Browsing by Subject "neonate"

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    Cerebral Arterial Asymmetries in the Neonate: Insight into the Pathogenesis of Stroke
    (Multidisciplinary Digital Publishing Institute, 2022-02-24) van Vuuren, Anica Jansen; Saling, Michael; Rogerson, Sheryle; Anderson, Peter; Cheong, Jeanie; Solms, Mark
    Neonatal and adult strokes are more common in the left than in the right cerebral hemisphere in the middle cerebral arterial territory, and adult extracranial and intracranial vessels are systematically left-dominant. The aim of the research reported here was to determine whether the asymmetric vascular ground plan found in adults was present in healthy term neonates (n = 97). A new transcranial Doppler ultrasonography dual-view scanning protocol, with concurrent B-flow and pulsed wave imaging, acquired multivariate data on the neonatal middle cerebral arterial structure and function. This study documents for the first-time systematic asymmetries in the middle cerebral artery origin and distal trunk of healthy term neonates and identifies commensurately asymmetric hemodynamic vulnerabilities. A systematic leftward arterial dominance was found in the arterial caliber and cortically directed blood flow. The endothelial wall shear stress was also asymmetric across the midline and varied according to vessels’ geometry. We conclude that the arterial structure and blood supply in the brain are laterally asymmetric in newborns. Unfavorable shearing forces, which are a by-product of the arterial asymmetries described here, might contribute to a greater risk of cerebrovascular pathology in the left hemisphere.
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    Feeding and swallowing in neonates with Hypoxic Ischemic Encephalopathy (HIE): a descriptive study
    (2024) Branfield, Samantha; Norman, Vivienne; Rhoda, Natasha; Joemat, Janine
    Background: Intrapartum-related complications, including intrapartum hypoxia and subsequent hypoxic ischemic encephalopathy (HIE), are the second highest cause of neonatal deaths in South Africa. For survivors, such complications may be associated with a substantial burden of impairment, including the inability to feed well and swallow safely, thus representing a possible neurological cause of oropharyngeal dysphagia (OPD). HIE may result in disturbances of physiological stability, state regulation, neuromuscular integration, coordinated oral movements, and/or feeding endurance. However, feeding and swallowing characteristics in this population of neonates are not well described in the literature. Research Aims: To describe the feeding and swallowing profile of neonates with HIE in a neonatal unit in Cape Town, South Africa, including characteristics of oral feeding readiness, oromotor skill, oropharyngeal swallowing and clinical signs and symptoms of OPD, time taken to reach full oral feeds, and feeding method at discharge from the neonatal unit. Method: A descriptive, exploratory, longitudinal design consisting of both prospective and retrospective data collection methods was used to examine the feeding and swallowing characteristics in a sample of 52 participants with HIE of varying severities. Clinical feeding and swallowing assessments were conducted for 13 participants using the Neonatal Feeding Assessment Scale (NFAS), and medical folder reviews were conducted for 39 participants. The medical and feeding information was documented using data collection forms, including the feeding management received from the on-site speech-language therapist. Data from both data collection methods were amalgamated onto Excel spreadsheets, and information from medically similar participants was identified and grouped together for descriptive and statistical analysis. Statistical analysis comprised the nonparametric Kruskal-Wallis test and the Mann-Whitney U test. Results: A main effect of oral feeding readiness was indicated with a median of 4 days (p = 0.036), and an interquartile range of 4 – 5 days (standard deviation = 3.7 days). The median number of days to full oral feeds for the sample was 5 days (p = 0.016) with an interquartile range of 4 – 6.8 days (standard deviation = 4.3 days). Participants with a severely abnormal initial aEEG and who did not receive cooling treatment demonstrated the longest average time to oral feeding readiness and,subsequently, to full oral feeds. Participants of all severities presented with feeding and swallowing difficulties primarily in the oral phase of swallowing. Few pharyngeal signs and symptoms of OPD were identified. Most participants (96.2%; n = 50) were discharged on full oral feeds, while the remaining 3.8% (n = 2) were discharged on nasogastric tube feeds (NGT) while awaiting gastrostomy placement. ii | P a g e Conclusion: Regardless of severity, neonates with HIE face an increased risk of feeding and swallowing difficulties. The findings highlight that neonates with HIE should be screened by a speech-language therapist for feeding and swallowing difficulties before discharge from hospital. This study contributes to the small body of research on feeding and swallowing difficulties in neonates with HIE, and may guide future research.
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    Interventions used by health care professionals to transition preterm infants and neonates from enteral feeds to full-oral feeds: A Scoping review
    (2021) Rabbipal, Yajna; Norman, Vivienne; Pascoe, Michelle
    Background: Preterm infants and neonates may present with dysphagia due to immaturity or the presence of medical conditions. Enteral feeds are used to ensure optimal nutrition is achieved while the neonates are developing appropriate oral feeding skills. Varied interventions may be used to transition neonates to full oral feeds as oral feeding is often a prerequisite for discharge from hospital. Aims: The main aim of this study was to summarize, interpret and analyse the literature on the different interventions used for the transition to full oral feeds in preterm infants and neonates to identify research gaps and to inform clinical practice on the best intervention options. A secondary aim was to validate the findings of the scoping review for the South African context. Methods: A scoping review was conducted. Relevant studies were identified by searching six databases, Google and Google scholar. Inclusion criteria included studies written in English, peer reviewed and published between 1998–2018, that described the interventions used to transition preterm infants and neonates to full oral feeds. Data were extracted from the articles using a data charting form and analysed descriptively and thematically. The findings were shared with health care professionals who work with premature infants and neonates who then participated in a semi-structured interview to provide feedback relevant to the South African context. Results: Forty-seven articles were included. Six broad intervention categories were identified: oral-motor, oral-sensory, other senses, timing, cue-based and utensils. Non-nutritive sucking (NNS) interventions were reported most frequently across single and combined interventions. Outcome measures reported included: time taken to full oral feeds, earlier hospital discharge, long-term feeding outcomes, weight and sucking proficiency. Improved outcomes were associated with NNS and NNS with oral stimulation. Nine health care professionals were interviewed. They confirmed using a number of the interventions, with NNS reported the most. Health care professionals also provided insight into the challenges of implementing some interventions due to limited resources and staffing in the South African context. Conclusions: There are a range of interventions reported in the literature and many of them are used in South Africa. Positive outcomes such as earlier transition to full oral feeds; earlier hospital discharge; improved weight gain and improved sucking proficiency have been reported with NNS and combined NNS and Oral Stimulation interventions, however further studies are needed.