The clinical manifestations of hemolytic disease of the fetus and newborn mediated by anti-K, an antibody of the Kell blood group system, are distinguishable from the classical form of the disease. Affected fetuses have low numbers of circulating reticulocytes and antibody titers and bilirubin levels are not reliable predictors of anemia. These observations suggest that antibodies to Kell glycoprotein lead to anemia through suppression of erythropoiesis. This study established a liquid erythroid progenitor cell culture model in which to perform analyses on the mechanism of the suppressive growth effect of anti-Kell glycoprotein. Using this culture model, this study demonstrated the requirement for co-ligation of Kell glycoprotein by a bivalent antibody for growth suppression. The absence of markers of apoptosis in cell cultures treated with anti-Kell glycoprotein suggests that the mechanism of growth suppression is distinct from programmed cell death and necrosis. Furthermore, this growth suppression cannot be rescued by erythropoietin.

Orientador: Maria Regina Bentlin / Resumo: INTRODUÇÃO: As infecções primárias de corrente sanguínea (IPCS) são responsáveis por aumento da morbimortalidade em recém-nascidos. OBJETIVOS: Determinar a incidência e a mortalidade das IPCS com confirmação laboratorial, após 72 horas de vida, em função dos agentes etiológicos, avaliar a resistência antimicrobiana dos agentes mais frequentes e rever o esquema de terapia empírica da Unidade. MÉTODOS: Estudo de coorte, retrospectivo, realizado na UTI Neonatal do Hospital das Clínicas - Faculdade de Medicina de Botucatu (UNESP), entre 2014 - 2016, após aprovação do Comitê de Ética. Critérios de inclusão: recém-nascidos com IPCS e hemocultura positiva após 72 horas de vida. Não incluídos agentes contaminantes e o crescimento de estafilococos coagulase negativa (SCoN) em apenas uma hemocultura. A amostra foi constituída por 71 recém-nascidos com 72 hemoculturas positivas. Foram estudadas variáveis maternas, gestacionais e do parto, procedimentos e resistência antimicrobiana. Desfechos: choque séptico e óbito. Os agentes foram comparados em grupos: Gram-positivos e Gram-negativos. Analise estatística: descritiva e comparação entre grupos com testes paramétricos e não paramétricos, com significância estatística de 5%. RESULTADOS: A incidência de IPCS foi de 10,2%, sendo 57% por Gram-positivos, 40% por Gram-negativos e 3% por fungos. A mortalidade foi de 21% e o óbito diretamente relacionado à IPCS ocorreu em 10% dos Gram-positivos e 14% dos Gram-negativos. Ventilação mecânica, uso ... (Resumo completo, clicar acesso eletrônico abaixo) / Mestre

A Dissertation submitted to the faculty of Medicine, University of the Witwatersrand, in partial fulfillment of the requirements for the Degree of Master of Medicine in paediatrics. / The aims of this study were to establish the incidence of perinatally and nosocomially acquired bacteraemia and funqaemia as determinad by blood and cerebrospinal fluid (CSF) isolates in the neonatal population seen at the Baraqwanath Neonatal Unit; to identify risk factors for infection and record the outcome. Other aims were to analyze tha susceptibility patterns of the organisms isolated with respect to changing antimicrobial policies and to compare these with previously reported studies. (Abbreviation abstract) / Andrew Chakane 2018

Jaundice is probably the most common newborn infant problem dealt with on a daily basis by the family practitioner and paediatrician. Jaundice occurs when the liver cannot clear a sufficient amount of bilirubin from the plasma. When the problem is excessive bilirubin formation or limited uptake or conjugation, unconjugated (i.e., indirect reacting) bilirubin appears in the blood and indirect hyperbilirubinemia is the predominant form of jaundice found in the newborn infant. In the vast majority of newborns, hyperbilirubinemia is transient and benign but, in rare cases, the serum bilirubin rises to a level that is toxic to the central nervous system. Understanding the pathogenesis and epidemiology of neonatal hyperbilirubinemia; recognizing, the problems involved in appropriate surveillance and monitoring of the jaundiced infant and the factors contributing to bilirubin encephalopathy; and implementing treatment of the jaundiced neonate in a timely fashion, are issues that have engaged clinicians and researchers for some 6 decades. This work will summarize my contributions to the field of neonatal hyperbilirubinemia and it includes papers published between 1971 and 2007. The description of this work will not follow its chronological sequence, but will be divided into the categories of diagnosis, epidemiology, pathogenesis, management, treatment, and bilirubin encephalopathy.

MSc, Nursing, Faculty of Health Sciences, University of the Witwatersrand, 2009

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / A assistÃncia ao recÃm-nascido com integridade da pele prejudicada deve ser prioridade para equipe de enfermagem. Objetivou-se analisar o uso das intervenÃÃes propostas pela Nursing Intervention Classification (NIC) indicadas para o diagnÃstico de enfermagem Integridade da pele prejudicada na Unidade de Terapia Intensiva Neonatal. Estudo exploratÃrio, descritivo, utilizando-se mapeamento cruzado em trÃs unidades neonatais pÃblicas, em Fortaleza-CE-Brasil. Participaram 42 enfermeiros atuantes em Neonatologia. A coleta de dados foi realizada de maio a setembro/2011, conforme a disponibilidade dos participantes. Aprovado pelo Comità de Ãtica das instituiÃÃes pesquisadas. No primeiro momento da coleta, os enfermeiros indicaram as atividades realizadas junto aos recÃm-nascidos com o diagnÃstico de enfermagem Integridade da pele prejudicada. Em seguida, foi realizada comparaÃÃo dessas atividades com as intervenÃÃes propostas pela NIC, caracterizando o mapeamento. A anÃlise ocorreu entre outubro/2011 e janeiro/2012. Para revisÃo e refinamento do mapeamento, os resultados obtidos foram encaminhados a nove enfermeiros experts em diagnÃstico de enfermagem, por meio do correio convencional e eletrÃnico. O mapeamento revelou que das 75 atividades sugeridas na NIC, 57 corresponderam Ãs indicadas pelos enfermeiros. As mais citadas pelos enfermeiros como desempenhadas cotidianamente foram relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; reposicionar o paciente pelo menos a cada duas horas, conforme apropriado; posicionar o paciente, de modo a evitar a tensÃo sobre a lesÃo, conforme apropriado; e remover curativo e fita adesiva. Tratamento tÃpico: aplicar emolientes à Ãrea afetada; aplicar curativo oclusivo transparente sempre que necessÃrio; e evitar o uso de sabonete alcalino na pele. SupervisÃo da pele: examinar a pele e as mucosas quanto à vermelhidÃo, ao calor exagerado, ao edema e à drenagem; e documentar mudanÃas na pele e mucosas. As atividades sugeridas pela NIC mais realizadas segundo opiniÃo dos enfermeiros (mÃdia ponderal entre 0,8 e 1) relacionadas ao cuidado com lesÃes: aplicar um curativo adequado ao tipo de lesÃo; manter tÃcnica assÃptica durante realizaÃÃo; trocar curativos, conforme a quantidade de exsudato e drenagem; limpar com soro fisiolÃgico ou substancias nÃo tÃxicas; posicionar o paciente, de modo a evitar tensÃo sobre a lesÃo e reposicionar o paciente pelo menos a cada duas horas. Referentes ao tratamento tÃpico: manter limpas, secas e sem vincos as roupas de cama; aplicar curativo oclusivo transparente; proporcionar higiene Ãntima; aplicar antibiÃtico tÃpico à Ãrea afetada; e aplicar emolientes à Ãrea afetada. Quanto à supervisÃo da pele: observar as extremidades quanto à cor, ao calor, ao inchaÃo, aos pulsos, à textura, ao edema e Ãs ulceraÃÃes; monitorar cor e temperatura da pele; e examinar a condiÃÃo da incisÃo cirÃrgica. ApÃs submissÃo do mapeamento à avaliaÃÃo por enfermeiros peritos, foi sugerido que das 22 atividades de cuidado com a pele, 13 permaneceriam com a nomenclatura NIC. Com relaÃÃo ao tratamento tÃpico, 23 atividades tiveram discretas alteraÃÃes e 10 permaneceram inalteradas. Relativo à supervisÃo da pele, trÃs foram modificadas e nove atividades mantiveram a nomenclatura NIC. Concluiu ser possÃvel a utilizaÃÃo da NIC como terminologia padronizada para descrever os cuidados de enfermagem prescritos, uma vez que essa classificaÃÃo mostrou-se, em sua maioria, adequada à realidade neonatal. / The assistance to newborns with impaired skin integrity should be a priority for the nursing staff. Thus, we aimed to analyze the use of the interventions proposed by the Nursing Intervention Classification (NIC) indicated for the nursing diagnosis Impaired skin integrity in the Neonatal Intensive Care Unit. This is an exploratory descriptive study using cross-mapping in three public neonatal units, in Fortaleza-CE, Brazil. The population was composed of 42 nurses working in neonatology. Data collection was conducted from May to September 2011, according to the availability of participants. The study was approved by the Ethics Committee of the institutions surveyed. In the first moment of collection, nurses indicated the activities they performed along with the newborns with the nursing diagnosis Impaired skin integrity. Next, we compared these activities with the interventions proposed by NIC, characterizing the mapping. The analysis occurred between October 2011 and January 2012. To review and refinement of the mapping, the results obtained were sent to nine nurses experts in nursing diagnosis through conventional mail and e-mail. The mapping revealed that from the 75 activities suggested by NIC, 57 corresponded to those indicated by nurses. The most mentioned by nurses as routinely performed were related to the care of injuries: apply an adequate bandage for the type of injury; reposition the patient at least once every two hours, as recommended; positioning the patient in order to avoid tension on the injury, as recommended; and remove bandage and tape. Topical Treatment: apply moisturizers to the affected area; apply a transparent occlusive dressing when necessary; and avoid the use of alkaline soap on the skin. Skin surveillance: examine the skin and mucous membranes for redness, excessive heat, edema and drainage, and document changes in the skin and mucous membranes. The activities suggested by NIC most performed according to the nursesâ opinion (weighted average of 0.8-1) related to the care of injuries were: apply an appropriate bandage for the type of injury; maintain aseptic technique during performance; changing dressings according to the amount of exudate and draining; cleaning with saline or non-toxic substances; positioning the patient in order to prevent tension on the wound; and reposition the patient at least once every two hours. As regards to topical treatment: keep bed linen clean, dry and wrinkle-free; apply transparent occlusive dressing; provide intimate hygiene; apply topical antibiotics to the affected area; and apply moisturizer to the affected area. As for the skin surveillance: observe the extremities for color, warmth, swelling, pulses, texture, edema and ulceration; monitor skin color and temperature; and examine the condition of the surgical incision. After submitting the mapping to the evaluation of expert nurses, it was suggested that, of the 22 activities of skin care, 13 remain with the NIC taxonomy. Regarding the topical treatment, 23 activities had minor changes and 10 remained unchanged. On the skin surveillance, 3 activities were modified and 9 kept the NIC taxonomy. We concluded that is possible to use the NIC as a standardized terminology to describe the nursing care prescribed, once this classification has proven, in most cases, appropriate to neonatal reality.

Thesis (MSD(Play therapy))--University of Pretoria, 2006. / Abstract in English and Afrikaans. Includes bibliographical references. Available on the Internet via the World Wide Web.

Purpose and methods: Effective parental education about newborn screening (NBS) may help to maximize the benefits and minimize the harms of screening. We investigated experiences, knowledge and opinions regarding NBS education among Ontario mothers. Mothers whose infants recently received NBS were invited to complete a mailed survey (n=1712). Results: Of the 750 participants, 93% recalled their infant receiving NBS, while 69% recalled receiving information about NBS. Of this group, fewer than 50% reported receiving information prenatally, yet a majority of mothers (64%) viewed this as the most important time for education. Those who received information prenatally reported higher satisfaction (OR 2.4). The 40% of mothers who recalled being informed about the meaning of results had higher knowledge about NBS (OR 2.7) and reported higher satisfaction (OR 4.2). Conclusions: Parental education about NBS could place greater emphasis on the prenatal period and on fostering understanding about the meaning of results.

Purpose and methods: Effective parental education about newborn screening (NBS) may help to maximize the benefits and minimize the harms of screening. We investigated experiences, knowledge and opinions regarding NBS education among Ontario mothers. Mothers whose infants recently received NBS were invited to complete a mailed survey (n=1712). Results: Of the 750 participants, 93% recalled their infant receiving NBS, while 69% recalled receiving information about NBS. Of this group, fewer than 50% reported receiving information prenatally, yet a majority of mothers (64%) viewed this as the most important time for education. Those who received information prenatally reported higher satisfaction (OR 2.4). The 40% of mothers who recalled being informed about the meaning of results had higher knowledge about NBS (OR 2.7) and reported higher satisfaction (OR 4.2). Conclusions: Parental education about NBS could place greater emphasis on the prenatal period and on fostering understanding about the meaning of results.

Föräldraskapet är en upplevelse som de flesta ser fram emot, men ibland uppstår komplikationer. Barnet behöver extra vård och föräldrarnas föreställningar kring tiden med det nyfödda barnet blir omkullkastade. Syftet med denna litteraturstudie är att beskriva föräldrarnas upplevelse av att deras nyfödda barn vårdas på neonatalavdelning. Metoden som används är en systematisk litteraturstudie där tidigare forskning inom området sammanställs. Använda databaser för sökningen av artiklar är Elin@Kalmar, Cinahl och PsychInfo. Artiklar som var relaterade till syftet kvalitetsgranskades och resultatet bygger på 10 vetenskapliga artiklar. Resultatet visar att föräldrarna upplever påfrestningar olika beroende på hur tidigt barnet är fött, föräldrarnas möjlighet till engagemang i omsorgsarbetet och hur smärtpåverkat barnet är. Även föräldrarnas sociala status och utbildning påverkar deras förmåga att hantera påfrestningarna. En känslostorm pågår hos föräldrarna där känslor som rädsla, skuld, oro, hopplöshet och overklighet är centrala. Det framkommer också hur viktigt det är att föräldrarna kan kommunicera med sjuksköterskan samt att muntlig och skriftlig information ger en känsla av kontroll och samhörighet. En öppen och jämställd relation med sjuksköterskan inger trygghet och tröst.