Die etiologiese verband tussen verstadigde neurologiese integrasie en latere leer-problematiek by kinders met klinies betekenisvolle neonatale bilirubienmetings (Afrikaans)

Abstract

In hierdie studie word die etiologiese verband tussen verstadigde neurologiese integrasie en latere leerproblematiek by kinders met klinies betekenisvolle neonatale bilirubienmetings ondersoek. Resente navorsing dui aan dat kinders met klinies betekenisvolle bilirubienmetings tydens die neonatale fase ‘n groter risiko loop om later verstadigde neurologiese integrasie te vertoon, veral weens die kwesbaarheid van die neonatale brein vir toksiene. Hierdie navorsingsresultate suggereer ‘n verband tussen klinies betekenisvolle neonatale bilirubienmetings en latere leerproblematiek, aangesien spesifieke breinareas wat deur neonatale bilirubien aangetas word ook vaardighede medieer wat belangrik is vir prestasie in sekere leerareas, te wete lees, skryf en reken. Neonatale fisiologiese geelsug is nie altyd met die blote oog sigbaar nie, en derhalwe word simptome soos oormatige slaperigheid en ingekorte behoefte aan voeding dikwels deur onervare moeders geïgnoreer, omdat die baba nie opmerklik “geel” is nie. Verder word neonatale fisiologiese geelsug nie altyd as sodanig gediagnoseer nie, weens verskeie faktore soos ontoereikende primêre gesondheidsorgdienste op die afgeleë platteland, tuisgeboortes en vroeë ontslag van moeders en babas uit klinieke en hospitale, veral gesien in die lig daarvan dat neonatale geelsug piekvlak tussen dag drie en dag sewe bereik. Bilirubienmeting is nie standaard prosedure by afgeleë klinieke nie, en waar ‘n rowwe skatting deur die klinieksuster op ‘n klinies betekenisvolle bilirubientelling dui, word moeders dan dikwels aangeraai om natuurlike fototerapie (sonlig) toe te pas. Verdermeer vind opvolgkonsultasies by ‘n klinieksuster dikwels eers plaas nadat die baba ongeveer een maand oud is, en voorligting aan die moeder rakende moontlike kwesbaarhede wat verband hou met klinies betekenisvolle neonatale bilirubienmetings is gebrekkig. Sodanige ouers kan dus heeltemal onbewus wees van die potensiële skade wat aangerig kan word aan die ontwikkelende brein, en intervensie vind gevolglik nie tydig plaas nie. Betekenisvolle duidinge wat uit hierdie navorsingsprojek mag voortvloei, kan derhalwe benut word ten einde spesifieke kwesbaarhede in kinders met klinies betekenisvolle neonatale bilirubienmetings tydig te kan identifiseer; en hoë-risiko leerders se moontlike latere leerproblematiek deur tydige intervensie tydens die voorskoolse jare te ondervang, voordat pobleme in die grondslagfase manifesteer. ‘n Empiriese ondersoek is uitgevoer waarby 37 deelnemers betrek is. Gebaseer op die resultate van die data-analise en interpretasie van die resultate word die hipotese aanvaar. Relevante aanbevelings met betrekking to praktykverbetering en verdere navorsing word gemaak. ENGLISH: With this study the etiological link between delayed neurological integration, high neonatal bilirubin measures and learning difficulties were investigated. Recent research findings suggest that children with high neonatal bilirubin measures are at a greater risk for delayed neurological integration later on, especially because of the susceptibility of the neonatal brain for toxins. The results of this research project suggest an etiological link between neonatal hyperbilirubinemia and learning difficulties at a later stage, since specific brain-areas which are affected by the bilirubin do mediate skills important for performance in certain learning areas, e.g. reading, writing and arithmetic. It is not always possible to notice neonatal physiological jaundice; hence, inexperienced mothers tend to ignore symptoms like sleepiness and lack of appetite, merely because their babies do not appear “yellowish”. Neonatal physiological jaundice is often misdiagnosed due to various factors like inadequate primary health care services in rural areas, home births and early discharge from hospitals - particularly in light of the fact that jaundice peaks between day three and day seven after birth. Measurement of neonatal bilirubin levels is not a standard procedure at rural clinics, and mothers are often advised to make use of natural phototherapy (sunlight) when the baby appears “yellowish”. Follow-up consultation often occurs when the baby is already one month old; hence mothers often receive inadequate information concerning neonatal hyperbilirubinemia. Parents might therefore be totally unaware of the potential vulnerability and harm to the developing brain, and intervention often does not take place. Significant indicators of this research project can be used to identify well in advance specific vulnerabilities in learners with neonatal hyperbilirubinemia, as well as potentially high-risk learners during the pre-school years, before such vulnerabilities escalate during the foundation phase. An empirical study with 37 participants was conducted. Based on the data analyses and interpretation of the results, the hypothesis was accepted. Relevant recommendations concerning best practice and further research were done.