The implementation of developmental care in South Africa seems problematic. As an effective care approach, developmental care (DC) reduces short- and long-term sequelae for pre-term and sick infants. This study therefore investigates and documents how DC can be implemented successfully in a South African context. The research design chosen, intervention design and development, has six phases: problem analysis and project planning, information gathering and synthesis, design, implementation, evaluation and advanced development, and dissemination. The sixth phase fell outside this study’s scope. Phase One, problem analysis and project planning, involved analysing and describing the level of DC practiced at the research site before implementation, and planning the implementation of DC in a South African public NICU. Planning involved consulting relevant literature and the multidisciplinary team of the NICU. Phase Two, information gathering and synthesis, consisted of identifying the factors involved in DC implementation from national and international examples of such implementation in neonatal intensive care. These factors were derived from available literature and other resources, including institutions where DC and kangaroo-mother care have been implemented, to provide a contextual framework for the intervention plan. The intervention plan for DC implementation at the research site was designed in Phase Three, based on the information gathered in Phase Two. The plan consisted of descriptive representations of the realities of clinical practice combined with applicable theoretical perspectives on the practice of DC. Guidelines for implementing DC were established as part of the plan. Phase Four involved the execution of the intervention plan in a South African public NICU, with participation from members of the multidisciplinary team. The intervention plan was refined and developed further in Phase Five, through monitoring and evaluating DC principles in the NICU. The guidelines were validated by an expert group. The study used Lincoln and Guba’s model (1985: 305) to ensure trustworthiness. No experimental and control groups were used as DC was implemented uniformly in the NICU, with all infants receiving this care. Harm or damage to research participants were not expected, as DC implementation benefits them and improves their working environment. Confidentiality was ensured for all participants and institutions involved. Informed consent for participation was obtained from individual members of the multidisciplinary team. Clearance was obtained from the ethics committee of the University of Pretoria, and institutional consent was obtained from the necessary organisations. This intervention study targeted the multidisciplinary team where medical, nursing, allied health profession and non-medical support personnel were involved in implementing DC. Phase One’s targets and goals included improving the quality of care rendered at the research setting, reducing developmental delays for preterm and sick infants and improved the working environment for the multidisciplinary team. Personnel targets were increasing the staffs’ knowledge and skills, and improving staff morale and job satisfaction. These targets and goals were achieved. / Thesis (PhD (Nursing Science))--University of Pretoria, 2006. / Nursing Science / unrestricted

Introduction: Approximately 3% to 4% of all pregnancies at term will have a fetus with a breech presentation. Studies have shown that the US has almost completely abandoned vaginal delivery for breech presentation through the influence of the "Term Breech Trial" (TBT) which concluded that a policy of planned caesarian section would reduce perinatal mortality, late neonatal mortality, and serious neonatal morbidity by approximately two-thirds for term fetuses. However, the recommendations are still being challenged by others.Objectives: The purpose of the study was to describe who in Virginia is having a vaginal delivery for a breech presentation and to determine if there is a difference in birth outcome based on mode of delivery for breech presentation of term infants.Methods: This population-based study used all birth records for term infants with breech presentation delivered between 1996 and 2005. Data were obtained from the Center for Health Statistics at the Virginia Department of Health. Descriptive statistics were done to characterize vaginal and caesarean section deliveries. These methods were compared using logistic regression for infant mortality and 5-minute Apgar scores as dependent variables.Results: In Virginia, over the last ten years, the prevalence of vaginal deliveries dropped from 13.1% to 6.6% for full term infants with a breech presentation, a decrease of almost 50%. Black women, younger mothers between the ages of 12 and 24, and women with less than or equal to a high school education had the highest occurrence of vaginal births. In the logistic models, the risk for infant death was highest for black women [OR = 1.93; (1.56, 2.38)], women with more than 13 prenatal visits [OR = 1.25; (1.02, 1.53) for 13-15 visits, OR = 2.33; (1 .82, 2.98) for >15 visits], infants who had a low birth weight [OR = 2.8 1 ; (2.08, 3.79)], and women who had a vaginal delivery [OR = 1.42; (1.10, 1.84)] The characteristics that were associated with a lower 5-minute Apgar score for breech infants delivered vaginally included the mother's method of payment, [Medicaid OR 1.75; (1.03, 2.97) and self pay OR 2.33; (1.13, 4.83)], low birth weight [OR = 2.54; (1.24, 5.22)], and delivery type [OR = 4.71; (2.95, 7.52)].Discussion/Conclusions: Our data showed that women who have a vaginal delivery for a term breech infant were more likely to be black, 12-24 years of age, no private insurance, and fewer prenatal visits and was associated with higher infant mortality and lower 5-minute Apgar scores. However, our results indicated that these infants had other significant problems, as indicated by the association with a high number of prenatal visits. Therefore, having physicians who are experienced in delivering breech infants vaginally, careful exclusion of risk factors and, educating the patient about the risks and complications of a vaginal delivery for breech fetuses could help decrease the potential risks for the mother and the infant.

Health Canada recommends exclusive breastfeeding (EBF) until 6 months followed by introducing iron-rich complementary foods (CFs) such as iron-fortified cereal and meat to prevent iron deficiency (ID). There is a concern that consumption of CFs with high iron dose may predispose infants to inflammation through reactive oxygen species (ROS) generation in their intestinal tract. The nutrient intake from these recommended first CFs had not been assessed in terms of meeting the daily requirements. Therefore the aim of this study was to assess if the recommended CFs are safe from a free radical and inflammatory perspective and to assess these CFs in relation to socio-demographic characteristics, feeding patterns, nutrient intake, iron status and growth. Eighty-seven EBF infants were randomly assigned to receive one of the following: iron-fortified cereal (Cer), iron-fortified cereal with fruit (Cer+Fr), meat (M). Urine and stool samples were collected before and after introduction of CFs to assess the following markers: urinary F2-Isoprostanes, fecal ROS, fecal iron and fecal calprotectin. Blood was collected from 18 infants to measure iron parameters. Socio-demographic characteristics and feeding patterns were obtained using questionnaires. Nutrient intake was collected using 3-day dietary records. There are maternal factors that were associated with selected feeding patterns. Nutrient intake was only adequate when provided by both breast milk and CFs. Plasma ferritin decreased over time in all groups (p = 0.04). Infants in M group had lower fecal iron than infants in Cer and Cer+Fr groups (p < 0.001, p = 0.014, respectively). An increase in fecal ROS formation (p < 0.002) after the introduction of CFs was observed. There are maternal socio-demographic factors such as lower parity and lower BMI that need to be targeted in the future to optimize feeding time, type and frequency. Infants with EBF may be at risk of developing ID despite the provision of iron-rich CFs. Untargeted iron fortification may result in untoward effects including ROS generation in the infant’s intestinal tract. In future, if these findings are further confirmed in EBF and formula-fed infants, reconsidering the strategies of iron fortifications to both meet infants’ requirements and minimizing oxidative stress maybe warranted. / October 2015

The early assistance to the newborn presenting oral motor sensorial system dysfunction conveys to the sucking development prevents the compromising of his nutrition. The aim of this study was to determine the criteria to the introduction of feeding through mouth and its possible correlation to the preterm infant from the Neonatal Intensive Care Unit of the University Hospital of Santa Maria. A total of 32 preterm infants were enrolled in this study. Inclusion criteria were: gestational age under 37 weeks, the condition of being clinically stable, discharging the need of mechanical respiratory assistance, the absence of neurological problem neither alteration that could interfere in the oral function development it was also necessary to present the conditions to introduce the oral feeding. Concerning legal representation, informed consent was obtained from parents and/or legal representation. This study was approved by Federal University of Santa Maria research ethical committee. The speech-language evaluation included the data collection from the patient s file; regarding: way of delivering, gender, birth weight, gestational age and appropriate weight for sizing, chronological age, weight in the specific date, physical pattern, respiratory assistance, heart and respiratory rate, behavior state, oral reflections, oral motor sensorial characteristics. Aspects of non-nutritive and nutritive sucking were also considered, such as: number of sucking in the first three burst, time of sucking, time of pauses among the sucking burst, strength and rhythm; besides the swallowed volume throughout the feeding and its length. The results were analyzed at the STATA program version 5.0 (1998) using the parametric test Variance ANOVA and non parametric test of Mann-Whitney beyond chisquare analysis and Spearman s correlation with the value of p lower that 0,05. The results showed that the medical team uses the 34 weeks post conception age, weight about 1700g and clinically stable at the moment of their transition from tube to bottle feeds. The analysis pointed to the need of the existence of searching, sucking and swallow reflexes so that the preterm infant can be allowed to perform the non-nutritive and nutritive sucking presenting strength and rhythm Furthermore, significant differences were found in fast rhythm of sucking because it s allows organized sucking and guarantee the efficient ingestion of liquid. / A assistência precoce ao recém-nascido com alterações no sistema sensório-motor oral possibilita o desenvolvimento da sucção e evita o comprometimento de sua nutrição. Esta pesquisa teve por objetivo verificar os critérios médicos e fonoaudiológicos, e suas possíveis correlações, para a liberação da alimentação por via oral para recém-nascidos pré-termo (RNPT) da Unidade de Terapia Intensiva Neonatal do Hospital Universitário de Santa Maria (HUSM UFSM). O grupo de estudo foi composto por 32 RNPTs, com idade gestacional menor que 37 semanas, clinicamente estáveis, sem uso de ventilação mecânica, sem alterações neurológicas ou alterações que pudessem interferir no desempenho das funções orais, e que tivessem liberação médica para iniciar a alimentação por via oral. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Federal de Santa Maria. A inclusão dos RNPTs na pesquisa deu-se mediante o consentimento livre e esclarecido dos pais e/ou responsáveis legais, expresso em termo elaborado com base na Resolução MS 196/96. A avaliação fonoaudiológica incluiu a coleta de dados oriundos do prontuário do paciente ou da mãe com relação a tipo de parto, sexo, peso de nascimento, idade gestacional e adequação quanto ao tamanho, bem como a observação das condições do RNPT no momento da avaliação, incluindo idade gestacional corrigida, idade cronológica, peso no dia da avaliação, padrão corporal, assistência respiratória, freqüência cardíaca e respiratória, estado comportamental, reflexos orais, características do sistema sensório-motor oral, sucção não-nutritiva e sucção nutritiva, considerando-se aspectos relacionados ao número de sucções nos três primeiros blocos, tempo de sucção, tempo de pausa entre os blocos, grau de força e ritmo das sucções, além do volume ingerido durante a SN e a duração da mamada. Os resultados foram analisados no programa STATA, versão 5.0 (1998); foi utilizado o teste paramétrico de Variância ANOVA, não-paramétrico de Mann-Whitney e Qui-quadrado; o coeficiente de correlação utilizado foi o de Spearman, com nível de significância de p<0,05. Os resultados obtidos indicam que a equipe médica utiliza como parâmetros para liberar a alimentação por VO a idade gestacional corrigida de 34 semanas, o peso em torno de 1.700 g e a estabilidade clínica do RN. Os resultados obtidos apontam para a necessidade de o RN apresentar os três reflexos orais de busca, sucção e deglutição, para que possa desempenhar a sucção não-nutritiva e nutritiva com força e ritmo. Além disso, verificou-se que foi estatisticamente significativo o ritmo rápido de sucção, o qual apresenta padrão de sucção mais organizado, garantindo a ingestão de líquidos de modo eficiente.