ABSTRACT
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
Subject(s)
Humans , Male , Female , Infant, Newborn , Hypoxia-Ischemia, Brain , DiagnosisABSTRACT
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
Subject(s)
Critical Care , InfantABSTRACT
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