Neonatal pain management has received increasing attention over the past four decades, along with the technological advances made in neonatal care which have increased the survival of neonatal patients. Empirical evidence confirms and acknowledges that the life-saving or life supporting procedures neonates are subjected to, during their admission into neonatal intensive care or high care facilities, are often painful. Research into the effects of neonatal pain emphasises the professional, ethical and moral, obligations by neonatal staff to manage neonatal pain effectively, in order to obtain positive patient outcomes both in the short and long term. This study used a non-experimental, prospective quantitative survey to investigate the knowledge, attitudes and beliefs of nurses and doctors concerning neonatal pain and its management. To answer the research question posed fully a third objective was included to explore current practice on this topic. The entire population (N=150) of neonatal staff working in neonatal wards of two tertiary hospitals in Gauteng, were invited to participate in the study. The data was collected using self administration of the Infant Pain Questionnaire. The response rate of this study was 35.33% (n=53).Data was analysed using “STATA” 12. Descriptive findings showed that, the majority of the respondents were female, from the professional nurse category, working in neonatal intensive care units with between 0 – 5 years experience in neonatal care. A significant finding was the unavailability of a pain management guideline in the neonatal units as reported on by 64% of the respondents. Despite this pain neonatal pain is recognised and treated. The main concern raised by this is the accuracy of assessment and adequacy of pain management interventions. The neonatal staff acknowledges and empathise with neonates’ pain experience. Results from comparative analysis using a Fischer’s exact test, showed a statistically significant (p<0.05) association between procedural pain ratings and the beliefs held by the participants about the increased frequency of pharmacological intervention implementation on five clinical procedures. This positive attitude towards neonatal pain management is important in ensuring consistent and adequate implementation of guidelines, hence adequate treatment of neonatal pain. A review of the pain management interventions used in the study setting showed preference for pharmacological pain management interventions for moderate to severe pain. This requires collaboration between the nurse and doctor. This finding was found to be consistent with international pain management standards. The nurses in the study also reported inadequate implementation of non-pharmacological interventions. This method of intervention use can be enhanced with empirical evidence. The small sample size and composition of respondents are noteworthy limitations, along with the exclusion of record review as part of this study. The main recommendation is to increase research neonatal pain management utilising existing structures in the practice, education and international resources.

This research report is submitted in partial fulfillment of the requirements for the degree of Master of Medicine in the Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg November 2014 / Background. Babies born before arrival to hospital (BBBAs) constitute a high-risk newborn population. The literature demonstrates that BBBAs have increased perinatal mortality and morbidity. Objectives. To describe the maternal and neonatal characteristics of BBBAs presenting to Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), South Africa, and assess whether they have increased morbidity and mortality compared with inborn babies. Methods. This was a matched case-controlled retrospective record review of newborns presenting to the neonatal unit of CMJAH between 1 January 2011 and 31 January 2013. BBBAs were matched 1:1 with the next consecutive inborn on birth-weight category and gender. Results. A total of 356 neonates were analysed. BBBAs had higher mortality than inborn controls within the first 24 hours of hospital presentation (7.9% v. 3.9%; p=0.05). Mothers of BBBAs were more likely to be unbooked (58.4% v. 10.7%; p<0.001) and of higher parity (p=0.0008). HIV prevalence was similar amongst cases and controls (24% v. 28.7%), however there were significantly more unknown HIV status in mothers of BBBA’s (49.6% v. 32%; p=0.01). Cases had a higher prevalence of early sepsis (22.9% v. 3.6%; p=0.03) and birth asphyxia (14.5% v. 0.8%; p<0.001) than controls. Overall, more deaths occurred in the very-lowbirth- weight (VLBW) (24% v. 10%; p=0.06) and low-birth-weight (LBW) (7.46% v. 0%; p=0.02) BBBA’s compared to controls. Conclusion. We demonstrated higher mortality in the immediate postnatal period and in the VLBW and LBW categories compared with hospital-delivered neonates. Once admitted, there was no difference in mortality, length of stay or number of ICU admissions between cases and controls. Mothers who delivered out of hospital were more likely to be multiparous and unbooked and to have unknown HIV, RPR and Rh results. Neonatal resuscitation, transport and immediate care on arrival at the hospital should be prioritised in the management of BBBAs.

Thesis (M.S.)--University of Wisconsin--Madison, 1972. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Wisconsin--Madison, 1982. / Typescript. Vita. Description based on print version record. Includes bibliographical references (leaves 113-132).

Thesis (Ph. D.)--University of Wisconsin, 1972. / Vita. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 88-93).

Thesis (M.S.)--University of Wisconsin--Madison, 1980. / Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 106-110).

The purpose of the study was to investigate the first manifestations of variation in human beings. The objective was to describe differences that first appear and to clarify some of the dimensions and limits which form the background of such variations. Thirty-nine neonates, all of whom, according to medical opinion, were normal, were used as subjects. Each child was observed for eight 30-minute periods while lying in his cot, and two or three times whilst being fed by his mother. These observation periods were spaced throughout the first, third, and fifth days of life and were planned to take account of the infant's age and feeding cycles. All recording was done in code by the same observer. The following analyses were carried out on cotside data and results were as described: Three states of infant behaviour which were named 'sleep’, 'specific activity', and 'mass activity' were differentiated in terms of the amount and type of movements that infants showed, and individuals were compared to see whether consistent dispositions toward either sleep or mass activity could be found. No such consistency was found. Individuals were compared to see whether or not some babies were consistently more active during sleep or mass activity than others. Results of this analysis were ambiguous. Head, facial, body, limb and extremity movements were totalled for each infant each day and results were compared to see whether infants differed in the sequences they showed. Results indicated that there were no established sequences during the first week. Mass activity was analyzed and seven differently structured patterns were found. Most of these became more frequent as the child grew older, and there were some differences in the patterns shown by different babies. Data from feeding observations enabled a comparison to be made between the feeding situations of bottle and breast fed infants. As a result it was found that breast fed infants experience a wider variety of maternal emotions, tend to be less skillfully handled and to show more signs of frustration. There was no significant difference between the two types of feeding group in proneness to sleep or mass activity. / Arts, Faculty of / Psychology, Department of / Graduate

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Thesis (M. Phil.)--University of Hong Kong, 1992.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1991.