459 resultados para Babies
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Background: Over the last 10 years, Australia's spontaneous vaginal birth rate has decreased approximately 1% each year and the caesarean section rate has increased approximately 1% each year. This trend has serious implications for the health of women and babies. As midwives we are the caretakers of normal birth and therefore partly responsible for its decline and the solution to its decline. Although antenatal education is in a potentially powerful position to promote normal birth, a structured review conducted as part of this thesis found that it does not realise that potential. Currently framed in pathogenesis, antenatal education in particular and maternity services in general, are in need of reframing. The theory of salutogenesis may offer a new lens as it focuses on health rather than illness. Sense of coherence is the cornerstone of salutogenesis and is a predictive indicator of health. What is unclear is the role pregnant women's sense of coherence plays in their birthing outcomes. This study explored associations between pregnant women's sense of coherence, their pregnancy choices, their anticipated labour choices, their labour and birthing outcomes as well as factors associated with modification to sense of coherence from the antenatal to postnatal periods. Methods: After a comprehensive review of the literature, questionnaire development and psychometric tool testing and modification, a longitudinal survey was conducted where eligible women completed a questionnaire before the 30th week of pregnancy (Phase One) and approximately 8 weeks after birth (Phase Two). Eligible women were less than 30 weeks pregnant with a single fetus, could read and write in English and lived in the Australian Capital Territory in Australia. Phase One provided information on women's sense of coherence scores, Edinburgh Postnatal Depression Scale (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices including care proVider, planned place of birth, planned birth type and anticipated epidural use and demographics. Phase Two provided information on women's sense of coherence scores, EPDS scores and their labour and birthing outcomes. Findings: 1074 women completed Phase One representing a 61.3% response rate. 753 women completed Phase Two representing a 70.1% retention rate between phases. Compared to women with low sense of coherence, women with high sense of coherence were older, reported fewer pregnancy conditions such as diabetes or hypertension, were less likely to have depressive symptoms, were more likely to feel well supported, were less likely to experience a caesarean section and more likely to experience an assisted vaginal birth. Sense of coherence was not associated with women's pregnancy choices. Higher EPDS scores, lower sense of coherence and greater satisfaction with birth were associated with an increase in women's sense of coherence from the antenatal to the postnatal period. Decreased birth satisfaction and experiencing epidural anaesthesia in labour and assisted vaginal birth were associated with a decrease in sense of coherence from the antenatal to the postnatal period. Conclusion: Strong sense of coherence in pregnant women halved the likelihood of experiencing caesarean section compared to women with low sense of coherence. Sense of coherence is a modifiable predictor of women's childbearing health and was found to be raised by birth satisfaction and lowered by birth dissatisfaction and labour interventions. These important findings add to the limited body of knowledge about sense of coherence and childbearing.
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Objetivo: Determinar el número de partos intrahospitalarios, en relación al primer control prenatal de las embarazadas de la consulta externa del Hospital “San Sebastián” del Sígsig. Material y métodos: Se realizó un estudio descriptivo en una muestra de 404 embarazadas, que acudieron a su primer control prenatal al Hospital “San Sebastián”, luego se determinó el porcentaje de gestantes que tuvieron el parto en este hospital. Resultados: La prevalencia del parto intrahospitalario en relación al primer control fue del 54.4%: 220 mujeres tuvieron el parto en el hospital. El resto 45.6% gestantes no acudieron al parto en esta institución. La media de edad fue de 25.7 años. La media de años de instrucción fue 7. La media de embarazos fue de 3. Conclusiones: El parto intrahospitalario en relación al primer control en esta zona es bajo: el 54.4% de gestantes, prácticamente solo la mitad, o una de cada dos embarazadas acude para el parto hospitalario; por lo tanto un gran número de gestantes está en riesgo de sufrir complicaciones, debido a que probablemente se den partos domiciliarios, atendidos por comadronas
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Background: Perinatal asphyxia is an important cause of mortality and permanent neurological and developmental deficit. Early and accurate diagnosis would help to establish the likely prognosis and may also help in determining the most appropriate treatment. Studies in experimental animal models suggest that a protein called Hsp70 may be a good and potentially useful marker of cellular stress that may be clinically useful in determining the presence of neonatal asphyxia. Objectives: Regarding the importance of early and accurate diagnosis of asphyxia, we conducted this study, which is the first investigation of the comparison of the serum Hsp70 antigen level between asphyxiated and healthy infants. Patients and Methods: In this observational study, the serum concentrations of Hsp70 antigen were compared between neonates suffering from perinatal asphyxia (n = 50) and normal neonates (n = 51). The inclusion criteria for the cases were neonates who had reached term and had at least two clinical criteria of asphyxia. Exclusion criteria were babies with gestational age < 37 weeks, infants with congenital abnormalities or positive blood culture. Exclusion criteria in this group were the requirement to hospital stay during first week of the life or babies whose mothers had difficulties during pregnancy or delivery. Term neonates without major anomalies who had asphyxia during delivery were enrolled in the first six hours after delivery, and control group consisted of healthy term neonates without problems and normal delivery process in the first week of life. The cord blood was taken during labor to measure Hsp70 antigen level by using an in-house ELISA (The enzyme-linked immunosorbent assay). Results: The median values of serum anti Hsp70 titers were significantly higher in asphyxiated neonates compared with non-asphyxiated neonates (0.36 [0.04 - 1.14] vs 0.24 [0.01 - 0.63]). At cutoff point = 0.3125 ng/mL, sensitivity was 58% and specificity 76% based on ROC curve. Conclusions: A significant difference between the serum concentrations of Hsp70 of the control and patient group was observed in this study. It is inferred serum concentrations of Hsp70 antigen may be a useful marker for the early diagnosis of that prenatal hypoxia.
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Background: Retinopathy of prematurity (ROP) is a disorder of developing retina of low birth weight preterm infants which can lead to blindness. One theory attributes the fibrosis seen in ROP to deregulation of vascularization in the retina. Vascular endothelial growth factor (VEGF) is one of the important mediators involved in vascularization. Objectives: This study was carried out to assess the role of VEGF and its receptor in retinopathy of prematurity. Patients and Methods: Around 200 preterm infants born in SSK hospital were screened at 33 - 34 weeks. These babies were followed up according to the international classification of retinopathy of prematurity (ICROP) criteria. Those infants who developed ROP at 38 - 40 weeks were enrolled in group A while an equal number of infants who did not develop ROP were included in group B. Each group comprised of 30 subjects each. Venous sampling was carried out twice, once at 33 - 34 weeks and then again at 38 - 40 weeks. VEGF and VEGF-R2 were estimated by commercially available ELISA kits. Results: There was no statistically significant difference between the levels of VEGF and VEGF-R2 in both groups at first visit as well as the follow up visit. However, the intra-group difference was significant between the first and the final visit in VEGF and VEGF-R2 levels in the cases with ROP. In the control population, the VEGF levels were significantly lower in the follow up visit as compared to the initial visit. Conclusions: Our study demonstrates that a significant difference is seen in the serum VEGF and VRGF-R2 in the second visit of the infants with ROP demonstrating that VEGF might be responsible for the initiation and aggravation of ROP.
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Background: Neonates and infants with hypomagnesemia present with seizures and psychomotor delay. Objectives: The present study evaluated the changes in magnesium (Mg) levels and factors associated with these in the first three days of life. Materials and Methods: We monitored 50 clinically asymptomatic neonates; they were not given any magnesium supplements even if they had hypomagnesemia at baseline. The variables analysed were: serum Mg; gestational age; birth weight; length; and the ponderal index. We used random effects (RE) models for longitudinal analysis of these data. Results: The mean standard deviation (SD) gestational age was 36.3 (3.6) weeks and the mean (SD) weight was 2604.2 (754.4) grams. About 31% of the neonates had hypomagnesemia (< 1.6 mg/dL) on day one; however, all had normal magnesium levels by day three of life (P < 0.001). At birth, after adjusting for intrauterine growth retardation status (IUGR), serum Mg levels were lower by 0.0097 mg/dL (95% CI: -0.019 to -0.0003) per 100 grams increase in weight of the neonate. After adjusting for IUGR status, the mean increase in the serum Mg levels was 0.14 mg/dL (95% confidence intervals [CI]: 0.10 to 0.18) per day. The per-day increase in magnesium levels was significantly higher in low birth weight babies (0.10, 95% CI: 0.01 to 0.18) compared with normal birth weight babies. Conclusions: Asymptomatic neonates may have a high prevalence of hypomagnesemia; however, the levels become normal without any magnesium supplementation. Even though regular monitoring of magnesium levels is useful, no supplements are required - particularly in clinically asymptomatic neonates.
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Introduction: ABCA3 glycoprotein belongs to the ATP-binding cassette (ABC) superfamily of transporters, which utilize the energy derived from hydrolysis of ATP for the translocation of a wide variety of substrates across the plasma membrane. Mutations in the ABCA3 gene are knowingly causative for fatal surfactant deficiency, particularly respiratory distress syndrome (RDS) in term babies. Case Presentation: In this study, Sanger sequencing of the whole ABCA3 gene (NCBI NM_001089) was performed in a neonatal boy with severe RDS. A homozygous mutation has been identified in the patient. Parents were heterozygous for the same missense mutation GGA > AGA at position 202 in exon 6 of the ABCA3 gene (c.604G > A; p.G202R). Furthermore, 70 normal individuals have been analyzed for the mentioned change with negative results. Conclusions: Regarding Human Genome Mutation Database (HGMD) and other literature recherche, the detected change is a novel mutation and has not been reported before. Bioinformatics mutation predicting tools prefer it as pathogenic.
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Objetivo Determinar la prevalencia de las malformaciones congénitas y las características de las madres y de los recién nacidos malformados en el Hospital Vicente Corral Moscoso. Metodología Se realizó un estudio de tipo descriptivo (se determinó la prevalencia por año), se revisaron las historias clínicas de las madres con recién nacidos entre el periodo del 2010 al 2014. Para recolectar la información se empleó un formulario pre elaborado, los datos se agruparon según la clasificación del CIE-10 y se tabularan usando Microsoft Excel. Para el análisis de los datos se utilizó el software estadístico SPSS versión 15. Se describieron las variables del estudio de acuerdo a las medidas estadísticas apropiadas. Resultados La prevalencia de las malformaciones congénitas fue de 1.70 por cada 100 recién nacidos. Las mujeres entre 20 a 24 años, presentaron el mayor porcentaje de recién nacidos malformados con un 34.95%. Los recién nacidos malformados fueron mayoritariamente del sexo masculino con 53.83%. El grupo de malformación más frecuente fueron las malformaciones y deformidades congénitas del sistema osteomuscular con 18.88%, de las cuales la gastrosquisis fue la más frecuente, representada por el 4.85%. El síndrome polimalformativo fue el tipo de malformación congénita con el mayor porcentaje con un 10.71%. Conclusiones El presente estudio revela que la prevalencia encontrada de recién nacidos con malformaciones congénitas, fue similar a investigaciones previas a nivel regional y local. Se incluyeron únicamente las malformaciones que constituyen alteraciones morfológicas evidentes, encontrándose una mayor frecuencia del síndrome polimalformativo
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Background: Morbidity and mortality of preterm babies are important issues in perinatal medicine. In developed countries, preterm delivery is the cause of about 70% of mortality and 75% of morbidity in the neonatal period, respectively. Objective: The aim of this study was to determine the risk factors for preterm labor and the outcomes, in terms of perinatal mortality and morbidity at the time of discharge home, among preterm infants at less than 34 weeks gestation. Materials and Methods: A retrospective study was conducted and all infants with a gestational age of 24 to 33 weeks and 6 days who were born from November 1st , 2011 to March 31, 2012 were enrolled in this study. Results: From 1185 preterm infants were born during this period, 475 (40.08%) infants with less than 34 weeks gestational age were included in the study. Our study showed the major obstetrical risk factors for preterm labor were as follows: preeclampsia (21%), premature rupture of membranes (20.3%), abruption of placenta (10%), and idiopathic cases (48.7%). The neonatal mortality rate in less than 34 weeks was 9.05%. Significant perinatal morbidity causesd in less than 34 weeks were as follows: sepsis (46.94%), respiratory distress syndrome (41.47%), patent ductus arteriosus (21.47%), retinopathy of prematurity (3.57%), necrotizing entrocolitis (1.68%), intra-ventricular hemorrhage (9%), and broncho-pulmonary dysplasia (0.84%). Conclusion: Preterm birth is associated with adverse perinatal outcome. This situation needs to be improved by directing appropriately increased resources for improving prenatal health services and providing advanced neonatal care.
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La pratique infirmière en contexte de parentalité précoce et de vulnérabilité sociale auprès de mères âgées de moins de 20 ans et leurs bébés comporte des défis pour les infirmières qui éprouvent des difficultés à établir des liens avec les jeunes pères. Leur pratique d’accompagnement est orientée principalement vers la dyade mère-enfant, tandis qu’elles se sentent peu outillées pour accompagner les jeunes pères dans leur rôle paternel. Des études récentes suggèrent de considérer le genre dans la compréhension de l’espace relationnel entre des pères et des infirmières, notamment dans des services de première ligne. Cette étude a pour but de décrire, selon une perspective sensible au genre, les représentations identitaires qui configurent la relation d’accompagnement entre des jeunes pères et des infirmières dans le cadre des Services intégrés en périnatalité et pour la petite enfance (SIPPE). Partant d’une recherche évaluative multicentrique du Programme de soutien aux jeunes parents (PSJP) des SIPPE, cette recherche qualitative interprétative présente une analyse secondaire de 34 entretiens semi-dirigés complétés auprès de jeunes pères et d’infirmières. L’analyse croisée du discours des participants et la modélisation systémique ont permis de représenter des conceptions identitaires et des dynamiques contextuelles qui composent la relation d’accompagnement entre des jeunes pères et des infirmières dans le PSJP/SIPPE. Cette relation prend principalement forme autour de l’échange d’informations axées sur les soins de l’enfant. De plus, elle est marquée par des représentations différenciées de l’identité parentale du jeune père (père présent et soignant vs père peu compétent), de son engagement dans les responsabilités afférentes à son rôle et par une dynamique de vigie-surveillance exercée par les infirmières. Cette relation peut se transformer à travers le temps, où le père conçu responsable et protecteur devient un allié pour l’infirmière, tout en demeurant sous surveillance. Parmi les contributions de cette recherche, nous signalons l’importance du soutien émotionnel en plus du soutien informationnel pour les pères qu’il importe de considérer à part entière dans l’accompagnement auprès de familles vivant en situation de vulnérabilité sociale. Enfin, cette recherche souligne la pertinence d’une perspective sensible au genre pour concevoir l’espace relationnel du soin et développer la pratique infirmière d’accompagnement.
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La plupart des femmes ayant été atteintes d’arthrite juvénile idiopathique (AJI) continuent de souffrir d’arthrite à l’âge adulte. Certains des médicaments utilisés dans le traitement de l’arthrite tels que les corticostéroïdes et les antiinflammatoires non stéroïdiens (AINS) ne sont pas recommandés durant la grossesse. Le but de ce mémoire est d’estimer l’impact de la prise de ces médicaments sur les événements néfastes à l’accouchement chez ces femmes et leur bébé. Des données administratives sur les prescriptions de médicaments et les hospitalisations d’une cohorte de 1756 femmes ayant souffert d’AJI sont utilisées. Elles ont permis de reconstruire l’historique de consommation de médicaments contre l’arthrite chez les femmes durant la grossesse et l’année précédente. Pour ce faire, deux sous-cohortes de femmes ayant souffert d’AJI ont été formées : une pour la période grossesse et une autre pour la grossesse et l’année précédant celle-ci. Les événements d’intérêt étaient : malformations congénitales, complications néonatales, complications maternelles et petit poids pour l’âge gestationnel. Les proportions de cas présentant l’un de ces événements variaient entre 11,52% et 37,08%. Les médicaments ont été modélisés en terme d’utilisation ou de durée totale de consommation durant la période d’étude. Pour chaque événement, des modèles logistiques ont été estimés pour mesurer l’association entre la prise de médicaments et l’événement, en ajustant pour des variables de confusion potentielles : hypertension avant la grossesse, âge à l’accouchement et obtention du diplôme de secondaire. La consommation de corticostéroïdes semble augmenter statistiquement significativement le risque de présenter des malformations congénitales mais n’avoir aucun impact sur les autres événements. Aucun lien statistiquement significatif n’a été observé entre la consommation de AINS et les événements d’intérêt.
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Human Fertility 17(3):165-9 This article describes the experiences of twelve Irish couples who had successful IVF treatment in Ireland. Irish Medical guidelines specify that IVF may only be used when no other treatment is likely to be effective. This article is based on data drawn from a longitudinal research study by Cotter (2009) which tells the stories of 34 couples who sought fertility treatment. Initially, the women assumed that they would become pregnant when they stopped using contraception. As a couple, it was the ‘right time’ for them to have a child - they were ready, socially and financially. For several months they were patient, hoping it would happen naturally. With envy and some despair they watched as their friends had babies. Infertility came as a shock to most of them. They were reluctant to talk about it to anyone, and over time their anxieties were accompanied by feelings of regret, stigma and social exclusion. They finally sought medical treatment. The latter involved a series of diagnostic treatments, which eventually culminated in IVF which offered them a final chance of having a ‘child of their own’. While IVF can be clinically assessed in terms of cycle success rates, their stories showed treatment as a series of discoveries, as an extensive range of diagnostic tests and procedures helped to reveal to them where their problems might lie. They described their treatments as a series of sequential ‘hurdles’ that they had to overcome, which further strengthened their resolve to try IVF. Much more knowledgeable at that stage, they embraced IVF as a final challenge with single minded dedication while drawing on all their psychological and biological resources to promote a successful outcome. Of the 34 couples who took part in the study, twelve got pregnant. Unfortunately, two children died shortly after birth but eighteen babies survived (see Table I). The findings suggest that health policy should raise awareness of infertility, and advise women to become aware of it just as in the past, when health policy addressed contraception. Increased public knowledge would reduce the stigma attached to the inability to have a baby. In the Irish case, infertility diagnosis should be reviewed with a view to giving eligible couples earlier access to IVF.
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OBJECTIVE: To identify whether the use of a notch filter significantly affects the morphology or characteristics of the newborn auditory brainstem response (ABR) waveform and so inform future guidance for clinical practice. DESIGN: Waveforms with and without the application of a notch filter were recorded from babies undergoing routine ABR tests at 4000, 1000 and 500 Hz. Any change in response morphology was judged subjectively. Response latency, amplitude, and measurements of response quality and residual noise were noted. An ABR simulator was also used to assess the effect of notch filtering in conditions of low and high mains interference. RESULTS: The use of a notch filter changed waveform morphology for 500 Hz stimuli only in 15% of tests in newborns. Residual noise was lower when 4000 Hz stimuli were used. Response latency, amplitude, and quality were unaffected regardless of stimulus frequency. Tests with the ABR stimulator suggest that these findings can be extended to conditions of high level mains interference. CONCLUSIONS: A notch filter should be avoided when testing at 500 Hz, but at higher frequencies appears to carry no penalty.
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La pratique infirmière en contexte de parentalité précoce et de vulnérabilité sociale auprès de mères âgées de moins de 20 ans et leurs bébés comporte des défis pour les infirmières qui éprouvent des difficultés à établir des liens avec les jeunes pères. Leur pratique d’accompagnement est orientée principalement vers la dyade mère-enfant, tandis qu’elles se sentent peu outillées pour accompagner les jeunes pères dans leur rôle paternel. Des études récentes suggèrent de considérer le genre dans la compréhension de l’espace relationnel entre des pères et des infirmières, notamment dans des services de première ligne. Cette étude a pour but de décrire, selon une perspective sensible au genre, les représentations identitaires qui configurent la relation d’accompagnement entre des jeunes pères et des infirmières dans le cadre des Services intégrés en périnatalité et pour la petite enfance (SIPPE). Partant d’une recherche évaluative multicentrique du Programme de soutien aux jeunes parents (PSJP) des SIPPE, cette recherche qualitative interprétative présente une analyse secondaire de 34 entretiens semi-dirigés complétés auprès de jeunes pères et d’infirmières. L’analyse croisée du discours des participants et la modélisation systémique ont permis de représenter des conceptions identitaires et des dynamiques contextuelles qui composent la relation d’accompagnement entre des jeunes pères et des infirmières dans le PSJP/SIPPE. Cette relation prend principalement forme autour de l’échange d’informations axées sur les soins de l’enfant. De plus, elle est marquée par des représentations différenciées de l’identité parentale du jeune père (père présent et soignant vs père peu compétent), de son engagement dans les responsabilités afférentes à son rôle et par une dynamique de vigie-surveillance exercée par les infirmières. Cette relation peut se transformer à travers le temps, où le père conçu responsable et protecteur devient un allié pour l’infirmière, tout en demeurant sous surveillance. Parmi les contributions de cette recherche, nous signalons l’importance du soutien émotionnel en plus du soutien informationnel pour les pères qu’il importe de considérer à part entière dans l’accompagnement auprès de familles vivant en situation de vulnérabilité sociale. Enfin, cette recherche souligne la pertinence d’une perspective sensible au genre pour concevoir l’espace relationnel du soin et développer la pratique infirmière d’accompagnement.
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L'obtention des données a été subventionnée par CIORA (Canadian Initiative for Outcomes in Rheumatology Care). CIORA a aussi financé l'analyse des données effectuées par Justine Zehr. L'Initiative Canadienne Pour Des Resultats En Soins Rhumatologiques (ICORA) a financé l'obtention des données et une partie de l'analyse statistique présentée dans ce mémoire.
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Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.
