Dissertations / Theses on the topic 'Neonatal outcomes'
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Hefley, Erin. "Interpregnancy Interval and Neonatal Outcomes." Thesis, The University of Arizona, 2014. http://hdl.handle.net/10150/315902.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Objectives: Interpregnancy interval (IPI), the time period between the end of one pregnancy and the conception of the next, can have a significant impact on maternal and infant outcomes. This study examines the relationship between interpregnancy interval and neonatal outcomes of low birth weight, preterm birth, and specific neonatal morbidities. Study Design: Retrospective cohort study comparing neonatal outcomes across 6 categories of IPI using data on 202,600 cases identified from Arizona birth certificates and the Newborn Intensive Care Program data. Comparisons between groups were made using odds ratios and 95% confidence intervals, and multivariable logisitic regression analysis. Results: Interpregnancy intervals of < 12 months and ≥ 60 months were associated with low birth weight, preterm birth, and small for gestational age births. The shortest and longest IPI categories were also associated with specific neonatal morbidities, including periventricular leukomalacia, bronchopulmonary dysplasia, intraventricular hemorrhage, apnea bradycardia, respiratory distress syndrome, transient tachypnea of the newborn, and suspected sepsis. Relationships between interpregnancy interval and specific neonatal morbidities did not remain significant when adjusted for birth weight and gestational age. Conclusions: Significant differences in neonatal outcomes (preterm birth, low birth weight, and small for gestational age) were observed between IPI categories. Consistent with previous research, interpregnancy intervals < 12 months and ≥ 60 months appear to be associated with increased risk of poor neonatal outcomes. Any difference in specific neonatal morbidities between IPI groups appears to be mediated through increased risk of low birth weight and preterm birth by IPI.
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Johnson, Courtney Denning. "Postterm pregnancy risk factors and neonatal outcomes /." Available to US Hopkins community, 2003. http://wwwlib.umi.com/dissertations/dlnow/3080692.
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Tong, Yanling. "Developing ANN approaches to estimate neonatal ICU outcomes." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape3/PQDD_0020/MQ57165.pdf.
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Chen, Wenxiong. "Neonatal hyperbilirubinemia long-term neurophysiological and neurodevelopmental outcomes /." Click to view the E-thesis via HKUTO, 2006. http://sunzi.lib.hku.hk/hkuto/record/B37489380.
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Chen, Wenxiong, and 陈文雄. "Neonatal hyperbilirubinemia: long-term neurophysiological and neurodevelopmental outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B37489380.
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Proctor-Williams, Kerry. "Neurodevelopmental Outcomes for Infants with Neonatal Abstinence Syndrome." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/1827.
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Kvale, Janice Keller. "Maternal and neonatal outcomes associated with selected intrapartum interventions." Case Western Reserve University School of Graduate Studies / OhioLINK, 1994. http://rave.ohiolink.edu/etdc/view?acc_num=case1061988693.
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Ankolekar, Kamini. "Hyperglycaemia, ethnicity and neonatal outcome study : a study conducted to review the influence of ethnicity on neonatal outcomes in pregnancies complicated with diabetes." Thesis, University of Leicester, 2016. http://hdl.handle.net/2381/37834.
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In England and Wales, about 2-5% of pregnancies are complicated with diabetes each year. Diabetes is a particular problem in the South Asian (SA) ethnic group with the prevalence of Type 2 Diabetes and GDM being about 6 times and 11 times higher respectively as compared to White British (WB) women. My PhD project was undertaken to study the influence of ethnicity and maternal hyperglycaemia during pregnancy on neonatal outcomes. This project consists of two retrospective studies and one prospective pilot study. The first retrospective study was undertaken to compare the neonatal outcomes in WB and SA infants born to mothers with gestational or pre-gestational diabetes (Type 1 and Type 2 diabetes). The second retrospective study was undertaken to compare the risk of morbidity and mortality between large for gestational age infants with a birthweight ≥ 97th centile and appropriate for gestational age infants with birthweight between 10th – 90th centile, both born to mothers without diabetes. Maternal hyperglycaemia during pregnancy leads fetal exposure to high blood glucose levels, which in turn leads to fetal hyperinsulinism. The neonatal complications seen in infants of diabetic mothers are due to persistent fetal hyperinsulinism after birth. Currently there is no clinical or biochemical test to identify, at birth, the infants who are at risk of neonatal complications. A prospective pilot study was undertaken to evaluate the feasibility of using cord blood C-peptide (surrogate marker of insulin) to identify infants born to mothers with diabetes and LGA infants of non-diabetic mothers at risk of postnatal complications. Such a test would enable early implementation of interventions to avoid complications and at the same time free the vast majority of infants from unnecessary medicalisation of their postnatal care.
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Poon, Chuen. "Cardiovascular outcomes of neonatal respiratory disease in infants and children." Thesis, Cardiff University, 2015. http://orca.cf.ac.uk/91302/.
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The aim of this thesis is to compare effects of respiratory distress syndrome (RDS) on the myocardial function of newborn preterm infants and the later effects of chronic lung disease of prematurity on pulmonary artery stiffness in school age children. The first study in this thesis compared global and regional myocardial function in preterm infants with respiratory distress syndrome (RDS) with preterm and term-born controls (30 with RDS, 30 preterm control ≤34 weeks, 60 term control) using conventional and tissue Doppler echocardiography at birth, at term, one month, and one year of age. The second study compared the pulmonary artery stiffness, an early preclinical marker of pulmonary hypertension, in children (aged 8-12 years) who had chronic lung disease of prematurity (CLD) with preterm and term-born controls. Pulmonary artery pulse wave velocity (PA PWV) was assessed in 59 children: 13 with CLD, 21 preterm (≤ 32 weeks gestation) and 25 term controls) using velocity encoded MRI technique while breathing room air and after 20 minutes of breathing 12% oxygen. At birth, infants with RDS had lower pulmonary artery AT:ET (p < 0.001), long axis shortening (p < 0.01), RV systolic velocity (p < 0.001) and higher TR (p < 0.01) compared to preterm and term control groups. The preterm groups was also noted to have diastolic dysfunction (lower mitral E:A) at birth (p < 0.001). At term corrected age, pulmonary artery AT:ET was still lower in the RDS group but no differences detected in TR between the groups. There were no differences in all parameters measured between the groups at one month and one year. 2 PA PWV was similar in all three groups at baseline when assessed at school age. However, following hypoxic challenge, PA PWV in children who had CLD increased significantly compared to preterm (p=0.025) and term controls (p=0.042). The findings in this thesis suggest that infants with RDS had mildly elevated pulmonary arterial pressure as a result of milder respiratory disease with improvement in antenatal and neonatal care. The RV global dysfunction in infants with RDS resolved with resolution of the respiratory condition. Both preterm groups underwent postnatal maturation of myocardial function and caught up with the term control group by one month corrected age. At school age, children who had CLD displayed increased pulmonary vascular reactivity to hypoxia and are at greater risk of developing pulmonary hypertension earlier.
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Srihari-Bhat, Prashanth. "Optimisation of neonatal ventilation from birth using physiological measurements as outcomes." Thesis, King's College London (University of London), 2017. https://kclpure.kcl.ac.uk/portal/en/theses/optimisation-of-neonatal-ventilation-from-birth-using-physiological-measurements-as-outcomes(79c78673-4c09-4f33-bdde-19d8e93b95cd).html.
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Aim: To optimize mechanical ventilation in the labour suite and on the neonatal unit using the results of physiological measurements as outcomes. A series of studies was undertaken to test the following hypotheses. 1. During the resuscitation of prematurely born infants, inflation pressures of 25/5 cmH2O would increase the expired tidal volume and end tidal carbon dioxide levels. In addition, maintenance of the first five inflations for two to three seconds would lead to higher tidal volumes. 2. In infants born at or near term, volume targeted ventilation (VTV) when compared to pressure limited ventilation (PLV) would be associated with shorter time to extubation, reduced work of breathing and better respiratory muscle strength. 3. In a dynamic lung model representing bronchopulmonary dysplasia, resistive unloading during proportional assist ventilation (PAV) would reduce the inspiratory load. 4. In infants with evolving bronchopulmonary dysplasia, PAV when compared to assist control ventilation (ACV) would be associated with reduced work of breathing, increased respiratory muscle strength and be associated with less ventilator-infant asynchrony and improved oxygenation as indicated by the oxygenation index (OI). 5. Extubation failure would be predicted by the tension time index of diaphragm (TTdi) and the tension time index of respiratory muscles (TTmus). Results: 1. The resuscitation study demonstrated that higher inflation pressures, but not longer inflation times produced significantly higher expired tidal volumes. 2. There were no significant differences in the time to successful extubation in at or near term-born infants supported by VTV or PLV; however, VTV was associated with significantly fewer episodes of hypocarbia. 3. The in-vitro study of PAV showed that the resistive unloading was relatively ineffective and hence as currently delivered is unlikely to be of clinical benefit to infants with a high resistance load. 4. PAV compared with ACV in prematurely born infants ventilated beyond the first week after birth resulted in a reduced work of breathing and a lower OI. 5. The TTdi study demonstrated that the TTdi and TTmus results significantly differed according to extubation outcome in ventilated infants. Overall TTdi ≥0.08 had 83% sensitivity and 81% specificity (90% sensitivity and 60% specificity in the preterm infants) in predicting extubation failure. Overall TTmus ≥0.19 had 50% sensitivity and 100% specificity (54% sensitivity and 100% specificity in the preterm infants) in predicting extubation failure.
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Perez, López Faustino R., Vinay Pasupuleti, Edward Mezones-Holguín, Priyaleela Thota, Abhishek Deshpande, Adrian V. Hernández, and Vicente A. Benítes-Zapata. "Effect of vitamin D supplementation during pregnancy on maternal and neonatal outcomes: a systematic review and meta-analysis of randomized controlled trials." Elsevier B.V, 2015. http://hdl.handle.net/10757/347325.
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faustino.perez@unizar.esObjective: To assess the effects of vitamin D supplementation during pregnancy on obstetric outcomes and birth variables. Design: Systematic review and meta-analysis of randomized controlled trials (RCTs). Setting: Not applicable. Patient(s): Pregnant women and neonates. Intervention(s): PubMed and 5 other research databases were searched through March 2014 for RCTs evaluating vitamin D supplementation calcium/vitamins/ferrous sulfate vs. a control (placebo or active) during pregnancy. Main Outcome Measure(s): Measures were: circulating 25-hydroxyvitamin D [25(OH)D] levels, preeclampsia, gestational diabetes mellitus (GDM), small for gestational age (SGA), low birth weight, preterm birth, birth weight, birth length, cesarean section. Mantel-Haenszel fixed-effects models were used, owing to expected scarcity of outcomes. Effects were reported as relative risks and their 95% confidence intervals (CIs). Result(s): Thirteen RCTs (n ¼ 2,299) were selected. Circulating 25(OH)D levels were significantly higher at term, compared with the control group (mean difference: 66.5 nmol/L, 95% CI 66.2–66.7). Birth weight and birth length were significantly greater for neonates in the vitamin D group; mean difference: 107.6 g (95% CI 59.9–155.3 g) and 0.3 cm (95% CI 0.10–0.41 cm), respectively. Incidence of preeclampsia, GDM, SGA, low birth weight, preterm birth, and cesarean section were not influenced by vitamin D supplementation. Across RCTs, the doses and types of vitamin D supplements, gestational age at first administration, and outcomes were heterogeneous. Conclusion(s): Vitamin D supplementation during pregnancy was associated with increased circulating 25(OH)D levels, birth weight, and birth length, and was not associated with other maternal and neonatal outcomes. Larger, better-designed RCTs evaluating clinically relevant outcomes are necessary to reach a definitive conclusion. (Fertil Steril 2015;-:-–-. 2015 by American Society for Reproductive Medicine.)
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Lanes, Andrea. "Pregnancy and Neonatal Outcomes Associated with the Use of Assisted Reproductive Technologies." Thesis, Université d'Ottawa / University of Ottawa, 2017. http://hdl.handle.net/10393/36022.
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Assisted reproductive technologies have become a common method used to treat infertility. These techniques have advanced quickly since the first birth of an in vitro fertilization (IVF) baby in 1978, at the Royal Oldham Hospital in the United Kingdom. Currently, IVF with or without intracytoplasmic sperm injection, is used throughout the world to achieve oocyte retrieval, fertilization, implantation of an embryo, clinical pregnancy, ongoing clinical pregnancy, and a live-born infant. The rationale for selecting one type of fertility treatment over another is multifactorial: the confirmed or unconfirmed cause of infertility, the age of the gamete donor and the recipient, the availability of the type of treatment, and the cost associated with the treatment. The ultimate goal of any fertility treatment is to achieve a successful pregnancy that results in a healthy infant. However, the literature is equivocal on the effects of fertility treatment cycles on the health outcomes of infants and mothers.
Presently, there are thirty-six fertility treatment centres across Canada, eighteen of which reside in Ontario. A national, comprehensive database of assisted reproductive technology treatment cycles (Canadian Assisted Reproductive Technologies Register (CARTR) Plus) began collecting data in 2013, and has made the research objectives of this doctoral thesis feasible. Before this data collection system, population-wide studies involving fertility treatments were not possible in Canada. Two understudied issues associated with IVF are the impact of fertility treatments on the maternal serum screening markers used in prenatal screening programs to identify fetal aneuploidies; and the association between fertility treatments and adverse perinatal outcomes, such as preeclampsia and stillbirth. Given the increasing number of women who are using fertility treatments to conceive, it is imperative that studies investigating the association with adverse outcomes are conducted.
As the science supporting fertility treatment procedure has advanced, so has prenatal screening. One of the first screening tests that are performed for newly pregnant women, including women who conceived following IVF, is maternal serum screening. The first objective of this doctoral thesis was to systematically review the literature on the association between IVF treatment and maternal serum screening marker levels and nuchal translucency (NT) thickness. After the search and screening of the literature there were 40 studies that were included in this systematic review. A decrease in pregnancy-associated plasma protein A (PAPP-A) and an increase in total human chorionic gonadotropin (hCG) was consistently reported for IVF pregnancies. However, since the levels of the other maternal serum screening markers reported also varied we were unable to generalize about the differences between prenatal screening results in the IVF population. These results led to investigating maternal serum screening marker levels among IVF patients in Ontario, Canada.
The second objective of this thesis was three-fold: 1) to investigate the accuracy of IVF identification on the Ontario prenatal screening record, relative to reference standard on the CARTR Plus database; 2) to compare the prenatal screening markers in IVF versus non-IVF pregnancies in the population of Ontario; and 3) to propose updated IVF adjustment factors for prenatal screening in the Ontario population, based on the more accurate coding for IVF status in the CARTR Plus database. Significant differences between IVF and non-IVF groups, based on both the prenatal screening requisition information and CARTR Plus information, were found among the ethnicity adjusted mean multiple of the median (MoM)s for several prenatal screening markers: alpha-fetoprotein (AFP), PAPP-A, unconjugated estriol (µE3), first trimester hCG, total hCG, and dimeric inhibin A (DIA). When we developed the proposed adjustment factors for all CARTR Plus identified pregnancies we found that for PAPP-A, total hCG, and µE3 the mean adjusted marker MoMs were significantly closer to 1.00, as compared to the prenatal screening adjusted or the unadjusted mean marker MoMs. Currently, there is no adjustment made to the other maternal serum screening markers and NT measurement.
The third objective was to examine the effect of type of infertility on placental-mediated adverse outcomes (preeclampsia, intrauterine growth restriction, placental abruption, and stillbirth). Type of infertility was classified as male factor (sperm count, poor sperm motility, and abnormal sperm morphology), female factor (ovulation disorders, tubal infertility, and uterine or cervical causes), and unexplained infertility. No significant associations were found between type of conception and the composite outcome, as well as each individual primary outcome. Similarly, the type of infertility was not associated with the composite outcome or any of the individual primary outcomes, except for female factor infertility, which was associated with increased probability of placental abruption.
Overall, the results from this doctoral thesis suggest that there are substantial differences seen in maternal serum screening marker MoMs among women who use IVF to conceive, suggesting that appropriate adjustment factors should be employed to ensure accurate results for determining the risk of Down syndrome and trisomy 18. Additionally, although the literature has shown an association between fertility treatment and placental-mediated adverse outcomes no significant associations were found in the population of Ontario. Further studies should be performed to confirm the results of these observational studies.
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Wang, Cong Kerynn. "Caesarean delivery on maternal request: systematic review on maternal and neonatal outcomes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2011. http://hub.hku.hk/bib/B46942609.
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Boynewicz, Kara, K. Sperapolus, and R. Ripley. "Interventions for Families and Infants with Neonatal Abstinence Syndrome: Outcomes and Treatment Planning." Digital Commons @ East Tennessee State University, 2020. https://dc.etsu.edu/etsu-works/8341.
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Smithgall, Lisa M. "Perceptions of Maternal Stress and Neonatal Patient Outcomes in a Single Private Room versus Open Room Neonatal Intensive Care Unit Environment." Digital Commons @ East Tennessee State University, 2010. https://dc.etsu.edu/etd/1772.
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Limited clinical evidence exists regarding whether the single private room Neonatal Intensive Care Unit (NICU) environment of care delivery has a positive, negative, or neutral impact on health outcomes for the high risk neonate and on maternal stress as compared to the open room design. The study purpose was to examine whether a difference exists in health outcomes in the open room versus single private room NICU environment. The factors considered were weight gain, ventilator days, hospital length of stay, incidence and grade of intraventricular hemorrhage (IVH), the number of parental visits, and perceptions of maternal stress. Infants hospitalized in an open room environment (n=52) were matched by gestational age to infants in a single private room NICU (n=52). Mothers of the infants from the open room (n=26) and the single private room (n=20) groups completed the Parental Stress Scale: Neonatal Intensive Care Unit (PSS:NICU) survey instrument. The t-test for independent groups demonstrated a difference for the number of parent visits (t=6.672, df=60.13, p<.001) with a significant increase in visitation frequency for infants in the single private room NICU. Maternal perceptions of stress were not different (t=.154, df=44, p=.878), and high stress scores were reported for both groups regardless of the infant's environment of hospitalization. This study demonstrates that the single private room environment promotes increased parental access to their infants. The finding of high levels of maternal perception of stress in both the open room and single private room NICU's demonstrates that the environment did not impact the perception of maternal stress. This finding supports the implication that mothers of hospitalized infants need nursing support regardless of the type of NICU environment.
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Alghamdi, Amal. "The associations between poor sleep in pregnancy and obstetric, perinatal and neonatal outcomes." Thesis, University of Leeds, 2017. http://etheses.whiterose.ac.uk/18998/.
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Background: Sleep has a complex nature that is thought to make it a risk factor for many health concerns, which have recently included poor pregnancy outcomes. Aim: Studying the association between sleep and poor pregnancy outcomes in pregnant women. Methods: To achieve this aim, several studies were done. First, the literature was searched to examine and critically evaluate the quality of current evidence in regards to sleep and pregnancy outcomes. Second, the latent complex nature of sleep was defined using latent class analysis and the UKHLS data set before examining the association between the generated patterns and socio-demographic features and health. Third, sleep events present in the UKHLS sleep module and the generated latent sleep patterns were examined in women from the UK population who were presented in the UKHLS study, and in women at risk of gestational diabetes (GDM) presented in the Scott/Ciantar study, in relation to poor pregnancy outcomes. Results: In the literature there was ‘positive’ evidence of an association between sleep and poor pregnancy outcomes. However, the evidence suffered from limitations, and the complex nature of sleep was not considered. Our definition of sleep as a latent variable revealed six latent sleep patterns which were associated with individual socio-demographic features and health. Sleep events and latent patterns did not always elevate the risk of poor pregnancy outcomes in women from the UK population or women at risk of GDM, as sleep lowered the risk on some occasions. Conclusion: Sleep might increase the risk of poor pregnancy outcomes, according to evidence from the literature review and the two empirical studies. However, the current evidence had many limitations, and further research is required in this area.
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Teixeira, Cláudia Sofia Morais. "Metabolic syndrome in pregnancy as a predictor of adverse obstetric and neonatal outcomes." Master's thesis, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20993.
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Larson, Holly A. "Comparison of Neonatal Outcomes in Maternal Users and Non-Users of Herbal Supplements." The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1211573673.
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Teixeira, Cláudia Sofia Morais. "Metabolic syndrome in pregnancy as a predictor of adverse obstetric and neonatal outcomes." Dissertação, Instituto de Ciências Biomédicas Abel Salazar, 2008. http://hdl.handle.net/10216/20993.
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Isom, Morgan L. "The Impact of Inappropriate Gestational Weight Gain on Pregnancy, Delivery, and Neonatal Outcomes." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/honors/233.
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Inappropriate weight gain during pregnancy is a widespread problem associated with adverse maternal and newborn outcomes. This study’s objective was to examine the impact of gestational weight gain (GWG) above and below the Institute of Medicine (IOM) guidelines on pregnancy, delivery, and newborn outcomes in a rural population. Women were recruited at the first prenatal visit, and data was collected through research interviews and examination of prenatal and delivery medical records. Prepregnancy weight and weight at delivery were obtained, and the final sample (n=913) was restricted to women with singleton pregnancies. Participants were categorized by prepregnancy body mass index (BMI) and GWG above, within, or below IOM guidelines based on gestational length. After controlling for pregnancy smoking, odds ratios (ORs) and 95% confidence intervals (CIs) were calculated to identify significant outcomes associated with high or low weight gain, with normal GWG as the control. Of the 913 participants, 208 (22.8%) had inadequate GWG, 255 (27.9%) gained within the recommended range, and 450 (49.3%) gained more than recommended. Inadequate GWG was associated with delivery before 39 weeks, oxygen administration to the infant, admission to the neonatal intensive care unit (NICU), and a hospital stay longer than seven days. Excess GWG was associated with preeclampsia, pregnancy-induced hypertension (PIH), gestational diabetes mellitus, cesarean delivery, labor longer than 12 hours, macrosomia, and large-for-gestational-age (LGA) infants. GWG outside IOM guidelines was prevalent in the sample and associated with numerous adverse outcomes, suggesting a need for increased awareness and improved management of GWG in this population.
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Bonet, Carné Elisenda. "lnvestigation of quantitative imaging biomarkers for assessing perínatal outcomes." Doctoral thesis, Universitat de Barcelona, 2014. http://hdl.handle.net/10803/290732.
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This Thesis consists of different studies focused in advancing towards the development of noninvasive imaging biomarkers to predict perinatal clinical outcomes. The structure of the PhD Thesis is divided in four projects to explore the development of a series of new methods based on image texture analysis allowing the analysis of medical images (i.e. ultrasound or magnetic resonance imaging) in the field of fetal medicine applications -mainly fetal lung maturity and fetal brain assessment-, to test their reproducibility and to select the best performing approach to develop an imaging biomarker predicting a clinical outcome of interest. The majority of the work was focused on developing a quantitative imaging biomarker for neonatal respiratory morbidity.
In order to achieve the objectives and to explore the development of a quantitative imaging biomarker fetal thorax ultrasound images were used for the studies 1, 2 and 3 to predict neonatal respiratory morbidity. To test the transversality of the quantitative texture analysis in other pathological models, fetal brain magnetic resonance images from Small-for-Gestational Age fetuses were used in study 4.
First study demonstrates that quantitative image features extracted from fetal thorax ultrasound images correlate with gestational age. This study also demonstrated that it is posible to extract information from the tissue in a non-invasive manner that correlated with the underlying physiological process, regular fetal lung maturation. In the second study the correlation between texture analyses and the existing fetal lung maturity test was tested. Thus, the second study provided evidence that the image features from lung ultrasound images correlate with fetal lung maturity test assessed by a standard test as TDx-FLM II. These findings opened the possibility to explore the introduction of non-invasive techniques into clinical practice to test fetal lung maturity. In the third study, the basic principles of a novel method to predict neonatal respiratory morbidity risk (quantusFLM™) were described, and a validation was performed to assess the ability of the method to blindly predict the risk of neonatal respiratory morbidity. Remarkably, this study provides evidence that purposedeveloped software based on quantitative texture analysis of fetal lung ultrasound images predicts neonatal respiratory morbidity with a similar performance to that reported for commercial fetal lung maturity tests in amniotic fluid. Additionally, in the last study the ability of image texture analysis to detect abnormalities in different fetal brain areas was evaluated, and their association with abnormal neonatal neurobehavior was tested. This study demonstrated the potential of quantitative imaging texture analysis for other image acquisition techniques and clinical outcomes.
As a final conclusion, this Thesis provides evidence that the non-invasive quantitative imaging techniques based on texture analysis extract quantitative information related to the underlying tissue that could be used to assist in clinical diagnosis.Esta tesis está compuesta por cuatro estudios para probar el uso de los métodos cuantitativos de análisis de texturas de imágenes para la predicción del riesgo en dos patologías fetales. En la mayor parte de la tesis (tres estudios) se utilizan imágenes de ultrasonido del tórax fetal para predecir la morbilidad respiratoria neonatal. En el primer estudio se relacionan las texturas obtenidas de las imágenes ecográficas del pulmón fetal con la edad gestacional, demostrando que se puede extraer información del tejido de forma no-invasiva que se correlaciona con el proceso fisiológico subyacente, la maduración normal del pulmón fetal. En el segundo estudio se correlacionan las texturas de las imágenes con el resultado del test TDx-FLM II, test que utiliza una muestra de líquido amniótico para predecir la madurez pulmonar feta, demostrando que el análisis de texturas de las imágenes pulmonares fetales contiene información sobre la madurez pulmonar fetal. En el tercer estudio, se desarrolla y evalúa un nuevo método de análisis de imagen del pulmón fetal para la predicción de la morbilidad respiratoria neonatal. Se describen los principios básicos de este nuevo método y se evalúa el funcionamiento del mismo con muestras ciegas. Los resultados obtenidos con el método no invasivo desarrollado para predecir la morbilidad respiratoria neonatal son similares a los reportados por las pruebas actuales, que requieren de líquido amniótico para el análisis y, por tanto, de una muestra obtenida de forma invasiva. Adicionalmente, en el último estudio se ha evaluado la capacidad del análisis cuantitativo de imagen en imágenes de resonancia magnética para detectar anomalías en distintas áreas del cerebro fetal que pueden estar asociadas con un neurocomportamiento neonatal anormal. De esta forma se prueba la transversalidad de las técnicas de análisis de texturas en distintos tipos de imágenes y patologías. Como conclusión final de los cuatro estudios, esta tesis aporta evidencias de que las técnicas no invasivas de análisis de imágenes médicas extraen información cuantitativa del tejido examinado que puede usarse para ayudar en el diagnóstico clínico.
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Cheong-See, Fi. "Predictors for adverse maternal and fetal outcomes in high risk pregnancy." Thesis, Queen Mary, University of London, 2017. http://qmro.qmul.ac.uk/xmlui/handle/123456789/25811.
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This thesis aims to undertake health technology assessments in high risk pregnancies through the following objectives: 1. In women with pre-eclampsia, a) To evaluate the association of maternal genotype and severe pre-eclampsia b) To assess the accuracy of tests in predicting adverse pregnancy outcomes c) To develop composite outcomes for reporting in trials on late onset pre-eclampsia 2. In women with multiple pregnancy, a) To study the association between chorionicity and stillbirth b) To identify the optimal timing of delivery in monochorionic and dichorionic twin pregnancies 3. In the field of prediction research in obstetrics a) To provide an overview of the existing prognostic models and their qualities b) To evaluate the methodological challenges and potential solutions in developing a prognostic model for complications in pre-eclampsia Methods The following research methodologies were used: Delphi survey, systematic reviews and meta-analyses. Results 1. a) Maternal genotype and severe pre-eclampsia: 57 studies evaluated 50 genotypes; increased risk of severe pre-eclampsia with thromobophilic genes. b) Accuracy of tests in predicting pre-eclampsia complications: 37 studies evaluated 13 tests. No single test showed high sensitivity and specificity. c) Delphi survey of 18/20 obstetricians and 18/24 neonatologists identified clinically important maternal and neonatal outcomes and maternal and neonatal composite outcomes were developed. 2. Prospective risk of stillbirth and neonatal deaths in uncomplicated monochorionic and dichorionic twin pregnancies: 32 studies were included. In dichorionic twin pregnancies, the risk of stillbirths was balanced against neonatal death at 37 weeks' gestation. In monochorionic pregnancies, there was a trend towards increase in stillbirths after 36 weeks but this was not significant. 3. a) From 177 studies included, 263 obstetric prediction models were developed for 40 different outcomes, most commonly pre-eclampsia, preterm delivery, mode of delivery and small for gestational age neonates. b) The obstetric prognostic model challenge of dealing with treatment paradox was explored and seven potential solutions proposed by expert consensus. Conclusion I have identified the strength of association for genes associated with complications in pre-eclampsia, components for composite outcomes for reporting in studies on pre-eclampsia, and the optimal timing of delivery for twin pregnancies. My work has highlighted the gaps in prediction research in obstetrics and the limitations of individual tests in pre-eclampsia.
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Reavey, Daphne Ann Ward-Smith Peggy. "Repetitive neonatal pain and neurodevelopmental outcomes at two years of age a correlational study /." Diss., UMK access, 2008.
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Thesis (Ph. D.)--School of Nursing. University of Missouri--Kansas City, 2008."A dissertation in nursing." Advisor: Peggy Ward-Smith. Typescript. Vita. Title from "catalog record" of the print edition Description based on contents viewed Sept. 12, 2008. Includes bibliographical references (leaves 84-96). Online version of the print edition.
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Leelodharry, Vakil Kumar. "Maternal and neonatal outcomes in late preterm prelabour rupture of membranes: a retrospective study." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29333.
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Background: The management of late preterm prelabour rupture of membranes (PPROM) is associated with an increased risk of neonatal prematurity related morbidity due to many obstetric care guidelines which favour delivery at 34 weeks or immediately upon diagnosis of ruptured membranes after 34 weeks gestation. However, expectant management of this group of patients (i.e delayed delivery) between 34+0 and 36+6 weeks of gestation is associated with an increased risk of neonatal and maternal infectious morbidities.
Aim of Study: The aim of this study was to evaluate the impact of the latency period on maternal and neonatal outcomes in late preterm prelabour rupture of membranes in a regional perinatal service in Cape Town, South Africa. The latency period was defined as the time from rupture of membranes to the time of delivery. In addition, we sought to investigate whether immediate induction of labour in the absence of overt signs of infection or fetal compromise should be prioritised in women who present with late preterm prelabour rupture of membranes.
Methods: This was a retrospective cohort study carried out over a period of two years in two secondary level hospitals of the Metro West area of Cape Town. The subjects were low risk HIV negative women with singleton pregnancies with ruptured membranes in the late preterm period. Maternal and neonatal outcomes were studied between two latency periods, namely short latency (< 48 hours) and long latency period (≥ 48 hours) after ruptured membranes.
Results and Conclusion: There were no significant differences in maternal and neonatal outcomes between the two groups of latency periods when latency was defined as the time from ruptured membranes to delivery. The study favoured a delayed induction thereby improving neonatal outcomes by decreasing the complications of prematurity. There were more adverse maternal outcomes, including an increase likelihood of augmentation of labour and more operative delivery along with its major risk, that of obstetric haemorrhage, were noted in the short latency period group. Therefore, a delayed induction policy appeared to be more appropriate. Preterm delivery places the newborn at risk of prematurity. Therefore, the risk of prematurity must be balanced with the risks of intrauterine infection and antepartum haemorrhage, the two major complications of expectant management if delayed induction is to be adopted. Proper monitoring of both the pregnant woman and fetus is essential when expectant management is carried out to avoid these adverse maternal and neonatal outcomes.
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Proctor-Williams, Kerry, and Brenda Louw. "Infants and Children Prenatally Exposed to Drugs: Neonatal Abstinence Syndrome (NAS) and Neurodevelopmental Outcomes." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/1814.
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McGowan, Jennifer Edna. "Neonatal outcomes and early childhood development of late preterm infants (born at 34-36 weeks gestation) following neonatal intensive care in Northern Ireland." Thesis, Queen's University Belfast, 2012. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.579735.
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Late preterm infants (born at 34-36 weeks gestation) have increasingly been regarded as 'at risk' rather than 'Iow risk' infants. The impact of neonatal morbidity and admission for neonatal care, on the longer term outcomes of LPls has not been fully explored. This thesis has sought to bridge an identified gap in the literature relating to this significant group of neonatal care graduates. The overall aim of this thesis was to consider the significant population of LPls who require admission for neonatal care. Firstly, maternal and perinatal risk factors and neonatal outcomes were considered through a descriptive analysis of neonatal data from the Neonatal Intensive Care Outcomes Research and Evaluation (NICORE) database. The second component of the thesis then considered specifically the early childhood development (cognition, language, motor development, physical health and growth) at three years of age of LPls who required neonatal Intensive Care (lC) compared with infants of the same gestational age who did not require Intensive Care. LPls who required neonatal care were identified as a unique group, with distinct characteristics and outcomes in the neonatal period when compared to other admitted infants. LPls requiring Intensive Care (IC) had increased maternal and perinatal risk factors and increased adverse neonatal outcomes compared to LPls who required Special Care Only (SCO). Findings from the follow-up study revealed that despite increased maternal and perinatal risk factors and neonatal morbidity, LPls who required admission to IC had similar cognitive, language and motor abilities and growth, compared with their peers, who were not admitted for le. However, LPls who required IC had increased health service usage compared to the non-IC infants. Having considered, for the first time, the neonatal outcomes and early childhood development of LPls on the basis of their requirement for neonatal Intensive Care, this thesis has provided a novel insight into the outcomes of this under-researched group of children.
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Mosquera, Paola Soledad. "Prevalência e fatores associados ao aleitamento materno exclusivo no primeiro mês de vida em Cruzeiro do Sul, Acre." Universidade de São Paulo, 2018. http://www.teses.usp.br/teses/disponiveis/6/6143/tde-12042018-124737/.
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Introdução - As práticas de alimentação no início da vida podem afetar diretamente o estado nutricional, crescimento, desenvolvimento e a sobrevivência infantil. Entre os indicadores de saúde infantil propostos pela Organização Mundial da Saúde, a prevalência do aleitamento materno exclusivo até 6 meses de idade (AME: quando a criança recebe somente leite materno direto da mama, ordenhado, ou de ama de leite, sem outros líquidos ou sólidos, com exceção de gotas ou xaropes contendo vitaminas, sais de reidratação oral, suplementos minerais ou medicamentos, podendo ser desagregado nos grupos etários 0-1, 2-3, 4-5 e 0-3 meses) é fundamental para o monitoramento das ações para promoção, proteção e apoio à amamentação. Objetivos - Investigar a prevalência e os fatores associados à prática de AME aos 30 dias de vida em Cruzeiro do Sul, Acre. Métodos - Análise de dados do estudo de coorte de nascimentos MINA-Brasil: Materno-INfantil no Acre. Entre julho de 2015 e junho de 2016, mães internadas para parto no Hospital Estadual da Mulher e da Criança do Juruá do município de Cruzeiro do Sul, Acre, foram entrevistadas sobre dados socioeconômicos, demográficos e história de saúde após aceite à participação no estudo. Para a presente análise, o desfecho de interesse -aleitamento materno exclusivo aos 30 dias de vida?, foi obtido 30 a 45 dias após o parto por meio de entrevista telefônica e classificado segundo critério da OMS (2010). Medidas de tendência central e dispersão, frequências absolutas e relativas, intervalos de confiança de 95% (IC95%) e teste de homogeneidade χ2 foram calculados segundo prática do AME. A análise de sobrevida por meio do estimador Kaplan-Meier foi utilizada para estimar a probabilidade e o efeito de fatores associados à prática do aleitamento materno exclusivo aos 30 dias de vida. O efeito dos preditores sobre a duração do AME no primeiro mês foi investigado em modelos múltiplos de regressão tempo de vida acelerado. A análise estatística foi realizada com auxílio do pacote estatístico Stata 14.0 ou superior, ao nível de significância de p<0,05. Resultados - No total, 962 mães responderam a entrevista telefônica de acompanhamento no puerpério. A prevalência de AME aos 30 dias de vida foi 36,7% e o tempo mediano para os que interromperam o AME nesse intervalo foi 16 dias. Quando consideradas todas as crianças nascidas no período e elegíveis ao seguimento, a probabilidade de AME aos 30 dias foi 43,7% e a mediana de AME foi 30 dias. Os fatores associados à duração do AME no período estudado foram: número de filhos vivos, uso de chupeta e história de chiado no peito. Observou-se que a duração do AME (time ratio - TR) foi 28% mais prolongada entre os bebês que tinham irmãos (1,28; IC95% 1,11-1,48). O uso de chupeta e história de chiado no peito foram associados à redução no tempo de AME em 33% (0,67; IC95% 0,58-0,78) e 20% (0,80; IC95% 0,69-0,93), respectivamente. Conclusões - A prática de aleitamento materno exclusivo aos 30 dias de vida em Cruzeiro do Sul, Acre, foi aquém das recomendações nacionais e internacionais. Mães primíparas interromperam o AME mais precocemente durante o primeiro mês quando comparadas às mães com mais de um filho; bebês que usaram chupeta ou apresentaram história de chiado no peito apresentaram menor duração do AME no primeiro mês de vida. Dada a importância do AME para a saúde materno-infantil e para a duração total do AM, os resultados deste estudo evidenciam a necessidade de ações intensivas para promoção, apoio e proteção da amamentação antes do primeiro mês de vida nesta população.Introduction - Early life feeding practices can directly affect nutritional status, growth, development, and child survival. Among the indicators of child health proposed by the World Health Organization, the prevalence of exclusive breastfeeding up to 6 months of age (EBF: when the baby receives only breastmilk, including milk expressed or from a wet nurse, without other liquids or solids, except for drops or syrups containing vitamins, oral rehydration salts, mineral supplements or medicines, which can be disaggregated in the age groups 0-1, 2-3, 4-5 and 0-3 months) is essential for monitoring actions to promote, protect and support breastfeeding. Objectives - To investigate the prevalence and factors associated with exclusive breastfeeding at 30 days of life in Cruzeiro do Sul, Acre. Methods - Data analysis of the MINA-Brazil birth cohort study in Cruzeiro do Sul, Acre state, Western Brazilian Amazon. Mothers of babies born from July 1, 2015 to June 30, 2016 at the only maternity hospital in the region were enrolled in this study after signing a free, informed consent form. Women were interviewed soon after giving birth and by telephone at 30-45 days postpartum. Socioeconomic, demographic, obstetric, infant feeding practices, child health and lifestyle data were collected. The outcome of interest was exclusive breastfeeding at 30 days of life, classified according to WHO guidelines (2010). Descriptive statistical data, 95% confidence intervals (95%CI) and chi-square tests were calculated. Kaplan-Meier survival analysis was performed to estimate the median duration and the probability of EBF at the end of the first month of life. In order to explore factors associated with time to EBF cessation, accelerated failure-time (AFT) models were run, following a conceptual framework hierarchical model for determinants of EBF. All analyses were done in Stata 14.0, at p<0.05. Results - During the follow-up period, 962 mothers answered the postpartum telephone interview. The prevalence of EBF at 30 days of life was 36.7% and the median duration was 16 days. Considering all children born in the study period and eligible for follow-up, the probability of EBF in the first month of life was 43.7% and the median duration was 30 days. Factors associated with time to EBF cessation were: having one or more children, pacifier use and history of wheezing. It was observed that duration of EBF (time-ratio - TR) was 28% longer among infants who had siblings (1.28; 95% CI, 1.11-1.48). Use of a pacifier and history of wheezing were associated with reduced EBF duration by 33% (0.67, 95% CI 0.58-0.78) and 20% (0.80, 95% CI 0.69-0.93), respectively. Conclusions - The exclusive breastfeeding practice at 30 days of life in Cruzeiro do Sul was considerably below nacional and international recommendations. Primiparous mothers stopped EBF earlier in the first month when compared to mothers with more than one child; infants who used pacifiers or had history of wheezing presented higher risk of not being exclusively breastfed in the first month of life. Given the importance of EBF for maternal and child health and for total duration of breastfeeding, the results of this study may provide a basis for intensive actions to promote, support and protect breastfeeding before the first month of life in this population.
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Lipsky, Sherry. "The relationship of police-reported intimate partner violence during pregnancy and maternal and neonatal health outcomes /." Thesis, Connect to this title online; UW restricted, 2002. http://hdl.handle.net/1773/10915.
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Lindeque, L. X. "Breech deliveries in Tygerberg Academic Hospital : maternal and neonatal outcomes of vaginal and abdominal deliveries - a case-controlled study." Thesis, Stellenbosch : Stellenbosch University, 2011. http://hdl.handle.net/10019.1/18074.
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Thesis (MMed)--Stellenbosch University, 2011.ENGLISH ABSTRACT: The Objective: To review the difference in short term neonatal and maternal outcomes among singleton infants with breech presentation delivered by vaginal or elective caesarean section route at term, at Tygerberg Academic Hospital (TBH) in Cape Town. The study design was a retrospective case control study. Method: Part I A total of 120 patients were selected. 60 vaginal breech deliveries and 60 elective caesarean sections for breech presentation (comprising the control group). 60 cases of vaginal deliveries were collected and 60 control cases of planned elective caesarean sections, where the indication for CS was breech presentation, were collected in the same manner. Part II Nineteen registrars completed a questionnaire regarding their subjective experiences of vaginal breech deliveries at Tygerberg Academic Hospital. Results: Part I An analysis of the results found statistically significant differences in maternal ages between the two groups, with younger women delivering by CS; gravidity and parity was lower in the CS group; blood loss was observed to be higher in the CS group with more women requiring a blood transfusion when compared to vaginal delivery; there were more neonatal admissions in the vaginal delivery group as well as more birth trauma, neonatal seizures and death in this group; Apgar scores were higher in the CS group and finally, neonates born by CS were more commonly discharged at the same time as their mothers in the CS group. Part II When analyzing the registrar questionnaire it can be noted that although clinicians are performing an adequate number of breech vaginal deliveries, with an average of 10 deliveries per year, the skills training for clinicians is invaluable. Not all registrars learned skills from a senior clinician and skills training in skills labs are essential for initial and even continual training of these clinicians. It is suggested that these skills training programs be made compulsory for all registrars and that a biyearly attendance and completing of such a course be mandatory for those wishing to work in the labour ward. Conclusions: Although not statistically significant, there was more morbidity and mortality associated with vaginal breech delivery.
AFRIKAANSE OPSOMMING: Doel: Om die korttermyn neonatale en moederlike uitkomste van enkeling swangerskappe met stuitligging wat vaginaal of met elektiewe keisersnee verlos is by die Tygerberg Akademiese Hospitaal in Kaapstad, te bepaal. Die werkstuk is ‘n retrospektiewe gekontroleerde-gevallestudie. Metode: Deel 1 ‘n Totaal van 120 pasiënte is gekies. 60 gevalle van vaginale stuitverlossings en 60 kontrolegevalle van beplande elektiewe keisersnitte waar die indikasie stuitligging was. Deel 2 Negentien kliniese assistente het die vraelys oor hul persoonlike ervaring van vaginale stuitverlossing by die Tygerberg Akademiese Hospitaal ingevul. Resultate: Deel 1 ‘n Ontleding van die resultate wys statisties betekenisvolle verskille in die moederouderdom van die twee groepe, met meer jong vroue wat met keisernit geboorte gee. Graviditiet en pariteit was laer in die keisersnit-groep. Bloedverlies was hoër in die keisersnit-groep en in vergelyking met die vaginale verlossings met meer vroue wat bloedoortapping benodig. In die vaginale verlossingsgroep was meer neonatale toelatings nodig asook meer geboortetrauma, neonatale konvulsies en sterftes. Apgar-tellings was hoër in die keisersnitgroep en neonate wat met ‘n keisersnitte gebore is, is meer dikwels saam met hul moeders ontslaan. Deel II Ontleding van die vraelys vir kliniese assistente wys dat hoewel klinici ‘n genoegsame getal van gemiddeld 10 vaginale stuitverlossings per jaar uitvoer, vaardigheidsopleiding vir klinici van onskatbare waarde sal wees. Nie alle kliniese assistente leer vaardighede by senior klinici nie en opleiding in ‘n vaardigheidslaboratorium is noodsaaklik vir die aanvanklike en selfs voortdurende opleiding van dié kliniese assistente. Dit word voorgestel dat hierdie vaardigheidkursusse verpligtend gemaak word vir alle kliniese asssistente en bywoning en voltooiing van die kursus twee maal per jaar verpligtend moet wees vir diegene wat in ‘n kraamsaal wil werk. Gevolgtrekking: Vaginale stuitverlossings, hoewel nie stastisties betekenisvol nie, het met meer morbiditeit en sterftes gepaardgegaan.
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Keough, T. Montgomery. "Adverse effects of second hand smoke exposure in non-smoking women: maternal and neonatal outcomes /." Internet access available to MUN users only. Search for this title in:, 2009.
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Proctor-Williams, Kerry. "Neurodevelopmental Outcomes for Infants with Neonatal Abstinence Syndrome: Implications for Speech-Language Pathologists and Audiologists." Digital Commons @ East Tennessee State University, 2013. https://dc.etsu.edu/etsu-works/1837.
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Gibbs, Lyndal. "Short-term outcomes of inborn vs out-born very low birth weight neonates (< 1500 g) in the Groote Schuur neonatal nursery." Master's thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/27943.
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Background and aim: The Groote Schuur Hospital (GSH) Neonatal Nursery provides Level 3 care for the Metro West Health District in the Western Cape. Worldwide, VLBW neonates have improved outcomes when delivered in Level 3 neonatal units, compared with those who are transported from other facilities. This study aims to identify the characteristics and clinical outcomes of our VLBW patients, with emphasis on differences between inborns and outborns. Methodology: A retrospective cohort study. VLBW neonates admitted to the GSH Neonatal Nursery between 1 January 2012 and 31 December 2013 were enrolled on the Vermont Oxford Network database and reviewed. Maternal and infant characteristics, and outcomes at the time of discharge from hospital were analysed. Results: A total of 1032 VLBW neonates were enrolled. 906 (87.8%) were delivered at GSH, and 126 (12.2%) were outborn. Access to antenatal care, antenatal steroids and inborn status were statistically significant predictors for mortality and survival without morbidity. The mothers of inborn patients were more likely to have received antenatal care (89.1% vs 57.9%, p <0.0001) and antenatal steroids (64.2% vs 15.2%, p <0.0001). Inborns required less ventilatory support (16.2% vs 57.9%, p <0.0001) and surfactant administration (25.3% vs 65.1%, p <0.0001). Inborns had a lower incidence of late infection (8.8% vs 23.4%, p <0.0001), severe intraventricular haemorrhage (3.7% vs 13.9%, p <0.0001) and chronic lung disease (5.3% vs 13.4%, p =0.003). The incidence of necrotising enterocolitis was similar between the two groups (5.9% vs 8.7%, p =0.227). 18.4% of inborns and 33.3% of outborns demised (p <0.0001), mostly on the first 2 days of admission. Mortality declined as birth weight increased. Of the survivors, 83.5% of inborns and 70.2% of outborns did not develop serious morbidity (p =0.003). Significant morbidity and mortality was noted in the outborn group weighing 800g and less, with only one outborn patient in the cohort surviving to discharge without major morbidity. Conclusion: VLBW neonates delivered at Groote Schuur Hospital had better outcomes than their outborn counterparts. Perinatal regionalisation is beneficial to our patients, with antenatal care, timeous in-utero transfer and antenatal steroids contributing to excellent outcomes.
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Allie, Nazneen. "Abdominal surgery in very low birth weight neonates in a developing world neonatal unit- Short term outcomes and risk factors for mortality." Master's thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33439.
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Background The surgical infant requires care in specialized neonatal units. Very low birth weight (VLBW) infants are a group particularly vulnerable to the risks and outcomes associated with preterm birth. There is an increased number of abdominal emergencies seen, attributed to improved survival in this birthweight category. Objectives To describe the short-term survival to discharge in VLBW infants following abdominal surgery at a South African public tertiary hospital and to examine the utility of common scoring systems for prognostication. Methods A retrospective study of VLBW infants with abdominal surgery was conducted in patients admitted to the neonatal unit at Groote Schuur Hospital between 2012 and 2016. CRIB and SNAPPE scores were calculated for patients where sufficient data was available. Results Fifty-two patients were included. The mean gestational age (GA) and birthweight (BW) were 29.5 weeks (SD 2.1) and 1102g (SD 197.8) respectively. Necrotizing enterocolitis was the most common (50%) surgical emergency. The leading postoperative complication was sepsis (37%). Fourty-two (81%) infants survived to discharge, the mean age at presentation 21 days (SD 21.1) with a mean hospital stay of 74 days in survivors vs 52 days in the non-survivors (p=0.06). There was no statistically significant difference in SNAPPE scores between survivors and non-survivors. Conclusion Abdominal emergencies have a high mortality and adds to the overall length of stay in VLBW infants. Neonatal scoring systems have proven to be useful adjuncts in predicting neonatal mortality, further study is warranted in infants who deteriorate due to surgical abdominal complications.
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Turner, Emmitt, Darshan Shah, Kathryn L. Duvall, David L. Wood, and Beth Bailey. "Perinatal Outcomes of Marijuana use on Opioid Exposed Pregnancy." Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/46.
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The prevalence of opioid use has increased in many populations including pregnant women, which has led to a substantial rise in infants born dependent on opioids due to in utero exposure. Many women use multiple substances aside from opioids during pregnancy, and their infants therefore present with a variety of symptoms. With increasing legalization and changing perception of marijuana, it has become one of the most commonly used substances during pregnancy. Few studies have evaluated concomitant use of marijuana and opioids in pregnancy despite both being implicated in adverse newborn outcomes. The primary aim of this study was to determine the association between marijuana use and pregnancy outcomes in opioid-exposed pregnancies. The secondary aim was to identify, in a sample of women already using opioids, maternal characteristics associated with marijuana use during pregnancy. A retrospective chart review was conducted from July 2011 to June 2016 of all births from 6 delivery hospitals in South-Central Appalachia to determine pregnancy and neonatal outcomes of pregnancies exposed to any form of opioid and positive urine drug screen for marijuana at the time of delivery. 2375 pregnancies met the inclusion criteria with 108 pregnancies positive for marijuana. Student t-test and Chi-Square test were used for group comparison for presence and absence of marijuana. Logistic regression was done for significant confounding variables to find aOR for marijuana exposure for neonatal abstinence syndrome diagnosis, premature birth, and low birth weight. Among opioid using women, marijuana positive women were more likely to be unmarried, nulliparous, and use tobacco and benzodiazepines. Infants born to the marijuana users were likely to be of earlier gestational age (3 days), lower birth weight, and preterm; with preterm birth and low birth weight (mean difference = 265 gms) increased two fold even after controlling for parity, marital status, tobacco and benzodiazepine use with aOR of 2.35 (1.30-4.23) and 2.02 (1.18-3.47) respectively. Ultimately, prenatal use of marijuana in opioid-exposed pregnancies carries significant risk of prematurity and low birth weight. For pregnant women continuing their American College of Obstetricians and Gynecologists recommended medical assisted treatment for opioid use disorder, providers should counsel women to abstain from marijuana during pregnancy.
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Nisha, Monjura Khatun. "Modifiable Risk Factors Associated with Adverse Perinatal Outcomes in Bangladesh." Thesis, The University of Sydney, 2019. https://hdl.handle.net/2123/21669.
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Background Globally, perinatal mortality accounts for approximately five million deaths (2.6 million stillbirths and 2 million early neonatal deaths) every year. Further, low birthweight which is a major adverse perinatal outcome constitutes more than 20 million births every year. Approximately 97%-99% of these adverse perinatal outcomes occur in low- and middle-income countries including Bangladesh. In Bangladesh, the burden of perinatal mortality remains high at 44 deaths per 1,000 pregnancies and low birthweight accounts for approximately 36% of births every year, yet many modifiable factors associated with these adverse perinatal outcomes remain under-investigated in the country. Aim and objectives The primary aim of this thesis was to gain a deeper understanding of modifiable risk factors contributing to adverse perinatal outcomes in Bangladesh. The specific objectives included investigating the association between polluting cooking fuels and perinatal mortality (stillbirth and early neonatal mortality) in Bangladesh; examining the effect of short and long birth intervals on adverse perinatal outcomes (first-day neonatal mortality, early neonatal mortality and small birth size) in Bangladesh; exploring community perceptions on birthweight and care practices for low birthweight infants in Bangladesh; and identifying modifiable socio-cultural factors influencing women’s early and adequate utilisation of antenatal care in rural Bangladesh. Methods In this thesis, both quantitative and qualitative methods were used. For the quantitative analyses (studies I and II), data were derived from the Bangladesh Demographic and Health Surveys (BDHS) from the years 1996-1997, 1999-2000, 2004, 2007, 2011 and 2014. Bivariate and multivariable analyses were conducted to obtain the crude and adjusted odds ratio (aOR) respectively. Wald test was used to assess statistical significance with a 95% confidence interval (CI). The ‘svy’ command was used in all the analyses to calculate the weighted values in order to adjust for the clustering effect and sample stratification. Data for the qualitative analyses (studies III and IV) were derived from the results of in-depth interviews, key-informant interviews and focus group discussions conducted in two rural settings of Bangladesh. In total, 32 in-depth interviews were conducted with 11 pregnant women, 12 recently delivered women, four husbands whose wives were pregnant or had a recent birth, and five mothers-in-law whose daughters-in-law were pregnant or had a recent birth. Two focus group discussions were conducted with husbands with eight participants in each and four key-informant interviews were conducted with community health workers. Thematic analysis was used to analyse the data. Results Study I included in this thesis examined the association between polluting cooking fuels (kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crop and animal dung) and perinatal mortality (stillbirth and early neonatal mortality) using BDHS data from the years 2004, 2007, 2011, and 2014. In the multivariable analysis, maternal exposure to polluting fuels compared with exposure to clean fuels (electricity, liquefied petroleum gas, natural gas, and biogas) was associated with early neonatal mortality (aOR: 1.46, 95% CI: 1.01, 2.10); however, no association was found for stillbirth (aOR: 1.25, 95% CI: 0.85, 1.84). While examining the impact of each type of polluting fuels on perinatal mortality, the association with perinatal mortality varied by types of polluting fuels. Maternal exposure to agricultural crop waste as the main fuel was associated with increased odds of both stillbirth (aOR: 1.76, 95% CI: 1.10, 2.80), and early neonatal mortality (aOR: 1.78, 95% CI: 1.13, 2.80). Maternal exposure to wood as the main fuel posed greater odds for early neonatal mortality (aOR: 1.52, 95% CI: 1.04, 2.21). Using polluting cooking fuels in an indoor kitchen was associated with four times higher odds of stillbirth (aOR: 4.12, 95% CI: 1.49, 11.41). Study II of this thesis was an investigation of the effect of short (<36 months) and long (≥60 months) birth intervals on adverse perinatal outcomes including first-day neonatal death, early neonatal death and small birth size using BDHS data from the years 1996-1997, 1999-2000, 2004, 2007, 2011 and 2014. In the multivariable analysis, infants with a birth interval of <36 months had increased odds of first-day neonatal mortality (aOR: 2.11, 95% CI: 1.17, 3.78) and early neonatal mortality (aOR: 1.58, 95% CI: 1.13, 2.22) compared with births spaced 36-59 months. A birth interval of ≥60 months was associated with increased odds of first-day neonatal mortality (aOR: 2.02, 95% CI: 1.10, 3.73) and small birth size (aOR: 1.17, 95% CI: 1.02, 1.34) compared with births spaced 36-59 months. In this study, maternal perception of an infant’s size at birth was very “small” or “smaller than average”, was used as a proxy for “low birthweight” due to the lack of birthweight estimates in Bangladesh. Using a qualitative design, study III aimed to gain an insight into the families’ perceptions on birthweight, including local meaning, terminology and causes of different categories of birthweight and families’ preventive and care practices for a low birthweight infant in the rural community of Bangladesh. Birthweight was not well-recognised and often excluded from the assessment criteria of a newborn’s health status in rural Bangladesh. Low birthweight was not considered as a criterion of an infant’s illness unless the infant appeared unwell. A common belief that giving birth to a small infant could avoid pregnancy complications and caesarean section, predominantly restricted women’s adoption of preventive practices of low birthweight, such as, pregnant women’s adequate and nutritious food consumption. Common practices to treat a low birthweight infant who appeared ill included breastfeeding, feeding animal milk, feeding sugary water, feeding formula, oil massage, and seeking care from formal and informal care providers including a spiritual leader. Care-seeking for a low birthweight infant was often delayed in the rural community due to financial constraints, home birth and several socio-cultural factors including maternal lack of decision-making autonomy and superstition. The contribution of the socio-cultural factors to the delays occurring in antenatal care utilisation in rural Bangladesh was a key focus in study IV. There were various socio-cultural factors in the rural community that influenced women’s early initiation of antenatal care, which subsequently hindered women’s adequate utilisation of antenatal care. Women’s lack of awareness on the appropriate timing of the first antenatal care contact, lack of decision-making autonomy and fear of medical interventions were the major barriers to early and continued antenatal care utilisation. There were many superstitions around pregnancy in the rural setting which prevented women seeking early and adequate antenatal care and led them to seek care from unskilled traditional care providers whose treatments were associated with several harmful practices. Conclusion The findings of this thesis highlight the importance of various factors associated with adverse perinatal outcomes which are modifiable within the context of existing programs in Bangladesh and potentially in other low- and middle-income countries. This thesis sheds light on the deleterious effect of polluting cooking fuels on the perinatal outcomes which could be modified with clean cooking interventions. Birth intervals shorter than 36 months and longer than 59 months are found to be associated with a range of adverse perinatal outcomes. Promoting an optimal birth interval of 36-59 months through postpartum family planning may reduce adverse perinatal outcomes. In rural Bangladesh, a lack of awareness of birthweight persists, which along with socio-cultural factors constrain preventive and care-seeking practices for a low birthweight infant. There are also various socio-cultural barriers contributing to the delayed and inadequate antenatal care utilisation of rural women in Bangladesh. Targeting these socio-cultural barriers with context- and community-specific interventions could prevent delays at the community level which would lead to significant improvements in perinatal outcomes.
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Barsman, Sarah Gutin. "Decision-Making for High-Risk Infants in the Neonatal Intensive Care Unit (NICU): Mothers' Attitudes and Experiences." Case Western Reserve University School of Graduate Studies / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=case1564484781963305.
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Sprague, Annie G., and res cand@acu edu au. "An Investigation into the Use of Water Immersion upon the Outcomes and Experience of Giving Birth." Australian Catholic University. School of Nursing, 2004. http://dlibrary.acu.edu.au/digitaltheses/public/adt-acuvp56.29082005.
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The use of deep-water immersion during labour and birth is commonplace in many countries including Australia, yet there has been little contemporary Australian data from which to form policies regarding its use during childbirth, or which have included women’s experiences using water immersion. The literature reviewed for this study was positive with regard to the effect of water immersion during childbirth and was associated with decreased rates of perineal trauma, low episiotomy rates, low rates of analgesic use, lower operative deliveries coupled with increased maternal satisfaction of the experience of childbirth when compared with births where water immersion was not involved. The purpose of this research was to investigate the influence of deep-water immersion upon maternal and neonatal outcomes and women's experiences of giving birth in Australia. This study used a mixed method in an attempt to fulfil this purpose: the first phase was a Quasi-experimental design and the second phase was based upon a Hermeneutic Phenomenological approach. Data were collected via a Random Chart Audit, from a random sample of fifty nulliparous women who used deepwater immersion during labour and childbirth and six women were selected to participate in a semi-structured interview. Data from each phase of this study revealed positive birth outcomes and these findings were supported by the literature. The women's stories were positive and comprised elements of four lifeworld themes. • Water’s Embrace • Warped Time • Naked but Clothed • The Shape of Water. Each of these themes encapsulated different aspects of the women's experiences, which when considered together, increased the understanding of the phenomenon of deep-water immersion upon the experience of giving birth.
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Martino, Jole. "Metabolic alterations induced by high maternal BMI and gestational diabetes in maternal, placental and neonatal outcomes." Thesis, University of Nottingham, 2013. http://eprints.nottingham.ac.uk/13714/.
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Maternal obesity and diabetes increase the risk of delivering large for gestational age infants (LGA), who have higher risk of long term obesity or metabolic syndrome [1]. As the underpinning mechanisms of how fetal growth is regulated by the placenta remain unclear [2], this thesis has investigated placental responses to high maternal BMI and gestational diabetes. Spanish pregnant women recruited at 20 gestational weeks were classified according to pre-pregnancy BMI as control (BMI<25kg/m2; n=59), overweight (BMI=25-30kg/m2; n=29) or obese (BMI>30kg/m2; n=22), and gestational diabetes status (GDM) classified at 28 weeks. Maternal anthropometry and gestational weight gain (GWG) were measured during pregnancy. Placenta, cord blood, newborn antrophometry and infant weight were sampled or measured. Expression of genes involved in placental energy sensing pathways, folate transporters and DNA methylation was determined using real-time PCR, and placental triglyceride concentrations, lipid peroxidation and genomic DNA methylation patterns measured. Data were analysed according to their parametric distribution by Kruskal-Wallis or 1-way ANOVA. Despite lower GWG, a greater proportion of obese women exceeded recommended weight gain [3], had higher placental weight and increased numbers of LGA infants. Maternal hyperinsulinaemia and hyperglycaemia with obesity were accompanied by unchanged placental IGFR1 and ISR1 expression, similar cord blood glucose and triglyceride concentrations. Placental mTOR was halved with obesity, whilst SIRT1 and UCP2 gene expression were 1.8 and 1.6 fold upregulated respectively with no differences in TBARS concentrations. Hyperleptinaemia in obese women resulted in unchanged placental leptin and leptin receptor expression, but higher cord blood leptin and monocyte concentrations with placental hypermethylation of genes involved in the immune response. Lower folate concentrations in obese mothers led to similar cord blood folate, and decreased placental FRα, but raised DNMT1, mRNA expression. No major differences were observed with GDM, probably due to small sample size. In conclusion, it appears that the placenta can protect the fetus of obese women by increasing antioxidant capacity, compensating for maternal hyperglycaemia and lower folate. However, maternal obesity was associated with enhanced cord blood leptin and monocyte concentrations, increased placental weight and more LGA delivery, leaving infants at ongoing risk of increased adiposity and inflammation. Therefore, current studies are currently exploring these interacting aspects.
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Jessop, Flora. "Correlation of macroscopic and microscopic placental lesions with obstetric and neonatal outcomes in an unselected population." Thesis, University of East Anglia, 2012. https://ueaeprints.uea.ac.uk/46544/.
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Many abnormalities of the placenta are reported to be significant in the setting of maternal health problems and adverse fetal/neonatal outcomes. In specific clinicopathological circumstances - eg vascular lesions in the growth restricted fetus – correlation does exist between the placental lesion and the clinical event. Relationships between “lower grade” placental lesions and clinical outcomes are less clear. Reports of associations between selected abnormalities and clinical outcomes are largely based on retrospective case control studies: the clinical groups studied tend to be high-risk. Understanding of the significance of these lesions in the wider population is lacking. This study reports on the clinical events and placental lesions documented in 1119 unselected women delivering at the conclusion of a singleton pregnancy in a single obstetric centre. Study methodology was such that the cohort comprised low-risk mothers delivering at or close to term. The incidence of potentially adverse obstetric and neonatal events in the study population was low. 97% delivered at term. Mean birth weight was 3485 g; mean Apgar scores were 9 at 1 minute and 10 at 5 minutes. 5.9% of infants required admission to neonatal intensive care. When classified in accordance with current standard reporting guidelines, 71% of placentas were classified as normal. Inclusion of lower grade histological lesions in the reporting schedule reduced the percentage of histologically normal placentas to 58%. Funisitis was found to be significantly correlated with adverse neonatal outcome. A number of other placental lesions - including cord coiling <10th and >90th centiles, placental infarction, villitis of unknown etiology and lower grades of acute placental inflammation - were not found to be associated with adverse obstetric or neonatal events. It is concluded that a number of placental lesions may not be relevant to adverse pregnancy outcomes in a low-risk population.
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Long, Anna-May. "Short and long-term outcomes of children born with abdominal wall defects." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:8f57a562-ca60-48b1-ba4f-356e65ee5bed.
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Background: Very occasionally, when a fetus is developing in the womb, problems occur with the normal processes controlling closure of the muscles of the abdominal wall and, as a result, some of the abdominal contents develop outside of the body. This is known as an abdominal wall defect. If the pregnancy continues to term, the newborn infant will need specialised surgical care. This situation occurs so infrequently that even a dedicated surgical centre will care for very few of these women and their babies in a year. Many centres have shared their experiences of managing these babies in the published literature but the majority of reports have included only a few infants. The focus of most previous studies has been to describe what happens to these newborn infants between birth and first discharge from hospital from a purely clinical perspective. Aim: To explore methodologies to holistically understand the short and longer-term outcomes of children born with abdominal wall defects and to use the information to improve the care of future affected infants. Methods: The quality of the published literature on short-term outcomes of children born with gastroschisis was scrutinised in a systematic review. The accompanying meta-analysis used published data as a means of identifying population outcome estimates. Two national population-based cohort studies were undertaken, exploring the short-term outcomes of children born with exomphalos and the outcomes at seven to ten years of children born with gastroschisis. The latter study included an assessment of childhood outcomes from the point of view of the children themselves, along with their parents. Further parental perspectives on experiences of care were explored in a qualitative analysis of in-depth interviews with parents of children born with exomphalos. Findings: Short-term outcomes of children born with gastroschisis have been published in a large number of small studies. Pooling the published data, where possible allowed the production of population estimates but heterogeneity between studies was marked. One in fourteen children born with gastroschisis died before their first birthday when managed in developed countries. Those who developed bowel complications in utero, had an increased risk of dying before one-year. The assessment of childhood outcomes for this latter group of children, who made up 11% of the population cohort, revealed a bleak outlook for many, of with one in three either dying or requiring complex surgery to gain allow them to be able to be fed via their gut, before their ninth birthday. Due to methodological limitations, the extent of neurological and gastrointestinal morbidity among survivors in the cohort is unclear, but the findings of both the highly selected responses from the parent report and those of the clinical study provide enough concern to suggest that alternative methodologies need to be explored to identify the extent of ongoing sequelae as children grow older. The live-born population of children with exomphalos is highly varied and a large burden of comorbidity was identified, however, two-thirds of infants were able to be have their abdominal wall defect surgically closed with a low-rate of early complications. A variety of techniques are employed by UK surgeons when the defect cannot be easily closed and evidence to guide management choice will be difficult to obtain using standard techniques due to the small number of these infants born annually in the UK. Parental experiences echoed the variability in management approach and in some cases highlighted a lack of respect for parental perspectives on management choice. Conclusion: Children born with abdominal wall defects represent a spectrum from those with severe comorbidity who will need ongoing care, to those who have a straightforward course and a relatively short stay in hospital. Methods of risk-stratifying infants for the purposes of outcome assessment have been explored. This approach is crucial to contextualising the progress of an individual infant and counselling their parents about their likely prognosis.
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Jorild, Elina, and Kristin Staf. "Perinatala utfall hos kvinnor som genomgått könsstympning." Thesis, Uppsala universitet, Institutionen för kvinnors och barns hälsa, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-411118.
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SAMMANFATTNING Bakgrund Kvinnlig könsstympning (Female Genital Mutilation, FGM) är en uråldrig tradition med starka band till kulturell och etnisk identitet. Mer än 200 miljoner kvinnor och flickor beräknas vara könsstympade och årligen riskerar cirka 3,9 miljoner ytterligare flickor att utsättas. Andelen kvinnor från länder där FGM är vanligt förekommande och som föder barn i Sverige har ökat i och med ökad invandring från dessa länder. FGM är internationellt betraktat som en kränkning av de mänskliga rättigheterna samt ett brott mot kvinnor och barns rättigheter. Syfte Att jämföra förekomsten och risken för perinatala komplikationer hos kvinnor med en diagnos av FGM med kvinnor utan denna diagnos som fött barn i Sverige mellan åren 2007 - 2017. Metod En populationsbaserad kohortstudie. Resultat Det huvudsakliga resultatet i denna studie är att barn födda av kvinnor med en FGM diagnos har en signifikant ökad risk för låg Apgar, födas lätta för tiden (SGA), drabbas av kramper, perinatal död inklusive intrauterin fosterdöd samt att födas överburna. Slutsats FGM är förknippat med ett flertal allvarliga perinatala komplikationer. Störst risk kunde ses mellan FGM och att födas lätt för tiden, födas överburen och intrauterin fosterdöd. Dessa samband var robusta oavsett vilket land kvinnan är född. Det går att dra slutsatsen att kvinnor med en FGM-diagnos och deras nyfödda barn tillhör en riskgrupp. Det är av stor vikt att arbeta preventivt för att skydda dessa kvinnor och barns hälsa.ABSTRACT Background Female Genital Mutilation (FGM) is an ancient tradition with strong ties to cultural and ethnic identity. More than 200 million women and girls are estimated to be exposed, and about 3.9 million more girls are at risk each year. The proportion of women from countries where female genital mutilation is common, and which gives birth to children in Sweden has increased with an increased immigration. Female genital mutilation is internationally considered as a violation of human rights and a violation of women's and children's rights. Aim To compare the incidence and risk of perinatal complications among women with a diagnosis of FGM with women without this diagnosis who has given birth to a child in Sweden during the years 2007 - 2017. Method A population-based cohort study. Results The main result of this study is that children born of women with an FGM-diagnosis have a significantly increased risk of low apgar scores, being born Small for Gestational Age, convulsions, perinatal death and prolonged pregnancy could be observed. Conclusion FGM is associated with a number of serious perinatal complications. The greatest risk was seen between female genital mutilation and being born Small for Gestational Age, prolonged pregnancy and intrauterine fetal death. These relationships were robust regardless of which country the woman was born. It can be concluded that women with an FGM diagnosis and their newborn children belong to a risk group. It is very important to work preventively to protect these women and children's health.
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Paramasivam, Gowrishankar. "Ultrasound assessment of fetal cardiac function and risk of adverse obstetric and neonatal outcomes in term fetuses." Thesis, Imperial College London, 2017. http://hdl.handle.net/10044/1/48187.
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Aim: To measure fetal cardiac output prior to labour and assess the risk of adverse obstetric and neonatal outcome in singleton pregnancies with appropriately grown for gestational age (AGA) fetuses at term. Methods: This was a prospective observational study conducted at Queen Charlotte’s and Chelsea Hospital, London UK. Fetal cardiac output and fetal cerebroplacental ratio (CPR) was measured within 72 hours before birth in 200 nulliparous women having singleton pregnancies with AGA fetuses. Scan details were not available to the clinicians and delivery was managed per the local protocol and guidelines. Obstetric and neonatal outcomes were obtained from case notes and correlated with the ultrasound findings. Results: Delivery was vaginal in 129 (64.5%) cases and by caesarean section in 71 (35.5%), including 34 (17.0%) for fetal distress and 37 (18.5%) for failure to progress. Fetuses delivered by caesarean section for fetal distress, compared to the remaining fetuses, had a lower median left cardiac output(LCO) (152.3 vs. 191.7 mL/min/kg; p=0.003), higher difference in the median ratio between the right to left cardiac output (RCO to LCO ratio) 1.925 vs. 1.340; p=0.002) and lower CPR (1.222 vs. 1.607; p < 0.0001). In screening for emergency caesarean section for fetal distress, for a 10% false positive rate, the detection rate with the RCO to LCO ratio was higher that with the LCO (41% vs. 29%) and with the CPR (41% vs. 27%). Similarly, the positive predictive value for the RCO to LCO ratio (45%) was higher than LCO (37%) and the CPR (35%). Conclusion: In AGA fetuses at term that develop intrapartum distress, there is evidence of prelabour redistribution of the cardiac output. The RCO to LCO ratio is superior to the LCO and CPR in predicting intrapartum fetal distress. Such assessments may be useful in stratifying patients for the intensity of monitoring during labour.
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Seita, Helene M. "Food allergies in pregnant women: a study of prevalence in expecting mothers and association with neonatal outcomes." Thesis, Boston University, 2013. https://hdl.handle.net/2144/12219.
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Thesis (M.A.)--Boston UniversityIntroduction: Food allergies, the second most common form of allergic disorders in Western countries, have been on the rise in the US over the past few decades especially in young children. As the exact causes of food sensitizations are still unknown, much research has been dedicated to solving the mystery of how and why individuals develop food allergies in the first place. However, very few studies have focused solely on the prevalence of food allergies in the adult population. Furthermore, the prevalence of food allergies in expecting mothers and their potential impact on mother-baby health outcomes have barely been investigated. As such, this retrospective chart review study aimed at comparing the prevalence of food allergies in pregnant women to that of the adult US population and investigated the potential effects of maternal food allergies on perinatal maternal outcomes and infant health. Methods: A total of 595 maternal charts and 614 infant charts were reviewed for expecting mothers age 18 to 49 years old who gave birth at New Hanover Regional Medical Center in Wilmington, NC, between November 15, 2011 and November 15, 2012. Mothers’ data collected included basic demographic information, presence and nature of food allergies, and if applicable, occurrence and length of High Risk Antepartum visits. In addition to basic infant demographic information, the infant health outcomes collected were, when applicable: gestational age at birth, birth weight, 1 and 5 minute APGAR scores, NICU admissions and length of stay, as well as infant death. All statistical tests were two-tailed and p values < 0.05 were considered significant. Results: Food allergies were documented in 5.6% (N = 22) of the mothers, which was not significantly different from the national average reported by the FDA (Vierk et al., 2007). The most commonly reported allergy in the study’s pregnant women sample was seafood (42.2%), and the least common maternal food hypersensitivity disorder in the sample was egg allergy (2.2%). No significant relationship was found between the presence of maternal food allergies and maternal or infant health outcomes. Conclusion: Our study found that the proportion of pregnant women with food allergies was consistent with the FDA-reported percentage of US adult population affected by food allergies. Furthermore, we were unable to establish significant relationships between the presence of maternal food allergies and mother-baby health outcomes.
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Scrimshaw-Hall, Emma. "The Role of Touch in Mitigating Withdrawal Symptoms and Increasing Attachment Outcomes in Opioid Exposed Infants." Scholarship @ Claremont, 2017. http://scholarship.claremont.edu/scripps_theses/951.
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Abstract
According to Bowlby, infants have a universal need to seek close proximity with their caregiver when under distress or threatened. This study seeks to look at attachment in a population that is undergoing extreme distress as they suffer from opioid withdrawal within the first few weeks of life. It aims to explore the role touch (kangaroo care) can have in creating the secure base that attachment theorists describe as the basis for all future attachments, and in reducing the length of Neonatal Abstinence Syndrome. It is hypothesized that infants born with drug dependencies who receive increased touch and holding throughout their withdrawal will have a shorter duration of Neonatal Abstinence Syndrome and will be more securely attached at 18 months than those who do not receive increased touch. It is also hypothesized that infants whose caregivers reported high scores of bonding with their infants in the first year of life will be more securely attached than those with lower scores of bonding. Infants who were sent home with their birth parents after discharge are hypothesized to be more securely attached at 18 months with their caregiver than infants who were sent home to a foster family. The results of this study will contribute to attachment literature in a population where research is lacking, and will add to the knowledge on Neonatal Abstinence Syndrome treatment.
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Williams, Natalie A. "Short and long-term effects of birth weight and neonatal medical complications on children's emotional and behavioral outcomes." Diss., Columbia, Mo. : University of Missouri-Columbia, 2008. http://hdl.handle.net/10355/5501.
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Thesis (Ph. D.)--University of Missouri-Columbia, 2008.The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on June 18, 2009) Vita. Includes bibliographical references.
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Ogden, Lori. "THE IMPACT OF MATERNAL NUTRITION DURING PREGNANCY ON INFLAMMATION AND BIRTH OUTCOMES." UKnowledge, 2019. https://uknowledge.uky.edu/nursing_etds/49.
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More than 85% of American adults do not consume recommended amounts of fruits or vegetables. Preterm birth and hypertensive disorders of pregnancy are common adverse conditions affecting pregnancy and are leading causes of maternal and fetal morbidity and mortality. Preterm birth affects nearly 10% of all births in the United States and is on the rise, as are hypertensive disorders, which have increased by 25% over the last two decades. Pregnancy is a state of controlled inflammation, and dysregulation has been linked to preterm birth and other adverse gestational outcomes. A healthy diet is recommended in pregnancy, but little is known about the effect fruit and vegetable intake on perinatal outcomes. Omega-3 (n-3) fatty acids are essential dietary components and are known to affect inflammatory state, but little is known about how they affect inflammation in pregnancy. As current evidence is lacking, further research is needed to investigate the relationships between maternal nutrition in pregnancy, inflammation and birth outcomes.
The purposes of this dissertation were to: 1) to review and evaluate the current evidence on the relationship between n-3 fatty acids and inflammation in pregnancy; 2) to evaluate the current state of the science on the impact of maternal dietary consumption of fruits and vegetables on preterm birth, gestational diabetes, preeclampsia, small for gestational age, gestational weight gain and measures of inflammation or oxidative stress in pregnancy; and 3) to examine relationships between maternal dietary intake of fruits and vegetables, cytokine expression in early and mid-pregnancy, preterm birth and gestational hypertension.
A critical review of literature examining the relationship between inflammation and n-3 intake during pregnancy found that multiple inflammatory cytokines in maternal and fetal tissues were lower in women who received n-3 supplements. A second review of literature review supported an inverse relationship between fruit and vegetables and risk of preeclampsia and suboptimal fetal growth. The available evidence was insufficient to establish relationships between fruit and vegetable intake and gestational diabetes, preterm birth or inflammation. A study evaluating the relationships between maternal fruit and vegetable intake, inflammation and birth outcomes was conducted. This study
provided evidence supporting a relationship between first and second trimester cytokine expression and maternal dietary intake of fruits and vegetables. Those who met recommended vegetable intake in the first trimester had higher first trimester serum CRP, IL1-α, IL-6 and TNF-α and lower first trimester cervicovaginal IL-6 levels. Those who met recommendations for first trimester fruit intake had 56% lower risk for preterm birth. Those who met second trimester vegetable intake recommendations had more than twice the risk of developing gestational hypertension.
The results of this dissertation provide support for the beneficial effects of omega-3 fatty acids and fruit and vegetable intake in pregnancy. Maternal intake of these dietary components may promote optimal immune status during pregnancy. Supplementation of maternal omega-3 fatty acids may help regulate inflammation via the anti-inflammatory effects their bioactive eicosanoids exert. Fruit and vegetables have antioxidant and anti-inflammatory effects that may also help balance the inflammatory state during pregnancy. These dietary components may help promote favorable immune status during pregnancy and reduce risk of adverse perinatal outcomes such as poor fetal growth, hypertensive disorders of pregnancy and preterm birth.
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Riccetto, Caroline de Paula Venezian [UNESP]. "Estudo randomizado do uso da sonda de Foley para preparo de colo uterino na indução do trabalho de parto em regime ambulatorial versus internação." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/151485.
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Objetivo: Determinar o efeito do uso da sonda de Foley para o preparo de colo uterino, em gestantes tratadas em regime ambulatorial versus internação. Sujeitos e métodos: Foi realizado um estudo prospectivo, randomizado e do tipo ensaio clínico. Trinta e sete mulheres com gestação de baixo risco foram randomizadas para o preparo de colo uterino, com sonda de Foley, em dois grupos: ambulatorial (n=17) e internação (n=20). Os principais desfechos avaliados foram: índice de Bishop final, número de gestantes que modificaram o índice de Bishop de desfavorável para favorável, tipo de parto, uso de ocitocina, tempo de internação, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Para a análise estatística foram utilizados o teste de qui-quadrado para comparar proporções e o teste t de Student para a comparação de médias. O nível de significância estabelecido foi de 5% ( = 0,05). Resultados: Não houve diferença estatística significativa entre os dois grupos quanto ao índice de Bishop final, tipo de parto, necessidade de uso de ocitocina, morbidade materna e neonatal grave, óbito neonatal, taquissistolia com alteração da frequência cardíaca fetal e Apgar de quinto minuto ≤ 7. Como esperado, as gestantes do grupo internação tiveram mais horas dentro do ambiente hospitalar do que as do grupo ambulatorial (77,7 horas no grupo ambulatorial versus 93,1 horas no grupo internação), entretanto não houve diferença estatística. Conclusão: Gestantes do grupo ambulatorial apresentaram os mesmos desfechos que gestantes do grupo internação, com diminuição do tempo de internação e, consequentemente, redução do custo de tratamento, além da possibilidade de permanecer maior tempo no conforto do lar e na convivência familiar.
Objective: To determine the effect of the use of the Foley catheter for the cervical ripening, in pregnant women treated on an outpatient basis versus hospitalization. Subjects and methods: A prospective, randomized clinical trial was conducted. Thirty-seven women with low-risk pregnancies were randomized to the cervical ripening with a Foley catheter in two groups: outpatient (n = 17) and hospitalization (n = 20). The main outcome measures were: Bishop's final index, number of pregnant women who modified Bishop's ratio from unfavorable to favorable, type of delivery, oxytocin use, hospitalization time, severe maternal and neonatal morbidity, neonatal death, tachysystole with alteration of Fetal heart rate and fifth-minute Apgar ≤ 7. For the statistical analysis the chi-square test was used to compare proportions and Student's t-test for comparison of means. The level of significance was set at 5% ( = 0.05). Results: There was no statistically significant difference between the two groups regarding the final Bishop index, type of delivery, need for oxytocin use, severe maternal and neonatal morbidity, neonatal death, tachysystole with altered fetal heart rate, and fifth-minute Apgar ≤ 7. As expected, the pregnant women in the hospitalization group had more hours within the hospital setting than the outpatient group (77.7 hours in the outpatient group versus 93.1 hours in the hospitalization group), however there were no statistical differences. Conclusion: Pregnant women in the outpatient group presented the same outcomes as pregnant women in the hospitalization group, with a reduction in the length of hospital stay and, consequently, a reduction in the cost of treatment, as well as the possibility of remaining longer in the comfort of the home and in the family support.
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Boltman, Haaritha. "A systematic review on maternal and neonatal outcomes of ingested herbal and homeopathic remedies used during pregnancy, birth and breastfeeding." Thesis, University of the Western Cape, 2005. http://etd.uwc.ac.za/index.php?module=etd&.
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Herbal and homeopathic compounds have been used to aid in childbearing and pregnancy for centuries. Much of this information is anecdotal and lacks scientific support, making it difficult to evaluate safety and efficacy. Increased public interest in alternative treatments leads to the need for a systematic review on the topic. Herbal remedies are most often used to treat the most common pregnancy-related problems like nausea, stretch marks and varicose veins. In contrast to this, concerns have also been raised about the adverse effects of these remedies. The primary objective of this research project was to conduct a systematic review to assess the maternal and neonatal outcomes of ingested herbal and homeopathic remedies using during pregnancy, birth and breastfeeding.
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McCook, Judy G., and Beth Bailey. "Should Our Approach for Reducing Poor Birth Outcomes Differ in Urban and Rural Populations?" Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/7178.
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Martini, Julia, Susanne Knappe, Katja Beesdo-Baum, Roselind Lieb, and Hans-Ulrich Wittchen. "Anxiety disorders before birth and self-perceived distress during pregnancy: Associations with maternal depression and obstetric, neonatal and early childhood outcomes." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2013. http://nbn-resolving.de/urn:nbn:de:bsz:14-qucosa-112654.
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Background: Maternal perinatal mental health has been shown to be associated with adverse consequences for the mother and the child. However, studies considering the effect of DSM-IV anxiety disorders beyond maternal self-perceived distress during pregnancy and its timing are lacking.
Aims: To examine the role of maternal anxiety disorders with an onset before birth and self-perceived distress during pregnancy for unfavourable maternal, obstetric, neonatal and childhood outcomes.
Study design: DSM-IV mental disorders and self-perceived distress of 992 mothers as well as obstetric, neonatal and childhood outcomes of their offspring were assessed in a cohort sampled from the community using the Munich-Composite International Diagnostic Interview. Logistic regression analyses revealed associations (odds ratios) between maternal anxiety disorders and self-perceived distress during pregnancy with maternal depression after birth and a range of obstetric, neonatal and childhood psychopathological outcomes.
Results: Lifetime maternal anxiety disorders were related to offspring anxiety disorders, but not to offspring externalizing disorders. Analyses focussing on maternal DSM-IV anxiety disorders before birth yielded associations with incident depression after birth. In addition, self-perceived distress during pregnancy was associated with maternal depression after birth, preterm delivery, caesarean section, separation anxiety disorder, ADHD, and conduct disorder in offspring.
Conclusion: Findings confirm the transmission of anxiety disorders from mother to offspring. Apart from maternal anxiety, self-perceived distress during pregnancy also emerged as a putative risk factor for adverse outcomes. The finding that maternal anxiety disorders before birth yielded less consistent associations, suggests that self-perceived distress during pregnancy might be seen as a putative moderator/mediator in the familial transmission of anxiety.