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Background. Clear risk profiles of neonates with mild and moderate hypoxic-ischaemic encephalopathy (HIE) are lacking.Objective. To describe and compare factors associated with mild and moderate HIE in South African neonates. Methods.A prospective, comparative design was used to describe factors among South African neonates with mild (n=13) and moderate (n=33) HIE in an urban tertiary academic hospital. HIE diagnosis and encephalopathy grading were conducted using the modified Sarnat stages. Thompson scores were recorded. Participants' clinical records were reviewed to identify factors. Descriptive data were obtained. Chi-square and Fisher's exact tests were used to compare categorical data, and Mann-Whitney tests were used to compare continuous data between groups. Results. Significant differences were found between groups' admission (p<0.001) and highest Thompson scores (p<0.001). The mild group's APGAR scores were significantly higher than those of the moderate group at five (p=0.012) and ten minutes (p=0.022). Duration of resuscitation (p=0.011) and time to spontaneous respiration (p=0.012) also differed significantly between groups. Significantly more moderate than mild participants received therapeutic hypothermia(TH) (p<0.001).Conclusion. Clinical tests and management factors differed significantly between groups. The findings provided the multidisciplinary team with an increased understanding of the heterogeneous HIE population and add to existing evidence for identifying neonates eligible for TH in resource-limited settings
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Humanos , Masculino , Femenino , Recién Nacido , Hipoxia-Isquemia Encefálica , DiagnósticoRESUMEN
BACKGROUND: There is limited description of the feeding characteristics of infants with unrepaired cleft lip and palate, exposed to HIV, but not necessarily infected. OBJECTIVE: To compare the feeding characteristics of infants with unrepaired cleft lip and palate and HIV-exposure, to infants with unrepaired cleft lip and palate only. METHOD: A two-group comparative design with a validated measure, the Neonatal Feeding Assessment Scale was used. The effectiveness of oral feeding skills were included as objective measure. Twelve participants with unrepaired cleft lip and palate and HIV-exposure and 13 with unrepaired cleft lip and palate were matched according to cleft type and use of feeding obturator. There were no differences between the groups for mean age, birth weight and gestation. Participants were between two and 89 days old, bottle fed, and had no syndrome/co-occurring disorder. RESULTS: Nine (75%) participants in the research group and only two (15.38%) in the control grouppresented with the likelihood of oropharyngeal dysphagia. Apart from feeding difficulties as a result of structural impairment, the research group showed symptoms of neurological involvement. CONCLUSION: The research group presented with distinctive symptoms of oropharyngeal dysphagia. More studies using different measuring tools are required to strengthen the evidence.
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Alimentación con Biberón/estadística & datos numéricos , Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Trastornos de Deglución/epidemiología , Infecciones por VIH/epidemiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Dispositivos de AutoayudaRESUMEN
Background. Infants in neonatal intensive care are at risk of swallowing difficulties; in particular oropharyngeal dysphagia (OPD) and oesophageal dysphagia (OD). OPD is treated by speech-language therapists while OD is managed by doctors. Diagnosis of dysphagia is a challenge as equipment for instrumental evaluations is not readily available. Additional information to guide clinical assessment may be valuable. Objective. To determine whether risk profiles of infants (=32 weeks' gestation) in a neonatal intensive care unit (NICU) and diagnosed with OPD or OD were distinctly different from one another. Methods. Non-probability convenience sampling was used to select 49 participants. Based on modified barium swallow (MBS) examinations; three groups of participants were identified: no dysphagia (n=11); OPD (n=13) and OD (n=25). Clinical data were collected to investigate associations between risk profiles and type of dysphagia. Results. Factors such as gestational age; birth weight; poor weight gain and Apgar scores showed no association with either type of dysphagia in the sample of infants with a mean gestational age of 35.53 weeks. Increased NICU stay; increased chronological age; problematic breastfeeding and use of tube feeding showed an association with OPD. Three risk factors; namely intrauterine growth restriction; premature rupture of membranes and nutritive sucking difficulties were associated with OD. Conclusion. Risk profiles associated with the two types of dysphagia may guide NICU personnel and speech-language therapists; especially in settings where no MBS equipment is available
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Cuidados Críticos , LactanteRESUMEN
The rape of individuals with mental retardation poses challenges for the judicial system as well as for the survivors themselves. As a result; the courts tend to refer these individuals for forensic mental health examination to assist them in proceeding with criminal trials. This sequence of events may appear unusual; considering that these individuals have already suffered significant trauma; and yet have to undergo mental health evaluation before the trial can begin. The questions posed by the courts to mental health experts deal with the cognitive assessment of the rape survivor; the survivor's ability to testify; and her/his capacity to consent to sexual intercourse. The paper provides an outline of this situation within the authors' work context in the KwaZulu-Natal Midlands; and also engages in a critical discussion of the issues involved in such forensic examinations; taking into consideration the implications for the expert witness and her/his approach to such examinations
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Adolescente , Niño , Discapacidad Intelectual/psicología , ViolaciónRESUMEN
AIM AND METHOD: An exploratory and descriptive study to obtain basic data on the extent, nature, sources and severity of injuries sustained on fruit farms was conducted. The possibility of utilizing lay health workers (LHWs) on farms to document routine information on injuries was also investigated. Descriptive information of all injuries occurring on selected farms, both occupational and other, needing some form of treatment, were documented over a one-year period from June 1999 to May 2000. A purposive non-probability sampling method was used. Forty-eight fruit farms with a history of trained LHWs were purposefully selected. Injuries were documented using a one-page questionnaire. RESULTS: A total of 500 injuries were recorded, giving an average of 10.4 injuries per farm per year. Half of these injuries were work-related. Workers aged 20-39 were most at risk. Injuries sustained were related to routine activities of fruit farming, occurred mostly in the orchards and involved cuts, bruises and abrasions to the hands, including the fingers, and the eyes. Most of the non-work related injuries occurred in and around the home. A third of these injuries were sustained by persons < 20. A large percentage of the non-work related injuries were violence- and alcohol related. Most of the injuries required basic primary health care that could be managed by the LHW. Injury severity caused people to take time off for one third of the cases. CONCLUSION: A relatively high occupational injury rate in comparison to high-income countries. Occupational Health and Safety legislation needs to be institutionalized and adhered to. Alcohol and violence on farms is a serious public health problem. LHWs could potentially play an important role in documenting injury data.
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Enfermedades de los Trabajadores Agrícolas/epidemiología , Agentes Comunitarios de Salud , Vigilancia de la Población/métodos , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , Enfermedades de los Trabajadores Agrícolas/prevención & control , Niño , Preescolar , Femenino , Frutas , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Sudáfrica/epidemiología , Heridas y Lesiones/etiología , Heridas y Lesiones/prevención & control , Heridas y Lesiones/terapiaRESUMEN
The early identification of infants with communication disorders or at risk for communication delays is still one of the biggest challenges of early communication intervention (ECI) and threatens to compromise its efficacy. Current approaches to the early identification of young children at risk for communication disorders involve strategies aimed at the identification of general developmental delays and may not be sufficiently sensitive and specific enough to detect the early stages of communication disorders. The risks for mortality and health are often identified early in life, but the concomitant risks for communication disorders in the same young children are frequently not identified at that opportune time. The current study involved a descriptive survey, describing the identification of communication disorders in 153 subjects, whose data was stored in and retrieved from a customized ECI database system. The findings revealed that the subjects were assessed at the average age of 18 months, but that identifications of risk conditions occurred prenatally, at birth, after the perinatal period and later in life. The time of identification related to the different communication disorders identified in the subjects and caregivers played a major role in detecting the first signs of communication disorders in their children. In order to provide a guideline for clinical practice, a transdisciplinary conceptual framework towards a coordinated effort for the early identification of risks for communication disorders in young children is proposed.
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Trastornos de la Comunicación/diagnóstico , Intervención Educativa Precoz , Cuidadores , Niño , Preescolar , Trastornos de la Comunicación/epidemiología , Trastornos de la Comunicación/etiología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Guías de Práctica Clínica como Asunto , Estudios Retrospectivos , Factores de Riesgo , Sudáfrica/epidemiología , Encuestas y CuestionariosRESUMEN
This study investigated the early communication functioning and hearing abilities of 44 infants with cleft lip and palate, ages 3 to 31 months old. The results revealed that 64% of the subjects had a history of recurrent otitis media with effusion and 33% displayed associated anomalies. 26% of the subjects had mild hearing losses and middle ear pathology at the time of data collection. The subjects as a group displayed average developmental levels for perceptual-cognitive, socio-personal and receptive language skills, but a limited phonetic repertoire and a statistically significant expressive language delay. The results indicated that the subjects experienced a motor developmental delay, but this was not statistically significant. The implications for early communication intervention are to conduct regular hearing measurements and to conduct regular parent-centered therapy with individualized home programmes. Efforts should be directed towards expanding early communication intervention services to include all infants with cleft lip and palate in South Africa.
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Labio Leporino/complicaciones , Fisura del Paladar/complicaciones , Trastornos de la Comunicación/etiología , Preescolar , Femenino , Humanos , Lactante , Masculino , Factores de RiesgoRESUMEN
Early communication intervention has advanced to include neonatal assessment and management. Currently, however, there are limited diagnostic tools developed from a speech-language pathology and audiology perspective. The purpose of the study was to design a comprehensive neonatal communication assessment protocol and use it to describe the communication skills of 50 biologically at-risk neonates (852 g-3060 g birthweight). The results indicated that the subjects' general development was within normal limits, but their communication abilities displayed a serious delay. A high risk register consisting of 13 factors predicting the subjects' communication abilities was compiled. The length of time before the subjects could successfully take bottle feeds was found to be the strongest predictor of their communication development. The study is of particular relevance to the present South African context which has an increased incidence of low birth weight, thus rendering an enlarged population of biologically at-risk neonates.
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Lenguaje Infantil , Comunicación , Recién Nacido/psicología , Tamizaje Neonatal/métodos , Protocolos Clínicos , Femenino , Humanos , Masculino , Factores de RiesgoRESUMEN
Children with Down syndrome are particularly at risk for language learning problems for reasons beyond the associated cognitive deficits. An early intervention programme and the application thereof on three Down syndrome infants aged 10 months at the initiation of the programme, is described. The subjects were individually assessed prior to the treatment programme and again at the completion thereof. Comparison of pre- and post treatment levels of functioning indicated that all three subjects made satisfactory progress, although developmental lags were still evident. The intervention programme was found to be clinically successful and verifies that the language development of Down syndrome infants can be facilitated by early intervention.