During a finite developmental phase – the brain growth spurt – the brain grows and matures at an accelerated rate. During this period the brain is more sensitive to harmful substances such as ethanol and environmental toxins than before or after. This period extends from the last trimester to the second year in humans and occurs postnatally in the mice used for these studies. The aims of this thesis were; to investigate common anaesthetics ability to promote acute apoptosis and late persistant behavioural aberrations measured with spontaneous behaviour in a novel home environment, learning in a radial arm maze and anxiety-like behaviour in an elevated plus maze, to measure alterations in BDNF, CaMKII, GAP-43, synaptophysin and tau after anaesthesia exposure, to evaluate clonidine as a potentially protecting agent and examine if theophylline, a chemically unrelated compound, causes similar effects as anaesthetics. Some of the results are: combinations of anaesthetics acting on the GABAA receptor (propofol or pentothal) and NMDA receptor (ketamine) exhibit more apoptosis and behavioural alterations than single anaesthetics. Ketamine, but not propofol, alters the content of CaMKII and GAP-43 proteins important in brain development. Propofol exposure alters the content of BDNF (brain derived neurotrophic factor) in hippocampus, frontal and parietal cortex. Neonatal propofol exposure leads to less sensitiveness to diazepam in adult age as measured with induced spontaneous behaviour and an elevated plus maze. Clonidine, an alpha2 adrenergic agonist does not cause any aberrations and appears to prevent apoptosis and behavioural alterations after ketamine. Theophylline, used as apnoea treatment in neonates, also increases apoptosis and alters normal behaviour. Thus, alterations both in neuronal survival, function and protein expression is apparent after neonatal exposure to anaesthetics. This is also shown in studies of Rhesus monkeys. However, it is still difficult to assess how these findings should extrapolate to humans. Epidemiological studies give conflicting results. Insufficient anaesthesia is not a solution as pain and stress cause even more pronounced problems. Minimizing anaesthetic exposure, delaying procedures until after the sensitive phase and finding protective agents, such as clonidine, are possible strategies. Evaluation of other substances that infants are exposed to is needed.

In-utero ethanol exposure may result in fetal alcohol spectrum disorder (FASD). Studies have suggested that women who drink ethanol are more likely to consume illicit drugs. Detection of such exposures has been done via meconium and hair testing and can serve to direct needed prevention methods and appropriate management and intervention for the neonate and the mother. This study examined maternal diabetes as a possible confounder for in-utero ethanol exposure testing and determined the trends in drug use associated with heavy in-utero ethanol exposure in a high-risk obstetric Canadian population. It was determined that maternal diabetes does not produce false-positive results in testing for in-utero ethanol exposure. Furthermore, heavy in-utero ethanol exposure was detected in 15.5% of samples and was associated with an increased exposure to amphetamines (OR=3.30) and opiates (OR=2.01), but a decreased exposure to cannabinoids (OR=0.61) when compared to neonates with no heavy in-utero ethanol exposure.

In-utero ethanol exposure may result in fetal alcohol spectrum disorder (FASD). Studies have suggested that women who drink ethanol are more likely to consume illicit drugs. Detection of such exposures has been done via meconium and hair testing and can serve to direct needed prevention methods and appropriate management and intervention for the neonate and the mother. This study examined maternal diabetes as a possible confounder for in-utero ethanol exposure testing and determined the trends in drug use associated with heavy in-utero ethanol exposure in a high-risk obstetric Canadian population. It was determined that maternal diabetes does not produce false-positive results in testing for in-utero ethanol exposure. Furthermore, heavy in-utero ethanol exposure was detected in 15.5% of samples and was associated with an increased exposure to amphetamines (OR=3.30) and opiates (OR=2.01), but a decreased exposure to cannabinoids (OR=0.61) when compared to neonates with no heavy in-utero ethanol exposure.

Aim: The aim of the study was to compare knowledge and attitudes towards Kangaroo Mother Care (KMC) among neonatal unit staff at two neonatal units 2008 and 2010. Method: Members of staff from two neonatal units completed a questionnaire with 22 statements and an open-ended question in 2008 and 2010. The data were analysed with Mann-Whitney U test and content analysis. Results: There were significant differences between unit A and unit B in both the 2008 survey and the 2010 survey, showing better knowledge of KMC and a more positive attitude to KMC in unit A. Content analysis of responses to the open-ended question revealed concerns in unit B that its care environment was not suitable for KMC. Conclusions: Hypothetically, the fact that staff in unit A work in facilities designed to facilitate KMC, receive training in KMC and practice continuous KMC in intensive care as well as in intermediate care, has resulted in good knowledge of KMC and a general improvement of staff attitudes to KMC.

<p>I Sverige föds ca 90 000 barn per år och cirka 10 % behöver vård på en neonatalavdelning. Orsakerna till det kan vara många, men vanligt är att barnen som drabbas, är för tidigt födda och då är extra utsatta pga. sin omognad. Syftet med studien var att ta reda på pappans upplevelse att vårda sitt barn på en neonatalavdelning. En kvalitativ forskning med innehållsanalys som metod valdes. Sju stycken pappor som hade vårdat sitt barn på en neonatalavdelning intervjuades med en frågeställning ”Hur upplevde du att vårda ditt barn på en neonatalavdelning”? Resultatet delades in i tre kategorier som ”vilja skapa anknytning till sitt barn”, ”känsla av otillräcklighet” och ”behov av att känna trygghet” med tillhörande underkategorier. I studien framkom att pappan tycker att det är viktigt att få vara nära barnet och vill gärna ta ansvar för vården. De var mycket nöjda med vården och hade tillit till vårdpersonalen men upplevde att de skulle velat haft mer stöd.  Det framkom även att de tyckte att det var frustrerande att vilja vara på flera ställen samtidigt. Med denna studie hoppas författarna kunna öka kunskapen som ska främja ett individuellt anpassat stöd för en bättre omvårdnad av det nyfödda barnet.</p><p> </p> / <p>In Sweden, about 90 000 children per year are born and about 10% of these need to be taken care in neonatal intensive care unit. The causes can be many, but the most common reason is that the children who suffer, are prematurely born and are extra vulnerable due to their immaturity. The purpose of the study was to find out the father's experience of caring for their child in a neonatal intensive care unit. A qualitative research using content analysis method was chosen. Seven fathers who had to provide care of their child in a neonatal department were interviewed with a question "How you did your experience to take care for your child at a neonatal department?" The results were divided into three categories such as "like to create ties to their child," "sense of inadequacy" and "need to feel safe" with its sub-categories. The study revealed that the father thinks that it is important to be close to the child and would like to take responsibility for the health care. They were very satisfied with the care and had trust in the caregivers, but felt that they would have had more support. The fathers also experienced frustration of the wish to be in several places simultaneously. In this study, the authors hope to raise awareness to promote a personalized support for a better care of the newborn baby.</p>

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 131-169). Available also in a digital version from Dissertation Abstracts.

No description available.

Infants born prior to 37 weeks gestation are at risk for countless medical problems and developmental delays. In order to help minimize these delays and improve the child’s potential, the Individuals with Disabilities Education Act, Part C, funds Early Intervention (EI) Services. These services may include speech, physical therapy, occupational therapy, or developmental therapy, among others. Purpose and Objective: While numerous studies show the benefits of EI therapies, little is known about barriers to EI participation, what the parents of these children who participate in EI think, or how to improve EI services. This study attempts to answer these questions. Methods: Surveys regarding EI were posted to three preemie parent organizations social media pages, and 140 surveys were returned. These surveys were analyzed for both quantitative and qualitative answers. Qualitative answers were coded and themes were garnered. Results: A total of 148 participants took the survey, and 76% had children that had participated or currently participate in EI. Of the parents who answered their child did not attend EI, most state there was no EI services near them, their child did not qualify, or the EI services were of poor quality. Of the EI parent surveys, most parents (73%) were happy with their child’s EI and their child’s progress, and would recommend EI to others. Most children had EI therapy at least weekly, and were referred to EI prior to leaving the NICU. Parents felt as though their child benefitted in nearly all domains. In addition to the benefits to their child, EI parents also felt as though therapy helped decrease their stress level, gave them a benchmark to measure their child’s progress and connected them with other professionals for their child. Some parents also provided recommendations to improve EI: decrease eligibility requirements, improve communication with parents, provide continuity of care, and create a bridge program for children three and up until they reach school age. Conclusions: With these suggestions, providers can help improve current EI services. Primary care providers should ensure children who are at risk for delays are referred, and EI services should improve communication with parents and enhance continuity of care.

Introduction: Therapeutic agents like doxorubicin, an anthracycline antibiotic drug, are widely used in cancer chemotherapy. The use of doxorubicin is limited however by an increased risk of cardiac damage as a side effect, and an increased cancer cell drug resistance mediated by efflux drug transporters. Strategies are needed to protect the heart and still allow the benefits of drug treatment. “Basic” fibroblast growth factor-2 (FGF-2) is a multi-functional protein. It is angiogenic and cardioprotective against ischemia-reperfusion injury. FGF-2 can also regulate cancer cell drug resistance or sensitivity, however, so far, there is no evidence that FGF-2 protects against doxorubicin-induced cardiac damage through effects on efflux drug transporter levels or function. Aims: To investigate whether: (1) FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage; and if so whether (2) an effect on efflux drug transporters might contribute to this cardioprotection by FGF-2. Methods: Neonatal rat cardiac myocyte cultures were treated with doxorubicin in the absence or presence of pre-treatment with FGF-2. To assess cell damage: (i) culture medium was tested for lactate dehydrogenase (LDH) activity as an indication of plasma membrane disruption; (ii) cells were stained with fluorescent apoptosis and necrosis biomarkers as well as (iii) terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) and acridine orange to assess DNA fragmentation or compaction. The role of FGF receptor (FGFR) or protein kinase C (PKC) was addressed through use of inhibitors including SU5402, or chelerythrine as well as bisindomaleimide. Multidrug resistance gene 1a and 1b (MDR1a, 1b), multidrug resistance gene 2 (MDR2) and multidrug resistance-related protein 1 (MRP1) gene expression, as well as the function of MDRs and MRPs protein products were assessed by real-time reverse transcriptase-polymerase chain reaction (qPCR), as well as retention/extrusion of (fluorescent) doxorubicin/calcein in cardiac myocytes, respectively. Efflux drug transporter inhibitors, including 20 µM cyclosporine A (CsA), 2 µM verapamil and 1 µM Tariquidar (XR9576) were used to asssess for a direct effect of FGF-2 on transporter function. Fluorescence-activated cell sorting (FACS) was used to measure fluorescent doxorubicin/calcein levels inside treated cardiac myocytes. Results: Doxorubicin increased the incidence of programmed cell death, DNA damage, and lysosome and LDH activity, while decreasing cell number at 24 hours. FGF-2 prevented the detrimental effects of doxorubicin. In turn, the protective effects of FGF-2 were blocked in the presence of FGFR or PKC inhibitors. FGF-2 treatment significantly increased MDR1a, MDR1b, MDR2, MRP1 RNA levels by qPCR, and protein levels as assessed by function, and specifically extrusion of doxorubicin/calcein, in the presence of doxorubicin when compared to doxorubicin treatment alone. Furthermore, inhibition of efflux drug transporters with CsA and Tariquidar (XR9576) significantly reduced the ability of FGF-2 to protect against doxorubicin-induced damage; the beneficial effect of FGF-2 was completely blocked by pretreatment with verapamil. Conclusion(s): These data indicate for the first time that exogenous FGF-2 can increase resistance to doxorubicin-induced neonatal rat cardiac myocyte damage, and implicate PKC and regulation of efflux transporter protein levels and/or function in the mechanism.

Infants in the NICU undergo many painful procedures and literature supports KMC as an effective intervention to diminish pain however, it is not used routinely in NICUs. The purpose of this qualitative study is to provide NICU nurses an opportunity to describe their experience of utilizing KMC for pain, and to interpret this experience with the goal of generating patterns that explain this understanding. The findings can be used to formulate interventions that foster the use of KMC. Using Interpretive Description as a philosophy of inquiry and research methodology, 8 NICU nurses were interviewed and participated in a focus group. Four patterns emerged: (1)”Seeing is Believing”; (2) Human Heartedness: “It’s the Least I can do”; (3) Playing it Safe; and (3) Creating the Possibility within Constraints.