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Changes in Bone and Mineral Metabolism and the Role of Vitamin D in Very Low Birth Weight Infants
Matějek, Tomáš ; Skálová, Sylva (advisor) ; Šumník, Zdeněk (referee) ; Kutílek, Štěpán (referee)
Changes in bone and mineral metabolism and the role of vitamin D in very low birth weight infants. Firstly, the aim of dissertation work was to estimate physiological parathyroid hormone (PTH) levels and their relationship with bone metabolism parameters in otherwise healthy preterm newborns with birth weight 1000-1500 g. Secondly, to evaluate vitamin D status in mothers and their very low birth weight infants (VLBW) at birth and at discharge with currently recommended supplementation of vitamin D. Thirdly, to compare clinical outcomes of VLBW infants with 25-hydroxy vitamin D [25(OH)D] levels ≤ and > 25 nmol/l in umbilical cord blood and finally to evaluate umbilical cord vitamin D as a risk factor for respiratory distress syndrome in preterm infants. It is a set of prospective observational studies involving immature newborns with birth weight below 1500 g. The parameters of mineral and bone metabolism were analysed in umbilical cord blood and newborn serum and urine during hospitalisation (PTH, 25-hydroxy vitamin D, S-Ca, S-P, ALP, U-Ca, U-P) and in pregnant women before delivery (25-hydroxy vitamin D). Bone mineralization was evaluated by bone densitometry. In a pilot study, from the total 134 examined serum samples for PTH levels the estimated reference range was 1.6 - 9.3 pmol/l. From the...
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Importance of thermomanagement in the care of premature newborn
Stránská, Monika ; Hocková, Jana (advisor) ; Kordulová, Pavla (referee)
The thesis is focused on premature newborn thermomanagement. It is focused particularly on very premature and extremely premature newborns which suffer the highest level of thermolability. The theoretical part deals with the particularities of premature newborn thermoregulation, newborns' reactions to thermal stress, thermomanagement in the delivery room and providing a thermoneutral environment in the incubator. The thesis describes a method of servo-control mode of body temperature, which has not been utilised for premature newborns in Czech Republic. The aim of the thesis is to start using this method and compare it with the method of manual control. Based on the total time not meeting the standard, number of failures and other parameters to assess which method is more suitable for body temperature regulation. The research sample consists of 47 newborsn who were born between the 24th and 32nd gestational week. Quantitative data collection at one-minute intervals was conducted in the 72 hours after birth. The method choice was random. Statistically important differences between the two methods were measured regarding the total time not meeting the standards. The incidence of hyperthemia was higher during manual method, hypothermia when servo-control. Total failure amount was 19%. However, the...
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The role of the lactation expert in nursing team in the care of premature newborns.
TALAŠOVÁ, Dana
In the first part of the diploma thesis we describe current state of taking care of newborns with special regard to mother's and newborn's needs and to the individual developmental care. We pay attention to the composition of the nursing team and to the conditions for its effective functioning. We cope with the importance of breast milk, breastfeeding and whole-community-based activities supporting breastfeeding. In the chapter about lactation consultancy we look into the history and present day to give a sense of this topic. The aim of the thesis is to make the description of the role of lactation consultant in the multidisciplinary team which takes care of premature newborns. We try to assess contribution of his presence to mothers of newborns and to nurses in the perinatal centres and at the same time to identify the problems lactation consultant are facing. We applied a qualitative research method of semi-structured interview for purpose of the study. We conducted the interviews with mothers of preterm infants, with nurses from the nursing team and with lactation consultants in ÚPMD in Prague and in České Budějovice Hospital. We investigated the rate of integration of lactation consultants into the nursing team within all perinatal centres in the Czech Republic. Lactation consultant provides mothers help with the stimulation of milk production and with the long-lasting breastfeeding maintenance. Lactation consultant supports mothers in breastfeeding and resolves problems related to breastfeeding a premature newborn. This help includes the psychological support. In relation to nurses, lactation consultant takes part in mothers' education in breastfeeding, manages human colostrum and mediates the mother-and-child contact when mother is separated from her baby. Nursing team is enriched with special knowledge and skills of lactation consultant. There were several problems identified: a lack of time for consultancy, the language barrier along with different cultural habits within minorities and the negative influence of layman discussion forums in the internet. Related to collaboration in the nursing team we encountered the problem of poor communication among lactation consultants and other team members. Mothers together with other team members, they all benefit from presence of lactation consultant in the nursing team.
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Nurse´s Contribution to Trophotherapy of Preterm Newborns in Intensive Care.
KRČMOVÁ, Pavla
The thesis is focused on nutrition of a preterm infant at an intensive care unit from the point of view of nursing activities. A nurse is faced to problems resulting from prematurity state like insufficient sucking, poor coordination of sucking and swallowing, she enters into interaction with parents who are afraid of the life and subsequently of the future of their beloved child. Natural nutrition, preferably with breast milk is irreplaceable in spite of the high development of initial formulas. This is why the mother of the child, who is vital for the newborn?s nutrition, has to be invited into the team. A hundred per cent enteral nutrition is not always possible, parenteral method has to be applied as well. Provision, evaluation and optimization of infant?s nutrition are results of activities of the whole team, i.e. of a nurse as well. The theoretical part of the thesis contains the findings of trophotherapy of a preterm newborn. It deals with parenteral as well as enteral alimentation, its composition and administration techniques. The empiric part lists and evaluates the research results that led to replies to research questions related to nurse?s contribution to trophotherapy of a preterm newborn, to the influence of permanent nasogastric tube on breathing and mucus congestion of the nose as well as to the awareness of nutrition problems among mothers of preterm infants. Measures resulting from the research results and recommendation for further examination are proposed at the end of the thesis. A brochure Preterm Baby Nutrition designed for distribution among mothers at neonatology and perinatology departments and Recommendations for Gastric Tube Introduction belong to the outputs. We should mention that the latter is based on procedures already presented. It was extended by recommendation of the place of introduction with regard to further intention of enteral nutrition administration.
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