. The team is concerned with performing techniques that are less aggressive to the newborn and perform the broken needle technique because they believe the technique is more advantageous and beneficial and has no adverse effects on the neonate. The technique studied seems to have no effect on the parameters related to neonatal pain, not demonstrating a decrease or increase in pain scores in neonates when compared to the cannon technique. No relation was found regarding the occurrence of adverse events / complications with PVP. It should be emphasized that attention should be drawn to patient safety in the puncture procedure and the team should review the tendency to the mechanistic model of care. It is suggested that other studies, including national studies, be carried out.

A research report is submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Sciences in Child Health Johannesburg, 2016 / Background: Leratong Hospital is a regional hospital in the West Rand of Johannesburg, South Africa. Statistics from maternity in 2008 showed high utilisation rates for delivery services at Leratong but a study on neonatal mortality was not yet done. It was therefore essential to measure and analyse the causes of new-born deaths so as to have policies to advance neonatal care. Objectives: To determine the neonatal mortality rate (NMR), the major neonatal causes of death and the occurrence of avoidable health factors. Methods: This was a prospective review of the clinical records of the 46 neonates who died within the 3 month period (15th April 2013 to the 15th July 2013). Data was obtained from neonatal admission and death registers. Information on the number oflive births was obtained from labour ward registers. Delegation books for nurses were checked to determine the number of nursing staff per shift as well as their allocation in different rooms. Neonate's age, birth weight, gender, race, place of origin, reason for admission and cause of death, were analysed. Health factors examined were access to high care services and to the neonatal ICU, number of staff on duty and the use of treatment guidelines. Questionnaires were used to collect information, and the consent to use clinical records was obtained from the mothers. Descriptive statistics were used to describe the frequencies and percentages of variables. Logistic regression of variables was applied to predict mortality. Results: The overall neonatal mortality rate at Leratong Hospital was lower than the rates found in South Africa and other studies in sub-Saharan Africa. Almost 37% of neonates died within 24 hours of admission. The three most common causes of death were: prematurity (39%), perinatal asphyxia (26%) and infection (20%). More than sixty per cent of deaths occurred in the admission room. Three-quarters of neonates who died (74%) were low birth weight neonates. A critical staff shortage (nurse: neonate rati02.: 1:10) was the most common modifiable factor (63% of deaths). Thirty seven per cent of neonates were denied access to ICU. The significant predictors of neonatal death were being born preterm (OR: 3.1, 95% CI 1.7-6.0), extremely low birth weight (OR: 27.5,95% CI 8.2-92.6), very low birth weight (OR: 5.0, 95% CI 2.1-12.3) and birth by caesarean section (OR: 3.2, 95% CI 1.6-6.2). Conclusions: The study found the neonatal mortality rate at Leratong Hospital in 2013 to be lower than rates recorded in South Africa. Our results showed that the most common causes of neonatal mortality were similar to those in other hospitals in sub-Saharan Africa and in South Africa. A high number of neonatal deaths were avoidable by providing high care services (including NCP AP and surfactant) and adequate number of nurses trained in newborn care in the admission room, improving access to neonatal ICU, early detection of perinatal asphyxia and improved neonatal resuscitation, and the supervision of medical doctors. / AC2016

While Fetal Alcohol Syndrome Disorder is a recognized problem with alcohol ingestion during the formation of facial features, Fetal Alcohol Spectrum Disorders are not as widely recognized. These disorders result from exposure to alcohol throughout pregnancy when the brain and nervous system are developing. The resulting disorders include attention deficit disorders, social disorders, inappropriate behaviors, learning disorders, and intellectual disability. The incidence of children with alcohol-related disorders is increasing as evidenced by children needing special services in the educational systems. It is unknown how much alcohol ingestion is safe during pregnancy or how genetic factors are involved in the development of these disorders. Women often get conflicting information from the media and other resources about safe levels of alcohol consumption during pregnancy. Abstinence of alcohol ingestion is the only known prevention of such intellectual disorders. It is hypothesized that women of childbearing age may not be knowledgeable of the relationship between drinking and the implications of alcohol exposure on fetal development. The purpose of this research is to determine what women of childbearing age know about alcohol consumption during pregnancy and if there is a knowledge deficit that exists among women of a certain age or women that use specific resources for health information. The researcher surveyed 40 female students at East Tennessee State University by using true or false questions concerning alcohol consumption related to fetal development in order to determine if a knowledge deficit exists. Based on the findings, it may be determined if women of childbearing age need educational materials from a reliable source.

The objectives of this study were to determine whether there was an association between clinical nursing knowledge of four birthing positions and current evidence-based research of those same positions and also to identify possible areas where nursing knowledge of those birthing positions was inadequate. This pilot study used convenience sampling to survey registered nurses (RNs) and licensed practical nurses (LPNs) on labor and delivery units. The survey was distributed to three hospitals in the southeastern United States, and twenty-four RNs and LPNs participated. Participants’ knowledge did not reflect current clinical evidence in two key areas, (1) the best position to minimize blood loss and (2) the best position to decrease the likelihood anal sphincter tears. Respectively, only 13% and 27.3% of participants selected the correct position. Continuing education for maternity nurses regarding current evidence-based practice concerning various birthing positions remains a need, and incorporating this could include more frequent opportunities for education classes and unit inservices. Results from this study should not be generalized, and more research is needed in this area to validate these findings.

Research has revealed that schizophrenics are significantly more likely to smoke cigarettes than the general population, and consume nicotine products at a much more prevalent rate. Further exacerbating this issue, it has been previously demonstrated in clinical populations that the type of antipsychotic treatment administered (typical versus atypical) may result in either an increase or a decrease of already heightened smoking behavior within the schizophrenic population. With these clinical issues in mind, the present study sought to examine the effects of antipsychotic treatment upon the associative reward of nicotine within the neonatal quinpirole model of schizophrenia. We found that treatment with the typical antipsychotic haloperidol blocked the associative reward of nicotine. Clozapine, an atypical antipsychotic, merely reduced the rewarding effects. These findings illustrate the centrality of the dopamine system, specifically the D2 receptor subtype, as an underlying mechanism of the rewarding effects of nicotine among rodents neonatally treated with quinpirole.