ORCID Profile
0000-0001-5337-0134
Current Organisations
University of Wollongong Illawarra Health and Medical Research Institute
,
James Cook University
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Publisher: Public Library of Science (PLoS)
Date: 14-08-2014
Publisher: Springer Science and Business Media LLC
Date: 09-11-2016
Publisher: Japan Epidemiological Association
Date: 2012
Publisher: Wiley
Date: 13-11-2014
DOI: 10.1111/JPC.12775
Publisher: BMJ
Date: 03-04-2007
Abstract: To characterise the relationships between peripheral microvascular blood flow and measures of physiological and cardiovascular function in preterm infants in the immediate newborn period. Prospective observational cohort study. Tertiary neonatal intensive care unit, New South Wales, Australia. Ninety-six preterm neonates (24-36 weeks' gestation) admitted to the neonatal intensive care unit. Relationship between laser Doppler-derived basal microvascular blood flow, functional echocardiographic measurements of cardiovascular status, mean arterial blood pressure and clinical illness severity at 24, 72 and 120 h of age. At 24 h of age, multiple linear regression revealed a significant positive relationship, independent of gestational age, between baseline microvascular blood flow and clinical risk index for babies (CRIB II) score (r2 = 0.442). Microvascular blood flow was inversely related to mean arterial blood pressure (r2 = -0.563), and correlated positively with left ventricular output (r2 = 0.435). Microvascular blood flow continued to exhibit a significant inverse relationship with mean arterial blood pressure (r2 = -0.4) at 72 h of age, but by 120 h no significant relationships were evident. This is the first study to show that baseline microvascular blood flow in premature infants exhibits significant relationships with clinical illness severity and cardiovascular function in the immediate postnatal period. The effects of temporal and functional changes in the microvasculature on cardiovascular adaptation warrant further detailed study.
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2007
Abstract: OBJECTIVE. Our objective was to determine whether continuous positive airway pressure therapy would safely reduce the need for up-transfer of infants with respiratory distress from nontertiary centers. METHODS. We randomly assigned 300 infants at & weeks of gestation with respiratory distress to receive either Hudson prong bubble continuous positive airway pressure therapy or headbox oxygen treatment (standard care). The primary end point was “up-transfer or treatment failure.” Secondary end points included death, length of nursery stay, time receiving oxygen therapy, cost of care, and other measures of morbidity. RESULTS. Of 151 infants who received continuous positive airway pressure therapy, 35 either were up-transferred or experienced treatment failure, as did 60 of the 149 infants given headbox oxygen treatment. There was no difference in the length of stay or the duration of oxygen treatment. For every 6 infants treated with continuous positive airway pressure therapy, there was an estimated cost saving of $10000. Pneumothorax was identified for 14 infants in the continuous positive airway pressure group and 5 in the headbox group. There was no difference in any other measure of morbidity or death. CONCLUSIONS. Hudson prong bubble continuous positive airway pressure therapy reduces the need for up-transfer of infants with respiratory distress in nontertiary centers. There is a clinically relevant but not statistically significant increase in the risk of pneumothorax. There are significant benefits associated with continuous positive airway pressure use in larger nontertiary centers.
Publisher: BMJ
Date: 27-09-2010
Abstract: To evaluate the effects of indomethacin or ibuprofen compared with placebo on closure, morbidity and mortality in preterm infants 24 h of life. MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, CINAHL, Cochrane Library, clinicaltrials.gov, controlled-trials.com, American Pediatric and European Paediatric Research Societies and Effective Care of the Newborn Infant. Systematic review with network meta-analysis of randomised studies comparing intravenous indomethacin, ibuprofen or placebo for PDA in preterm infants at >24 h of life. Ten trials compared intravenous indomethacin versus intravenous ibuprofen, nine intravenous indomethacin versus placebo and one intravenous ibuprofen versus placebo. Both intravenous indomethacin (pooled RR 2.39 (95% CI 2.05 to 2.78)) and intravenous ibuprofen (RR 2.40 (95% CI 2.03 to 2.84)) closed a PDA more effectively than placebo. Intravenous ibuprofen was associated with approximately 30% greater risk of chronic lung disease than intravenous indomethacin (RR 1.28 (95% CI 1.03 to 1.60)) or placebo (RR 1.29 (95% CI 0.99 to 1.70)). Differences in risk or benefit were not significant between any combination of intravenous indomethacin, intravenous ibuprofen or placebo groups for intraventricular haemorrhage, necrotising enterocolitis and death. Reporting on neurological outcomes was insufficient for pooling. Intravenous indomethacin or ibuprofen administered to preterm infants for PDA at >24 h of life promoted ductal closure, but other short-term benefits were not seen. Treatment with intravenous ibuprofen may increase the risk of chronic lung disease. Good-quality evidence of treatment effect on morbidity, mortality and improved neurodevelopment is urgently needed.
Publisher: Elsevier
Date: 2012
Publisher: Elsevier BV
Date: 12-2014
DOI: 10.1016/J.JHIN.2014.09.006
Abstract: This study aimed to assess probiotic cross-colonization between infants in a neonatal unit where probiotics were being administered to preterm infants during a clinical trial. We tested stool s les from all infants present in the unit at two time points the first was during the trial and the second was after trial completion. S les from 43 infants were tested during the trial all five infants receiving probiotics and three of 38 not receiving probiotics were colonized. Only one of 44 infants tested after the trial was colonized. The rate of cross-colonization was lower than in previous probiotic studies.
Publisher: Wiley
Date: 11-10-2010
DOI: 10.1111/J.1365-2702.2010.03357.X
Abstract: Aims and objective. To compare agreement between International Normalised Ratio results from Point of Care testing with laboratory testing for cardiac inpatients receiving warfarin sodium. Background. Availability of point of care technology for International Normalised Ratio testing offers considerable benefits to patients and health care staff across a range of context. Design. Prospective comparison study. Method. Setting – Four cardiac wards in a regional referral hospital in New South Wales, Australia. Participants – 50 cardiovascular inpatients receiving warfarin therapy, including those patients being converted from intravenous heparin sodium. Intervention‐Point of Care International Normalised Ratio testing via finger prick using the CoaguChek ® XS attended within one hour of laboratory International Normalised Ratio testing. Paired International Normalised Ratio results were compared using spearman rank and Mann–Whitney rank sum. Bland–Altman plots were used to demonstrate agreement. Results. One hundred and seventeen blinded paired tests were carried out, 44 on patients receiving intravenous heparin. Laboratory and Point of Care International Normalised Ratio testing were highly significantly correlated ( r = 0·953, p 0·0001, n = 117). There was close agreement between Point of Care International Normalised Ratio and laboratory International Normalised Ratio results for patients receiving warfarin regardless of whether they were receiving heparin sodium. There was a mean bias of +0·2 units (95% CI 0·145–0·246). The presence of diabetes significantly reduced the difference between paired tests. Bias significantly increased above an International Normalised Ratio of 4·5 units. Ninety‐seven per cent of all values fell between 20% limits of agreement after accounting for the mean bias of +0·2 units. Conclusion. Results indicated Point of Care International Normalised Ratio testing can be used for clinical decision making for cardiovascular inpatients receiving warfarin. Clinical guidelines need to be developed and tested in appropriate population groups and across different contexts, because of the potential for significant patient benefit. Relevance to clinical practice. Point of Care International Normalised Ratio results in time and procedural efficiency, care responsiveness, cost saving, increased patient comfort and reduced handling errors (Pharmacotherapy 22 2002: 677), as well as the potential for continuity of care.
Publisher: Hindawi Limited
Date: 2012
DOI: 10.1155/2012/741613
Abstract: Maternal asthma is a common disease to complicate human pregnancy. Epidemiological studies have identified that asthma during pregnancy increases the risk of a number of poor outcomes for the neonate including growth restriction, lower birthweight, preterm delivery, neonatal resuscitation, and stillbirth. Asthma therefore represents a significant health burden to society and could have an impact on the lifelong health of the children of women with asthma. Our research has identified that maternal asthma in pregnancy induces placental dysfunction and developmental perturbation in the fetus in a sex specific manner. These alterations in development could increase the risk of metabolic disease in adulthood of children of asthmatic mothers, especially females. In this paper, we will discuss the evidence currently available that supports the hypothesis that children of mothers with asthma may be at risk of lifelong health complications which include diabetes and hypertension.
Publisher: Cambridge University Press (CUP)
Date: 12-2008
DOI: 10.1375/JSC.3.2.73
Abstract: Background: Parental smoking remains a significant risk to the preterm infant both pre and post delivery. Pharmacologically supported interventions have been previously contraindicated in this group during the perinatal period and during breastfeeding. We designed an evidence-based intervention for use in our high-risk population. This report assesses our outcomes after one year. Method: Questionnaire administered a median of 6 months after intervention. Results: There was no significant difference between those participants who returned the survey ( n = 42) versus the group as a whole ( n = 70). A total of 33% ceased smoking, p .0001. If no nonresponders ceased smoking then this gives an overall success rate of 20%, p .0001. Successful quitters had been smoking for a mean of 11 ( SD = 7) years. Self-reported light smokers ( 10 cigarettes per day) were significantly more likely to quit ( p .01). Purchase of follow-on nicotine patches was a significant predictor of success in quitting ( p = .02). If relapse occurred, it appeared to happen early and was mainly associated with current stressors. Conclusions: We have designed and applied a multidisciplinary intervention for parents and carers to be used in the perinatal period to decrease the postnatal risk for neonatal intensive care graduates. Our rates of successful smoking cessation are as good as, or better than, many published rates for opportunistic intervention. We suggest that randomised trials be focused on ways to further improve interventions at this time of opportunity for these infants and their families.
Publisher: SAGE Publications
Date: 2009
DOI: 10.1080/00048670902721087
Abstract: Objectives: The aim of the present study was to determine the characteristics and short-term outcomes of mother–infant pairs with comorbid drug dependency and psychiatric disorders. Methods: A population-based retrospective chart review was carried out of 879 drug-dependent mother and infant pairs in New South Wales (NSW) and the Australian Capital Territory (ACT) who delivered between 1 January and 31 December 2004. Results: Psychiatric comorbidity (dual diagnosis, DD) was identified in 396 (45%) of the 879 drug-dependent women. DSM-IV depression (79%), followed by anxiety (20%), was most prevalent. DD women were more likely to use hetamines (29% vs 18%, p 0.05), less likely to use opiates (42% vs 51%, p 0.05) and to have had no antenatal care (24% vs 8%, p 0.05). They also had more previous pregnancies (4, range = 2–5 vs 3, range = 2–5, p 0.05) and domestic violence (29% vs 14%, p 0.05) was more common. DD infants were less likely to be admitted to a nursery (47% vs 55%, p 0.05). Withdrawal scores were similar (maximum median Finnegan scores = 4 (interquartile range = 3–8) vs 10 (interquartile range = 7–12, p = 0.30) but fewer needed withdrawal medication (19% vs 27%, p 0.05). Maternal psychotropic agents did not worsen the severity of neonatal withdrawal. Conclusions: Psychiatric comorbidity, especially depression, is common and affects almost half of drug-using mothers. Antenatal care, drug use and social outcomes are worse for DD mothers and their infants. It is recommended that all drug-using women be assessed antenatally for psychosocial disorders so that timely mental health intervention can be offered, if required.
Publisher: Wiley
Date: 09-2014
DOI: 10.14814/PHY2.12145
Publisher: Wiley
Date: 30-09-2016
DOI: 10.14814/PHY2.12941
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2008
Publisher: Wiley
Date: 06-07-2016
DOI: 10.1111/AJR.12310
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2009
Publisher: Wiley
Date: 10-04-2008
DOI: 10.1111/J.1742-6723.2008.01078.X
Abstract: Cardiac output is considered an important parameter when assessing the cardiovascular status of a critically ill patient. Both non-invasive (e.g. bioimpedance, echocardiography) and invasive methods (Swan Ganz catheter) have been used to measure cardiac output. The ultrasonic cardiac output monitoring device provides a new method of non-invasively assessing cardiac output in various clinical settings. The ultrasonic cardiac output monitoring device was introduced clinically in 2001, and appears to be a promising adjunct in the assessment of the cardiovascular state in a variety of patient cohorts. In this short review article, we will introduce this new technique, discuss the required skills and compare it with methods already in use. In particular, a critical comparison with the 'gold standard', the invasive measurement of cardiac output with the pulmonary artery catheter, will be given.
Publisher: American Medical Association (AMA)
Date: 08-2011
DOI: 10.1001/ARCHPEDIATRICS.2011.43
Abstract: To determine the effectiveness and safety of moderate whole-body hypothermia in newborns with hypoxic-ischemic encephalopathy born in hospitals with and without newborn intensive care facilities or complicated hypothermia equipment. Multicenter, international, randomized controlled trial. Neonatal intensive care units in Australia, New Zealand, Canada, and the United States (N = 28) from February 2001 through July 2007. Newborns of 35 weeks' gestation or more, with indicators of peripartum hypoxia-ischemia and moderate to severe clinical encephalopathy, randomly allocated to hypothermia (n = 110) or standard care (n = 111). Whole-body hypothermia to 33.5°C for 72 hours or standard care (37°C). Infants who received hypothermia were treated at ambient environmental temperature by turning off the radiant warmer and then applying refrigerated gel packs to maintain rectal temperature at 33°C to 34°C. Death or major sensorineural disability at 2 years of age. Therapeutic hypothermia reduced the risk of death or major sensorineural disability at 2 years of age: 55 of 107 infants (51.4%) in the hypothermia group and 67 of 101 infants (66.3%) in the control group died or had a major sensorineural disability at 2 years (risk ratio, 0.77 [95% confidence interval, 0.62-0.98] P = .03). The mortality rate decreased, and the survival rate free of any sensorineural disability increased. Adverse effects of hypothermia were minimal. Whole-body hypothermia is effective and appears to be safe when commenced within 6 hours of birth at the hospital of birth in term and near-term newborns with hypoxic-ischemic encephalopathy. This simple method of hypothermia could be used within strict protocols with appropriate training on correct diagnosis and application of hypothermia in nontertiary neonatal settings while awaiting retrieval and transport to the regional neonatal intensive care unit. anzctr.org.au Identifier: ACTRN12606000036516.
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1016/J.JAAPOS.2011.03.009
Abstract: The ophthalmological examination of premature infants, which is essential for the detection of retinopathy of prematurity (ROP), can be painful and distressing for the infant. Various researchers have investigated the benefits of topical anesthesia, oral sucrose, and non pharmacological intervention for pain relief. The purpose of this study is to review the current state of knowledge on the effectiveness of these approaches. A literature search was performed with MEDLINE (January 1980 to January 2011) and the Cochrane Central Register of Controlled Trials, Issue 1 of 4 (January 2011), to determine the currently available evidence on methods of pain relief for premature infants undergoing ROP examination. Most studies supported the use of topical proparacaine, which marginally decreased pain without any side effects. Oral sucrose did not significantly reduce pain scores during ROP examinations, and withholding feeding before the examination was not beneficial. Infants given pacifiers had lower pain scores than those without pacifiers, and infants who were nested experienced less distress during and after the procedure. Conflicting data existed on the benefits of different examination techniques, but the insertion of a lid speculum appeared to be the most uncomfortable aspect of the screening examination. Topical anesthetics marginally reduce pain during eye examination in premature infants. Contrary to standard practice, it appears that patients are more comfortable if they are fed before the examination, and there is no benefit of oral sucrose. Nonpharmacological interventions, including sucking on a pacifier and nesting, may also be beneficial.
Publisher: Wiley
Date: 02-02-2012
DOI: 10.1111/J.1440-1754.2011.02220.X
Abstract: There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO(2) ) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94-96% for infants ≥ 33 weeks gestation with respiratory distress reduce oxygen exposure? A 'Before After' study was undertaken in three SCNs. Data were recorded for all infants admitted to the SCNs who required oxygen over a 3-year period. Infants were analysed in gestational age groups: 33-36 weeks (late preterm) and +37 weeks (term ost-term). Of the 19,830 infants born, 868 (4%) were treated with oxygen. The introduction of an oxygen-targeting protocol resulted in a statistically and clinically significant reduction in the proportion of infants who were treated with any oxygen for 1 h or more, 4 h or more and in the proportion who received >30% FiO2 for 1 h or more (all P ≤ 0.01). This reduction was significant for infants of both gestational age groups. The median duration of oxygen for term ost-term infants was reduced from 12 h pre-protocol to 10 h post-protocol (P= 0.01) however, no significant difference was found for the preterm group (reduced from 11 to 8 h, P= 0.07). Introduction of a uniform oxygen protocol in SCNs for infants ≥ 33 weeks gestation with respiratory distress reduces the number of infants receiving oxygen and, in term infants, the duration of oxygen exposure.
Publisher: Walter de Gruyter GmbH
Date: 2012
DOI: 10.1515/JPM.2011.116
Publisher: Bioscientifica
Date: 07-2005
DOI: 10.1677/JOE.1.06030
Abstract: Females have a significantly greater life expectancy than males, which in part may be due to the cardio-protective effects of the female sex hormone, estrogen, on vascular function. However, the sex-specific mechanisms contributing to these differences are complex and not fully understood. Previously we have reported that corticotropin-releasing hormone (CRH) has potent dilator effects in the female skin circulation via mast cell degranulation. Furthermore the dilator response to CRH was more enhanced in females than in age-matched males, suggesting that estrogens may be involved. In this study we examined whether CRH-induced dilation and endothelial cell-dependent dilation in the skin circulation of pre-menopausal females were associated with changes in estrogen during the menstrual cycle. CRH-induced dilation (1 nM) was enhanced in the presence of high circulating concentrations of estrogen and a positive correlation was identified between CRH-induced dilation and plasma estrogen concentrations. Endothelial cell-dependent dilation was examined using acetylcholine. Acetylcholine-induced dilation (1 nM) was not correlated with circulating concentrations of estrogen. These data suggest the variation in CRH-induced dilation in the skin microvasculature during the menstrual cycle may be due to estrogenic effects on mast cell function and not due to direct changes in endothelial cell function.
Publisher: Springer Science and Business Media LLC
Date: 22-09-2011
DOI: 10.1038/JP.2011.118
Publisher: BMJ
Date: 28-09-2012
DOI: 10.1136/BJOPHTHALMOL-2011-300950
Abstract: The objectives of this study were to measure optic disc size in full term infants and to determine whether this value is influenced by sex or birth weight. Retinal images from a cohort of full term infants admitted to a tertiary perinatal centre were obtained using a retinal camera. Optic disc size was measured by carefully delineating the outline with a cursor using image analysis software. MEDLINE was then systematically searched to compare the data with other published articles. 35 images of left and right eyes from 35 infants were assessed. An image from one eye per patient was then chosen for analysis. The following results were found: mean birth weight 3050±706 g mean gestation 38.9±1.4 weeks. Mean optic disc area was 1.26±0.23 mm(2) mean vertical diameter was 1.37±0.15 mm and mean horizontal diameter was 1.14±0.12 mm. The vertical diameter of the optic disc was significantly longer than the horizontal diameter (p<0.0001). Birth weight and sex did not influence the size of the optic disc in term infants. There were no differences in optic disc measurements between male and female infants and between low birth weight and normal birth weight infants.
Publisher: Elsevier BV
Date: 03-1999
Publisher: Wiley
Date: 11-02-2001
DOI: 10.1046/J.1440-1754.2001.00589.X
Abstract: A previous report demonstrated post-transfusion leucocytosis as a potential confounding factor in the diagnosis of sepsis in critically ill adult patients. In We wished to establish if the same phenomenon occurred in the sick preterm neonate and whether this significantly altered the indices considered for potential neonatal infection. Transfusion and full blood count data in a level 3 neonatal intensive care unit were prospectively recorded for 3 months. One hundred and fourteen transfusion events were recorded from 37 infants. Median white blood cell count increased 0.9 x 109/L (confidence interval (CI) 0.4-2.4) in the first 8 h following transfusion (P = 0.032). Median neutrophil count increased by 0.4 x 109/L (CI 0.1-1.7) in the same 8 h (P = 0.05). Median neutrophil left shift decreased 1.2% (CI 1.1-5.8%) over the 24 h post-transfusion. No change in band count was observed. A mild post-transfusion white cell increase occurs in sick neonates. Because of the magnitude of effect, it is unlikely that this interesting physiological response would interfere with the diagnosis of sepsis in this population.
Publisher: BMJ
Date: 11-2017
Publisher: Springer Science and Business Media LLC
Date: 19-06-2014
DOI: 10.1038/JP.2014.111
Abstract: A substantial number of children exposed to gestational opioids have neurodevelopmental, behavioral and cognitive problems. Opioids are not neuroteratogens but whether they affect the developing brain in more subtle ways (for ex le, volume loss) is unclear. We aimed to determine the feasibility of using magnetic resonance imaging (MRI) to assess volumetric changes in healthy opioid-exposed infants. Observational pilot cohort study conducted in two maternity hospitals in New South Wales, Australia. Maternal history and neonatal urine and meconium screens were obtained to confirm drug exposure. Volumetric analysis of MRI scans was performed with the ITK-snap program. Scans for 16 infants (mean (s.d.) gestational age: 40.9 (1.5) weeks, birth weight: 3022.5 (476.6) g, head circumference (HC): 33.7 (1.5 cm)) were analyzed. Six (37.5%) infants had HC <25th percentile. Fourteen mothers used methadone, four used buprenorphine and 11 used more than one opioid (including heroin, seven). All scans were structurally normal whole brain volumes (357.4 (63.8)) and basal ganglia (14.5 (3.5)) ml were significantly smaller than population means (425.4 (4.8), 17.1 (4.4) ml, respectively) but lateral ventricular volumes (3.5 (1.8) ml) were larger than population values (2.1(1.5)) ml. Our pilot study suggests that brain volumes of opioid-exposed babies may be smaller than population means and that specific regions, for ex le, basal ganglia, that are involved in neurotransmission, may be particularly affected. Larger studies including correlation with neurodevelopmental outcomes are warranted to substantiate this finding.
Publisher: Springer Science and Business Media LLC
Date: 03-2009
DOI: 10.1203/PDR.0B013E318193EDF1
Abstract: This study aimed to characterize early neonatal microvascular function after preecl tic pregnancy with respect to infant sex and in utero growth. Peripheral microvascular blood flow was examined prospectively from 6 to 72 h of age using laser Doppler flowmetry in a cohort of term infants of normotensive women and women with late-onset preecl sia. For male infants, those born to preecl tic women had greater microvascular blood flow at 6 h (p < 0.05) with no change over time. Male infants of normotensive women exhibited increasing blood flow with time (p = 0.005). Female infants of preecl tic mothers exhibited similar blood flow at 6 h of age to females of normotensive mothers, followed by significantly greater blood flow by 72 h (p < 0.001). Altered fetal microvascular structure and function in response to maternal preecl sia may result in sexually dimorphic patterns of fetal growth and account for alterations in neonatal microvascular adaptation after birth.
Publisher: Informa UK Limited
Date: 18-04-2011
DOI: 10.3109/14767058.2011.569618
Abstract: Dysregulated vascular resistance contributes to hypotension following preterm birth with sex-specific differences in microvascular function conferring a male disadvantage. We hypothesized that glucocorticoid mediated, sex-specific differences in the endogenous catecholamine norepinephrine and endothelially derived endothelin-1 (ET-1) contribute to microvascular dysfunction in preterm neonates in the immediate newborn period. Umbilical and plasma ET-1 and normetanephrine, in 24 h urine s les, were determined at 24, 72, and 120 h of age in 24-34 week infants (n = 60). Microvascular blood flow was determined by laser Doppler flowmetry. In infants born within 72 h of antenatal glucocorticoid exposure, normetanephrine was higher in females than males (p = 0.048). Normetanephrine was inversely correlated with both microvascular blood flow at 24 h (p = 0.025) and CRIB II (p = 0.001). While umbilical arterial ET-1 was higher in females delivered <72 h after antenatal betamethasone (p = 0.006), plasma ET-1 did not correlate with microvascular blood flow or illness severity. Only sex and normetanephrine contributed significantly to both microvascular blood flow and endothelium dependant vasodilatation. These data support glucocorticoid mediated, sex-specific differences in mediators of vascular tone that may contribute to the impaired mechanisms compromising successful hemodynamic adaption to neonatal life and resulting in excess male morbidity and mortality.
Publisher: Wiley
Date: 19-06-2015
DOI: 10.1111/APA.13039
Abstract: The starting fraction of inspired oxygen for preterm resuscitation is a matter of debate, and the use of room air in full-term asphyxiated infants reduces oxidative stress. This study compared oxidative stress in preterm infants randomised for resuscitation with either 100% oxygen or room air titrated to internationally recommended levels of preductal oxygen saturations. Blood was collected at birth, two and 12 hours of age from 119 infants <32 weeks of gestation randomised to resuscitation with either 100% oxygen (n = 60) or room air (n = 59). Oxidative stress markers, including advanced oxidative protein products (AOPP) and isoprostanes (IsoP), were measured with high-performance liquid chromatography and mass spectrometry. Significantly higher levels of AOPP were found at 12 hours in the 100% oxygen group (p < 0.05). Increases between two- and 12-hour AOPP (p = 0.004) and IsoP (p = 0.032) concentrations were significantly higher in the 100% oxygen group. Initial resuscitation with room air versus 100% oxygen was associated with lower protein oxidation at 12 hour and a lower magnitude of increase in AOPP and IsoP levels between two and 12 hours of life. Correlations with clinical outcomes will be vital to optimise the use of oxygen in preterm resuscitation.
Publisher: American Academy of Pediatrics (AAP)
Date: 10-2015
Abstract: Neonatal abstinence syndrome (NAS) occurs after in utero exposure to opioids, but outcomes after the postnatal period are unclear. Our objectives were to characterize childhood hospitalization after NAS. Population-based linkage study of births, hospitalization, and death records of all children registered in New South Wales (NSW), Australia, between 2000 and 2011 to a maximum of 13 years. Infants with an International Statistical Classification of Disease and Related Problems, 10th Edition, Australian Modification, coding of NAS (P96.1, n = 3842) were compared with 1 018 421 live born infants without an NAS diagnosis. Infants with NAS were more likely to be admitted into a nursery (odds ratio 15.6, 95% confidence interval: 14.5–16.8) and be hospitalized longer (10.0 vs 3.0 days). In childhood, they were more likely to be rehospitalized (1.6, 1.5–1.7), die during hospitalization (3.3, 2.1–5.1), and be hospitalized for assaults (15.2, 11.3–20.6), maltreatment (21.0, 14.3–30.9), poisoning (3.6, 2.6–4.8), and mental/behavioral (2.6, 2.1–3.2) and visual (2.9, 2.5-3.5) disorders. Mothers of infants with NAS were more likely to be Indigenous (6.4, 6.0–7.0), have no antenatal care (6.6, 5.9–7.4), and be socioeconomically deprived (1.6, 1.5–1.7). Regression analyses demonstrated that NAS was the most important predictor of admissions for maltreatment (odds ratio 4.5, 95% confidence interval: 3.4–6.1) and mental and behavioral disorders (2.3, 1.9–2.9), even after accounting for prematurity, maternal age, and Indigenous status. Children with NAS are more likely to be rehospitalized during childhood for maltreatment, trauma, and mental and behavioral disorders even after accounting for prematurity. This continues to adolescence and emphasizes the critical need for continued support of this vulnerable group after resolution of NAS.
Publisher: Massachusetts Medical Society
Date: 25-02-2016
Publisher: Massachusetts Medical Society
Date: 21-12-2017
Publisher: Oxford University Press (OUP)
Date: 16-10-2014
DOI: 10.1093/NAR/GKT928
Publisher: CSIRO Publishing
Date: 2009
DOI: 10.1071/RD08224
Abstract: 5α-Reduced steroids, including allopregnanolone, suppress neuronal activity and can have neuroprotective effects in the fetus. 5α-Reductases in the placenta may contribute precursors to brain allopregnanolone synthesis. Preterm birth and glucocorticoids, administered for fetal lung maturation or for maternal asthma, may influence reductase expression. The aims of the present study were to evaluate placental 5α-reductase isoform expression during late gestation and to examine fetal sex differences and the effects of glucocorticoid therapies on the expression of these enzymes. Expression of the two 5α-reductase isoenzymes was measured in placental s les, whereas cortisol concentrations were measured in cord blood, from two cohorts. The first cohort consisted of women who delivered preterm and received betamethasone treatment (n = 41) the second cohort consisted of women who delivered at term and were either healthy controls (n = 30) or asthmatics who had used glucocorticoids (n = 24). Placental expression of both isoenzymes increased with advancing gestation and there were marked sex differences in levels of 5α-reductase I (P 0.05), but not of 5α-reductase II. The expression of both enzymes was positively correlated with cortisol levels (P 0.05), but there was no effect of recent glucocorticoid exposure. These findings suggest that the preterm neonate may have lower developmental exposure to 5α-reduced steroids and may lack steroid-mediated neuroprotection depending on fetal sex.
Publisher: SAGE Publications
Date: 03-10-2012
DOI: 10.5301/JN.5000220
Abstract: Low birth weight (LBW), defined as birth weight below 2,500 g, is an important risk factor for the development of hypertension and renal disease in adult life. LBW is associated with a reduced nephron number, which results in hyperfiltration. The objective of this study was to compare the glomerular filtration rates (GFRs) of LBW and normal-birth-weight (NBW) term infants relative to their kidney volumes. Term infants (born after 37 weeks of gestation) who had been admitted to Townsville Hospital's neonatal unit were recruited for this study. Serum cystatin C was used to calculate gfr. a kidney ultrasound was used to measure renal volume. all assessments were performed during the first week of life. Data from 39 infants (17 male, 22 female 13 LBW, 26 NBW) were analyzed. There were no significant differences in the median cystatin C (1.36 mg/L, inter quartile range [IQR] = 1.12 - 1.41, vs. 1.17 mg/L, IQR = 1.10 - 1.39 p = 0.39) and gestational age. There was no significant difference in the median GFR (53.0 ml/min per 1.73 m2, IQR = 50.8-66.9, vs. 63.2 ml/min per m2, IQR = 51.8-69.5 p = 0.39) between LBW and NBW infants, but LBW infants had smaller total renal volume compared with NBW infants (18.0 ± 4.7 mL vs. 24.4 ± 6.2 mL p = 0.002). Within 6 days, LBW infants achieved a similar GFR to NBW infants, despite 25% smaller kidney volumes. Thus, the single-nephron glomerular filtration rate must be increased in LBW infants. Prior to this study, it was unclear when hyperfiltration begins, but our results demonstrate that hyperfiltration begins in early life.
Publisher: American Academy of Pediatrics (AAP)
Date: 2012
Abstract: To determine whether male gender has an effect on survival, early neonatal morbidity, and long-term outcome in neonates born extremely prematurely. Retrospective review of the New South Wales and Australian Capital Territory Neonatal Intensive Care Unit Data Collection of all infants admitted to New South Wales and Australian Capital Territory neonatal intensive care units between January 1998 and December 2004. The primary outcome was hospital mortality and functional impairment at 2 to 3 years follow-up. Included in the study were 2549 neonates 54.7% were male. Risks of grade III/IV intraventricular hemorrhage, sepsis, and major surgery were found to be increased in male neonates. Hospital mortality (odds ratio 1.285, 95% confidence interval 1.035–1.595) and moderate to severe functional disability at 2 to 3 years of age (odds ratio 1.877, 95% confidence interval 1.398–2.521) were more likely in male infants. Gender differences for mortality and long-term neurologic outcome loses significance at 27 weeks gestation. In the modern era of neonatal management, male infants still have higher mortality and poorer long-term neurologic outcome. Gender differences for mortality and long-term neurologic outcome appear to lose significance at 27 weeks gestation.
Publisher: Georg Thieme Verlag KG
Date: 21-09-2013
Abstract: We performed a study to assess whether the development of the retinal microvasculature reflects nephron growth and therefore nephron number. In our study, we determined the association between kidney volume (nephron number) and the retinal microvasculature of term low-birth-weight (LBW) and normal-birth-weight (NBW) infants (11 LBW and 27 NBW). LBW infants had significantly larger retinal arteriolar and venular diameters (104.2 ± 21.4 versus 87.0 ± 12.7 μm p = 0.004 146.8 ± 19.5 versus 128.0 ± 19.5 μm p = 0.01, respectively) compared with NBW infants. LBW infants also had smaller mean renal volumes (9.3 ± 2.3 versus 12.2 ± 3.1 ml p = 0.008). There were negative correlations between retinal arteriolar and venular diameters and renal volumes (r = -0.34, p < 0.05 r = -0.37, p < 0.05, respectively). The larger the kidney (and, by implication, the greater the nephron number), the smaller are the diameters of retinal arterioles and venules. Thus, the degree of dilation of the retinal microvasculature provides an indirect index of renal growth.
Publisher: BMJ
Date: 05-1994
Abstract: Detailed understanding of the immune response to severe acute respiratory syndrome coronavirus (SARS-CoV)-2, the cause of coronavirus disease 2019 (CO-VID-19) has been h ered by a lack of quantitative antibody assays. The objective was to develop a quantitative assay for IgG to SARS-CoV-2 proteins that could be implemented in clinical and research laboratories. The biotin-streptavidin technique was used to conjugate SARS-CoV-2 spike receptor-binding domain (RBD) or nucleocapsid protein to the solid phase of the ImmunoCAP. Plasma and serum s les from patients hospitalized with COVID-19 (n = 60) and s les from donors banked before the emergence of COVID-19 (n = 109) were used in the assay. SARS-CoV-2 IgG levels were followed longitudinally in a subset of s les and were related to total IgG and IgG to reference antigens using an ImmunoCAP 250 platform. At a cutoff of 2.5 μg/mL, the assay demonstrated sensitivity and specificity exceeding 95% for IgG to both SARS-CoV-2 proteins. Among 36 patients evaluated in a post-hospital follow-up clinic, median levels of IgG to spike-RBD and nucleocapsid were 34.7 μg/mL (IQR 18-52) and 24.5 μg/mL (IQR 9-59), respectively. Among 17 patients with longitudinal s les, there was a wide variation in the magnitude of IgG responses, but generally the response to spike-RBD and to nucleocapsid occurred in parallel, with peak levels approaching 100 μg/mL, or 1% of total IgG. We have described a quantitative assay to measure IgG to SARS-CoV-2 that could be used in clinical and research laboratories and implemented at scale. The assay can easily be adapted to measure IgG to mutated COVID-19 proteins, has good performance characteristics, and has a readout in standardized units.
Publisher: Wiley
Date: 12-2014
DOI: 10.14814/PHY2.12245
Publisher: Elsevier BV
Date: 08-2012
DOI: 10.1016/J.EARLHUMDEV.2012.01.005
Abstract: Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available. To determine current neonatal resuscitation practices and availability of oxygen blending equipment in non-Western hospitals. 196 email addresses were obtained through perinatal societies representing 45 hospitals in 14 countries in Asia, Africa and the Middle East. 68 (34.6%) responses were received from all 14 countries. The majority (90%, n=61) of respondents were aware of recent guideline changes but continued to resuscitate with PO because of the lack of equipment and uncertainty about international guidelines (61%, n=41 for term, 44%, n=30 for preterm). Most (81%, n=55) believed that PO caused adverse effects in term neonates. The availability of oxygen blending equipment correlated significantly with the country's gross domestic product. The majority of the practitioners we surveyed in non-Western countries are aware of the most recent recommendations regarding oxygen use in neonatal resuscitation. However, lack of oxygen blending equipment remains a hindrance to the use of blended gas at resuscitation in low resource, non-western countries. Global guidelines from developed countries must take into account the resource limitations and implementation difficulties faced by countries with restricted resources, where the majority of the high-risk infants are born.
Publisher: American Academy of Pediatrics (AAP)
Date: 07-2009
Abstract: OBJECTIVE: With male gender as a strong predictor of cardiovascular instability, we hypothesized that gender-specific differences in circulating carbon monoxide levels contributed to dysregulated microvascular function in preterm male infants. METHODS: Infants born at 24 to 34 weeks of gestation (N = 84) were studied in a regional tertiary neonatal unit. Carboxyhemoglobin levels were measured through spectrophotometry in umbilical arterial blood and at 24, 72, and 120 hours after birth. Microvascular blood flow was determined through laser Doppler flowmetry. RESULTS: Carboxyhemoglobin levels demonstrated a strong inverse relationship with gestational age (r = −0.636 P & .001) and were higher in boys (P = .032). Repeated-measures analysis of variance showed a significant decrease in arterial carboxyhemoglobin levels over time (P & .001), with significant between-subjects effects for gestational age (P = .011) and gender (P = .025). Positive correlations with microvascular blood flow at 24 hours of age (r = 0.495 P & .001) and 120 hours of age (r = 0.548 P & .001) were observed. With controlling for gestational age, carboxyhemoglobin levels at 72 hours were greater for infants who died in the first week of life (P = .035). CONCLUSIONS: The gestational age- and gender-specific differences in carboxyhemoglobin levels and the relationship with dysregulated microvascular blood flow, a state related to greater illness severity and hypotension, are novel findings not confined solely to sick preterm infants. Both inducible heme oxygenase-dependent and non–heme oxygenase-dependent pathways may initially play a central role in carbon monoxide production, inducing pathophysiologic processes in a gender-specific manner.
Publisher: BMJ
Date: 07-10-2017
DOI: 10.1136/ARCHDISCHILD-2016-312366
Abstract: To determine the association between SpO 2 at 5 min and preterm infant outcomes. Data from 768 infants weeks gestation from 8 randomised controlled trials (RCTs) of lower (≤0.3) versus higher (≥0.6) initial inspiratory fractions of oxygen (FiO 2 ) for resuscitation, were examined. In idual patient analysis of 8 RCTs Lower (≤0.3) versus higher (≥0.6) oxygen resuscitation strategies targeted to specific predefined SpO 2 before 10 min of age. Infants weeks gestation. Relationship between SpO 2 at 5 min, death and intraventricular haemorrhage (IVH) grade 3. 5 min SpO 2 data were obtained from 706 (92%) infants. Only 159 (23%) infants met SpO 2 study targets and 323 (46%) did not reach SpO 2 80%. Pooled data showed decreased likelihood of reaching SpO 2 80% if resuscitation was initiated with FiO 2 .3 (OR 2.63, 95% CI 1.21 to 5.74, p .05). SpO 2 % was associated with lower heart rates (mean difference −8.37, 95% CI −15.73 to –1.01, *p .05) and after accounting for confounders, with IVH (OR 2.04, 95% CI 1.01 to 4.11, p .05). Bradycardia (heart rate bpm) at 5 min increased risk of death (OR 4.57, 95% CI 1.62 to 13.98, p .05). Taking into account confounders including gestation, birth weight and 5 min bradycardia, risk of death was significantly increased with time taken to reach SpO 2 80%. Not reaching SpO 2 80% at 5 min is associated with adverse outcomes, including IVH. Whether this is because of infant illness or the amount of oxygen that is administered during stabilisation is uncertain and needs to be examined in randomised trials
Publisher: Wiley
Date: 06-09-2018
DOI: 10.1111/APA.14012
Abstract: To collate and assess international clinical practice guidelines (CPG) to determine current recommendations guiding oxygen management for respiratory stabilisation of preterm infants at delivery. A search of public databases using the terms 'clinical practice guidelines', 'preterm', 'oxygen' and 'resuscitation' was made and complemented by direct query to consensus groups, resuscitation expert committees and clinicians. Data were extracted to include the three criteria for assessment: country of origin, gestation and initial FiO A total of 45 CPGs were identified: 36 provided gestation specific recommendations (<28 to <37 weeks) while eight distinguished only between 'preterm' and 'term'. The most frequently recommended initial FiO CPG recommendations for delivery room oxygen management of preterm infants vary greatly, particularly in regard to gestational ages, initial FiO
Publisher: BMJ
Date: 29-11-2018
DOI: 10.1136/ARCHDISCHILD-2017-313355
Abstract: To determine the influence of burn injuries on childhood performance in national standardised curriculum-based school tests. Birth and health records of 977 children who were hospitalised with a burn injury between 2000 and 2006 in the state of New South Wales, Australia, were linked to performance scores in the National Assessment Program: Literacy and Numeracy test, a compulsory nationwide curriculum-based test (CBT) and compared with children who were not hospitalised for burns and who were matched for birth year, gender, gestation and socioeconomic status. Test scores in years 3 (ages 8–9), 5 (ages 10–11) and 7 (ages 13–14) in numeracy, writing, reading, spelling, grammar and punctuation. Mean age at first burn injury was 28 months (median: 20, range: 0–140). Children with burns were significantly more likely to have younger mothers (28.5 vs 29.6 years) (P .001), be indigenous (OR 2.5 (95% CI 2.1 to 3.1)) (P .001) and have siblings (OR 1.2 (95% CI 1.1 to 1.4)) (P .001). They were also less likely to meet national minimum standards in most domains of testing until year 5, even after adjustment for parental education levels, parental smoking, maternal age and indigenous status. Each 10% increase in total body surface area burnt was associated with a decrease in year 5 scores by 37.0% in numeracy and 71.9% in writing. Most childhood burn injuries occur before the start of formal schooling. Children who are hospitalised for burns perform more poorly in CBT even after accounting for family and socioeconomic disadvantage. Rehabilitation of children with burn injuries must address school performance to decrease any long-term negative societal impact of burns.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.JAND.2012.09.021
Abstract: The ability of parents to accurately report energy intake in toddlers has rarely been validated using the gold-standard doubly labeled water (DLW) method to assess total energy expenditure (TEE). The aim of the study was to evaluate the accuracy of toddler energy intake (EI), estimated using the Australian Child and Adolescent Eating Survey (ACAES) food frequency questionnaire (FFQ) by parent report compared with a weighed food record (WFR) and TEE measured by DLW. Twelve toddlers had TEE assessed over 10 days using DLW. Usual energy intake was estimated by the primary caregiver, using standard toddler portions in ACAES-FFQ and a 4-day WFR and daily EI (in kilocalories) derived using national nutrient databases. Accuracy of reporting was calculated from absolute (EI-TEE) and percentage (EI/TEE×100) differences between EI and TEE and Pearson correlations and limits of agreement from Bland-Altman plots. Toddlers (n=12, 7 boys) had a mean age of 3.2±0.5 years, body mass index 16.2±0.9 kg, body mass index z score 0.1±0.8, EI from ACAES-FFQ 1,183±281kcal/day, and WFR 1,179±278 kcal/day and DLW TEE 1,251±149 kcal/day. The mean difference and limits of agreement (±2 standard deviations) compared with DLW was -68 (-623, 488) kcal/day for the FFQ and for the WFR -72 (-499, 354) kcal/day. Although both a semiquantitative FFQ and WFR can adequately estimate toddler energy intake at the group level in this population, toddler-specific portion size estimates should be assigned to foods listed in the FFQ. Choice of method is likely to depend on practical issues, including cost and burden.
Publisher: BMJ
Date: 13-02-1993
Publisher: Wiley
Date: 23-06-2013
DOI: 10.1111/J.1440-1754.2007.01113.X
Abstract: In Australian hospitals: (i) to identify current practices in the initial oxygen management of infants with respiratory distress (ii) to identify factors important in deciding to transfer an infant and (iii) to identify thresholds for transfer. All Australian hospitals with: >200 registered deliveries, a special care unit (SCU) or neonatal intensive care unit (NICU), and at least one paediatrician were surveyed in 2004 (n=176). The questionnaire sought information on the initial oxygen management and factors important in deciding to transfer. Three scenarios were also used to identify thresholds for pH, carbon dioxide and oxygen levels at which transfer should occur. Responses from SCU were compared with those from NICU. 15/19 (79%) NICUs and 118/157 (75%) SCUs responded. Initial oxygen management varies widely among SCUs and NICUs. NICUs set significantly lower saturation (SaO(2)) targets in two of the three scenarios. NICUs are statistically significantly more likely to regard 'Medical Staff Experience' and 'Time to Nearest NICU' as important compared with SCUs (P<0.05). NICUs would 'Probably' and 'Definitely Transfer' infants at significantly lower oxygen levels in all three cases (P<0.05). SCUs are significantly less likely to transfer babies with pH of <7.25 compared with NICUs. There was no difference between the centres for CO(2) level. The wide variation that exists between nurseries in the initial management of infants with respiratory distress and in the thresholds for transfer strongly suggests the need for the development of practice guidelines.
Publisher: Elsevier BV
Date: 02-1996
Publisher: BMJ
Date: 02-1991
DOI: 10.1136/ADC.66.2.253
Abstract: A case of congenital parvovirus (B19) viraemia with associated thrombocytopenic purpura and platelet antigen incompatibility in an infant is reported. Results of laboratory investigations indicated that the baby was infected in utero.
Publisher: Wiley
Date: 05-2007
DOI: 10.1111/J.1440-1754.2007.01083.X
Abstract: This study sought to identify the number of special care nurseries (SCNs) already using CPAP in 2004, and the number considering its use in the following 2 years, and to describe the characteristics of those hospitals. All Australian hospitals with >200 registered deliveries in the year 2002, a SCN and at least one paediatrician were eligible (n = 157). Separate questionnaires were sent to the nurse unit manager (NUM) and the paediatrician responsible for the SCN in late 2004. Of 157 eligible SCNs, 143 (91%) responded. CPAP was being used in 24/143 (17%). Of those nurseries not already using CPAP a further 45/119 (38%) were considering doing so in 2005/2006. State/Territory, greater availability of junior medical staff, use of a helicopter/airplane for transferring infants to tertiary centres and number of paediatricians were significantly associated with use of CPAP (all P < 0.05). Consideration of use was significantly associated with greater availability of junior medical staff, larger numbers of births and time to nearest (tertiary) centre (all P < 0.05). There is a strong predisposition for the use of CPAP in SCNs despite the lack of evidence for its benefits or risks there. Studies are urgently required on the clinical benefits and risks of CPAP in a non-tertiary centre before the widespread introduction of CPAP takes place.
Publisher: Wiley
Date: 02-08-2012
DOI: 10.1111/J.1440-1754.2012.02508.X
Abstract: Probiotics are micro-organisms that confer health benefits on the host. Postulated mechanisms include: increasing resistance of the mucosal barrier to migration of bacteria and their toxins by strengthening intestinal cell junctions, modification of host response to microbial products, augmentation of immunoglobulin A mucosal responses, enhancement of enteral nutrition to inhibit the growth of pathogens production of antimicrobial proteins and competitive exclusion of potential pathogens. Published meta-analyses and systematic reviews report the effects of probiotics on important clinical outcomes in neonates. This paper will review the evidence for probiotic supplementation in neonatology, with a focus on preterm infants.
Publisher: Wiley
Date: 2007
DOI: 10.1002/AJMG.A.31867
Abstract: We present two siblings with a previously undescribed congenital disorder of glycosylation (CDG). The first child died in utero with severe hydrops fetalis and the second presented following preterm delivery with respiratory insufficiency, generalised edema and a protein-losing enteropathy. Both had a similar pattern of facial dysmorphism and joint contractures. The diagnosis of CDG-I was made following the birth of the second child based on the serum transferrin isoform pattern. CDG-Ia and -Ib were excluded by specific enzyme analysis. Joint contractures are a relatively uncommon finding in CDG, although fetal hydrops (CDG-Ia) and protein-losing enteropathy (CDG-Ib) are well recognized. CDG must be considered in the differential diagnosis of hydrops fetalis, congenital hypoproteinemia and death in early infancy, particularly when associated with dysmorphic features.
Publisher: American Academy of Pediatrics (AAP)
Date: 05-2017
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2008
Publisher: Wiley
Date: 29-01-2013
DOI: 10.1111/JPC.12093
Abstract: To identify the proportion of preterm infants needing neonatal intensive care (NIC) between 29 and 34 weeks gestation. To identify any associated risk factors. This population-based study identified all babies, born without congenital abnormalities, between 29 and 34 weeks gestation inclusive. A 21-month period ending September 2009 was used. The need for NIC was defined using specific cardiorespiratory and nutritional criteria. The use of continuous positive airway pressure alone was not included as a need for NIC. Data were extracted from a neonatal clinical database and in idual medical records. Complete data were available from 707 out of 709 eligible infants born in the study period. The percentage of infants requiring cardiorespiratory support varied from 39 to 2.7% at 29 and 34 weeks, respectively. If nutritional criteria were included, this increased to 77% at 29 weeks and 7.2% at 34 weeks. Multivariate analysis determined that gestational age and delivery by Caesarean section increased the need for intensive care (P-value <0.01). Antenatal steroids, gender, underlying maternal medical conditions, being small for gestational age or twin pregnancy had no statistically significant impact. This study supports the National Health and Medical Research Council Guidelines of in-utero transfer at <33 weeks gestation. Gestational age and delivery by Caesarean section remain major indicators for the need for NIC. In special care nurseries that have the capability and expertise to use nasal continuous positive airway pressure, the main indication for NIC is for nutritional support.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2013
Publisher: Springer Science and Business Media LLC
Date: 04-04-2013
Publisher: Wiley
Date: 25-01-2010
Publisher: Elsevier BV
Date: 03-2021
Publisher: Springer Science and Business Media LLC
Date: 04-08-2016
DOI: 10.1038/PR.2016.156
Abstract: The preterm newborn is at high risk of developing cardiovascular compromise during the first day of life and this is associated with increased risk of brain injury. Standard treatments are volume expansion and administration of inotropes, typically dopamine and/or dobutamine, but there is limited evidence that inotropes improve clinical outcomes. This study investigated the efficacy of dopamine and dobutamine for the treatment of cardiovascular compromise in the preterm newborn using a piglet model. Preterm and term piglets were assigned to either dopamine, dobutamine or control infusions. Heart rate, left ventricular contractility, cardiac output, blood pressure, and cerebral and regional blood flows were measured during baseline, low (10 µg/kg/h), and high (20 µg/kg/h) dose infusions. At baseline, preterm piglets had lower cardiac contractility, cardiac output, blood pressure, and cerebral blood flow compared to term piglets. The response of preterm piglets to either dopamine or dobutamine administration was less than in term piglets. In both preterm and term piglets, cardiac output and cerebral blood flow were unaltered by either inotrope. In order to provide better cardiovascular support, it may be necessary to develop treatments that target receptors with a more mature profile than adrenoceptors in the preterm newborn.
Publisher: Wiley
Date: 13-09-2012
DOI: 10.1111/J.1440-1754.2012.02557.X
Abstract: The frequency of premature births is increasing world-wide. This factor, combined with improved survival and revised screening criteria, is resulting in an increased workload in screening for retinopathy of prematurity. Digital retinal imaging is emerging as an important alternative tool for diagnosing retinopathy of prematurity, and its use has even been extended to developing countries. Neonatal nurses and technicians can be trained to use digital imaging devices effectively. This is important in areas that do not have ready access to paediatric ophthalmologists. The ability to transfer images electronically makes it a valuable tool in telemedicine, while the ability to store and retrieve images is also advantageous from a medico-legal perspective. Image analysis software can further improve the accuracy of diagnosis. The main limitation of this technology is its high capital cost.
Publisher: Springer Science and Business Media LLC
Date: 05-10-2013
Publisher: Wiley
Date: 05-02-2016
DOI: 10.1111/PPE.12282
Abstract: This study analyses the incidence of Neonatal Abstinence Syndrome (NAS) in a large geographically defined population in Australia. Database linkage analysis of all births between 2000 and 2011 in New South Wales (NSW), Australia. The diagnosis of NAS was derived from hospital coding P96.1, 'Neonatal withdrawal symptoms from maternal use of drugs of addiction'. Temporal trends were studied by comparing epoch 1 (2000-05) with epoch 2 (2006-11). The relationship with changes in maternal factors was further analysed. The NAS was coded in 3842 of 1 022 263 live born infants (0.38%). NAS incidence peaked at 5.07 per 1000 live births in 2002, decreasing to 3.18 in 2011 and was negatively correlated with maternal age (r = -0.7). The rate of NAS in epoch 2 (3.4 per 1000 births, 95% CI 3.28, 3.58) was significantly lower than in epoch 1 (4.1 per 1000 births, 95% CI 3.96, 4.33). Epoch 2 mothers were significantly older (mean 29.8 years vs. 28.3 years), less likely to be multiparous (OR 0.7, 95% CI 0.6, 0.9) or smoke (OR 0.4, 95% CI 0.4, 0.5). They were more likely to engage in antenatal care earlier (mean first visit: 14.1 vs. 18.9 weeks). Most infants (~80%) were born at term (>37 weeks gestation). The incidence of NAS as a discharge diagnosis has decreased in our population since 2002. Mothers are also older and engaging earlier in prenatal care. Whether these changes alter NAS presentation and diagnosis or whether pregnant women are using drugs that do not cause typical NAS (e.g. hetamines) is uncertain and requires further study.
Publisher: Elsevier BV
Date: 03-2021
Publisher: BMJ
Date: 06-2017
Publisher: Springer Science and Business Media LLC
Date: 11-02-2009
Publisher: American Medical Association (AMA)
Date: 07-2012
DOI: 10.1001/ARCHPEDIATRICS.2012.284
Abstract: To investigate the effects of hypothermia treatment on magnetic resonance imaging (MRI) patterns of brain injury in newborns with hypoxic-ischemic encephalopathy compared with normothermia, including the prognostic utility of MRI for death and/or disability at a postnatal age of 2 years. Substudy of a randomized controlled trial. Participating centers in the Infant Cooling Evaluation trial. Trial participants (gestational age ≥35 weeks with moderate to severe hypoxic-ischemic encephalopathy, randomized to whole-body hypothermia or normothermia) with available MRIs. We performed qualitative evaluation of T1- and T2-weighted and diffusion MRIs. The posterior limb of the internal capsule was classified as normal or abnormal, whereas the basal ganglia and thalami, white matter, and cortical gray matter were classified as normal or mildly abnormal or moderately/severely abnormal. Death or major disability at 2 years. We evaluated 127 MRIs (66 patients treated with hypothermia and 61 with normothermia mean age at scan, 6 postnatal days). The odds of having moderate/severe white matter or cortical gray matter abnormalities on T1- and T2-weighted MRI were reduced by hypothermia (white matter odds ratio, 0.28 [95% CI, 0.09-0.82] gray matter odds ratio, 0.41 [0.17-1.00]). Abnormal MRI findings predicted adverse outcomes, with T1- and T2-weighted and diffusion MRI abnormalities in the posterior limb of the internal capsule and basal ganglia and thalami demonstrating the greatest predictive value. There was little evidence that prognostic value of the MRI was modified by therapeutic hypothermia (all interactions, P > .05). Brain injury on T1- and T2-weighted MRI is reduced in hypothermia-treated newborns. Abnormal MRI findings are prognostic of long-term outcome in moderate to severe hypoxic-ischemic encephalopathy regardless of treatment with hypothermia.
Publisher: Public Library of Science (PLoS)
Date: 18-03-2016
Publisher: Springer Science and Business Media LLC
Date: 15-12-2011
DOI: 10.1038/PR.2011.9
Abstract: Microvascular dysfunction, characterized by inappropriate vasodilatation and high blood flow in the peripheral microcirculation, is linked to physiologic instability and poor outcome in neonates. Specifically, preterm neonates have significantly higher levels of baseline microvascular blood flow than term neonates at 24 h postnatal age. Because of similarities between human and guinea pig endocrine profiles and maturity at birth, we hypothesized that preterm guinea pig neonates would provide a suitable model for studying the mechanisms underlying transitional microvascular function. Guinea pigs that were delivered preterm showed immaturity and had markedly reduced viability. Baseline microvascular blood flow was significantly higher in preterm animals than in term animals. No effect of intrauterine growth restriction or birth weight on baseline microvascular blood flow was observed in either preterm or term animals. These results are consistent with recent clinical findings and support the use of the guinea pig as a suitable model for future studies of the mechanisms underlying perinatal microvascular behavior. Guinea pigs were delivered either prematurely or at term. Laser Doppler flowmetry was used to study microvascular blood flow at 23 h postnatal age.
Publisher: Wiley
Date: 23-12-2013
DOI: 10.1111/JPC.12468
Abstract: To describe the epidemiology of enteroviral meningoencephalitis in northern New South Wales, Australia, with a specific focus on neonatal and young infant cases. A retrospective review of PCR-confirmed enteroviral meningoencephalitis cases in the Hunter New England Local Health District of northern NSW was conducted for the period 2008-2012. One hundred nine patients met the case definition. There was summer seasonality, with 50% (55/109) of cases occurring between December and February. Neonates and young infants (<3 months of age) accounted for 42% (46/109) of cases, with 20% (9/46) being premature births. Fever (83%) was the most common presentation in this age group, followed by irritability (40%), feeding difficulties (40%) and rash (17%). All received at least one antibiotic during their admission, with 26% (12/46) also treated empirically with acyclovir. There was one death. Where testing was undertaken, cerebrospinal fluid (CSF) protein levels were high in 90% (28/31) of neonates and young infants, but the CSF white cell count was variable, with 57% 100/mm(3) . Early diagnosis of enteroviral meningoencephalitis could alter management, potentially reducing the period of treatment with empirical antimicrobials and permitting earlier discharge.
Publisher: Wiley
Date: 27-06-2018
DOI: 10.1111/APA.14436
Abstract: This study aimed to determine whether neonatal intensive care therapies increase the risk of carcinogenesis in childhood. This study used population-based data on 1 072 957 infants born in New South Wales, Australia, between 2000 and 2011 and multivariate logistic regression to examine any associations between therapies used in the neonatal intensive care unit and diagnoses of cancer until mid 2012. A total of 1126 of 1 072 957 (0.1%) children were diagnosed with cancer. Cancer risk was significantly increased by preterm birth (gestation <37 weeks adjusted odds ratio (aOR) 1.3 (95% confidence interval: 1.0-1.6), birth weight ≥4 kg (aOR 1.4, 1.2-1.6) and caesarean delivery (aOR 1.2, 1.1-1.4). Extremely preterm (<28 weeks of gestation) infants were more likely to develop hepatic tumours (aOR 12.7, 3.3-48.3) than term infants. The only therapy used in the neonatal intensive care that was independently associated with an increased risk of cancer was nitric oxide (aOR 8.6, 4.3-17.4). Eight of the 790 (1%) infants treated with nitric oxide developed cancer (gestation range 30-41 weeks, age of cancer diagnosis: four months-five years). Treatment with nitric oxide was associated with a higher risk of childhood cancer. These findings require further research.
Publisher: Wiley
Date: 14-07-2016
DOI: 10.1111/APA.13503
Abstract: This population-based study determined the delivery room management and outcomes of extremely preterm infants born with Apgar scores of 0. We linked birth, neonatal intensive care unit (NICU) and death records for babies who were born between 22 + 0 and 27 + 6 weeks of gestation with a one-minute Apgar score of 0, in New South Wales, Australia, between 1998 and 2011. We classified 2173/2262 (96%) of infants with a one-minute Apgar score of 0 as stillborn. Resuscitation was provided for 48/89 (54%) live births and 40/2173 (2%) stillbirths. Cardiac massage was given to 44 infants, including three 22-week stillborn babies. Of the 13 live births admitted to an NICU, 11 survived to hospital discharge. Most (98%) of the 2212 deaths occurred on the first day of life. One baby who was classified as stillborn lived for 51 days. Resuscitation increased the mean (95% confidence interval) duration of survival from 1 (0-2) to 45 (0-104) hours (p < 0.001). No infant with a five-minute Apgar score of 0 survived. Clinicians resuscitated extremely preterm infants without a detectable heartbeat, even at 22 weeks of gestation. No infant survived without resuscitation or if their heartbeat was not regained by five minutes.
Publisher: MDPI AG
Date: 12-10-2021
DOI: 10.3390/NU13103561
Abstract: Supplementation of omega-3 long chain polyunsaturated fatty acids (n-3 LCPUFA) may enhance self-regulation (SR) and executive functioning (EF) in children of preschool age. The aim of the Omega Kid Study was to investigate the effect of n-3 LCPUFA supplementation on SR and EF in typically developing preschool-aged children. A double-blind placebo-controlled pilot trial was undertaken, the intervention was 12 weeks and consisted of 1.6 g of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day compared to placebo. The HS-Omega-3 Index® was assessed by capillary blood s les at baseline and post-intervention. Seventy-eight children were enrolled and randomised to either the n-3 LCPUFA treatment (n = 39) or placebo (n = 39) group. Post intervention, there was a significant three-fold increase in the HS-Omega-3 Index® in the n-3 LCPUFA group (p 0.001). There were no improvements in SR or EF outcome variables for the n-3 LCPUFA group post intervention compared to the placebo group determined by linear mixed models. At baseline, there were significant modest positive Spearman correlations found between the HS-Omega-3 index® and both behavioural self-regulation and cognitive self-regulation (r = 0.287, p = 0.015 and r = 0.242, p = 0.015 respectively). Although no treatment effects were found in typically developing children, further research is required to target children with sub-optimal self-regulation who may benefit most from n-3 LCPUFA supplementation.
Publisher: Springer Science and Business Media LLC
Date: 06-08-2016
DOI: 10.1038/PR.2016.160
Abstract: Microvascular dysregulation following preterm birth is associated with increased illness severity and hypotension, particularly in males. Sympathetic nervous vascular regulation is evident in females. We hypothesized that sympathetic dysfunction in male preterm infants may contribute to a failure of peripheral microvascular vasoconstriction. Microvascular blood flow of infants 24-43 wk gestational age was assessed at 6, 24, and 72 h of age by laser Doppler. Blood flow Fourier transformed frequency distribution spectra (low frequency/high frequency ratio) were used to assess the influence of sympathetic tone on microvascular regulation. Total sympathetic output was assessed as urinary normetanephrine. Microvascular sympathetic activity at 24 h postnatal age decreased in early preterm males, but not females. Peripheral sympathetic activity increased with advancing postnatal age in females, but decreased in males. In early preterm infants, total normetanephrine outputs increase significantly with postnatal age, in both sexes. Sympathetic activation following preterm birth is sexually dimorphic, with preterm males having reduced sympathetic tone and reduced upregulation of sympathetic tone following birth. There is evidence of a disconnect between central sympathetic activity and local peripheral microcirculatory sympathetic drive. This may relate to autonomic nervous immaturity and highlights the need to understand how preterm birth may affect autonomic function.
Publisher: Public Library of Science (PLoS)
Date: 03-02-2016
Publisher: Springer Science and Business Media LLC
Date: 02-03-2018
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.PLACENTA.2011.08.010
Abstract: Glucocorticoids (GC) are known to influence fetal ROS production and anti-oxidant defences yet little attention has focused on the potential for effects in the placenta. We hypothesised that antenatal GC exposure alters placental pro-oxidant-anti-oxidant balance sex-specifically, based upon the known relationship between male sex and poor pregnancy outcome. Placentae were collected from 60 women who delivered between 24 and 31 completed weeks gestation and placental oxidative and nitrative stress (protein carbonyl, lipid hydroperoxide, and nitrotyrosine concentration) and anti-oxidant enzyme activity (glutathione peroxidase, thioredoxin reductase, and superoxide dismutase) measured. A pro-oxidant state was observed in placentae of male compared to female infants born within 72 h of antenatal GC exposure, with higher levels of protein carbonyl content (p = 0.04), lipid hydroperoxide (p < 0.01) and nitrotyrosine content (p = 0.02), and lower levels of glutathione peroxidase activity (p = 0.01). A pro-oxidant state continued to be observed in placentae of males compared to females born outside of 72 h, with higher protein carbonyl content (p = 0.04) and lower glutathione peroxidase activity (p = 0.01) than females, however no differences in placental lipid hydroperoxide and nitrotyrosine content were observed. These sex-specific alterations in products of placental oxidative stress could not purely be explained by differences in clinical illness severity (CRIB2 score). Therefore, these sex-specific alterations in placental pro-oxidant-antioxidant balance in response to antenatal betamethasone exposure, independent of illness severity, could contribute to the patho-physiologic processes underlying oxygen radical diseases of the newborn, conditions known to exhibit a male excess.
Publisher: Springer Science and Business Media LLC
Date: 04-04-2017
Publisher: Wiley
Date: 02-07-2018
DOI: 10.1113/JP275583
Publisher: Wiley
Date: 26-10-2015
DOI: 10.1111/BCP.12741
Publisher: Elsevier BV
Date: 11-2011
DOI: 10.1016/J.MVR.2011.07.011
Abstract: Currently, there are no published data on retinal microvasculature size in human infants born at term. The purpose of this study was to determine the normal retinal microvasculature measurements in human infants born at term with normal birth weight and to compare these results with measurements in children and adults. Retinal arteriole and venule measurements were obtained in a cohort of 20 full-term infants. Digital retinal images were obtained from both eyes after pupillary dilation using a digital retinal camera. Measurements of vessel diameter were then obtained using semi-automated software. Twenty infants (9 female infants and 11 male infants) were analyzed. The retinal arteriole diameter was 66.8-123.0 μm (mean, 85.5 (14.3) μm), and the venule diameter was 102.0-167.8 μm (mean, 130.0 (16.0) μm). There were no differences in the arterial or venule diameters between the male and female infants (83.2 (12.2) vs. 88.3 (16.9) P=0.4372 124.3 (16.0) vs. 137.0 (18.0) P=0.08). The arteriovenous ratio was found to be 0.66 (95% CI 0.62-0.71). The coefficient of correlation between the retinal arterioles and venules was 0.56. The retinal arteriole and venule diameters increase as a person matures. The arteriovenous ratio also increases with age. In newborn infants, retinal venules are significantly larger than retinal arterioles. The arteriovenous ratio is smaller in neonates compared to adults indicating the retinal arteriole diameter increases at a different pace compared to retinal venule. Sex does not influence the retinal microvasculature size in infants. The presence of spontaneous retinal hemorrhage and the inability to account for refractive errors were the main limitations of this study.
Publisher: Wiley
Date: 30-10-2019
DOI: 10.1111/MICC.12507
Abstract: H Preterm (GA62) and full-term (GA69) guinea pig fetuses and neonates were studied. Microvascular blood flow was assessed by laser Doppler flowmetry. Thiosulfate, primary urinary metabolite of H In preterm animals, postnatal H In preterm neonates, H
Publisher: BMJ
Date: 05-05-2017
DOI: 10.1136/ARCHDISCHILD-2016-310435
Abstract: To systematically review outcomes of infants ≤28+6 weeks gestation randomised to resuscitation with low (≤0.3) vs high (≥0.6) fraction of inspired oxygen (FiO Systematic review of randomised controlled trials of low (≤0.3) vs high (≥0.6) FiO Death in hospital, bronchopulmonary dysplasia (BPD), retinopathy of prematurity >grade 2 (ROP), intraventricular haemorrhage >grade 2 (IVH), patent ductus arteriosus (PDA) and necrotising enterocolitis (NEC). A total of 251 and 253 infants were enrolled in 8 studies (6 masked, 2 unmasked) in the lower and higher oxygen groups, respectively, (mean gestation 26 weeks) between 2005 and 2014. There were no differences in BPD (relative risk, 95% CIs 0.88 (0.68 to 1.14)), IVH (0.81 (0.52 to 1.27)), ROP (0.82 (0.46 to 1.46)), PDA (0.95 (0.80 to 1.14)) and NEC (1.61 (0.67 to 3.36)) and overall mortality (0.99 (0.52 to 1.91)). Mortality was lower in low oxygen arms of masked studies (0.46 (0.23 to 0.92), p=0.03) and higher in low oxygen arms of unmasked studies (1.94 (1.02 to 3.68), p=0.04). There is no difference in the overall risk of death or other common preterm morbidities after resuscitation is initiated at delivery with lower (≤0.30) or higher (≥0.6) FiO
Publisher: Wiley
Date: 06-2017
DOI: 10.14814/PHY2.13304
Publisher: Wiley
Date: 25-04-2012
DOI: 10.1111/J.1440-1754.2012.02471.X
Abstract: To ascertain the characteristics and short-term outcomes of infants born to illicit drug-using mothers in public hospitals in the state of New South Wales and the Australian Capital Territory during 2004. Patients were identified retrospectively by hospital records searches using ICD-10 morbidity codes and records of local Drug and Alcohol Services. Records were reviewed on site. All public hospitals (n= 101) with obstetric services were included. A total of 879 (1.4%, 95% confidence interval: 1.3-1.5%) drug-using mothers were identified from 62,682 confinements. Opiates (46.8%), hetamines (23.0%) and polydrug (16.4%) exposure were most common. There were eight stillbirths. Among these 871 infants, prematurity (23.6%) and low birthweight (27.1%) were common and 51.1% were admitted to nurseries for further care. Two infants died. Major congenital anomalies were detected in 15 infants. Pharmacological treatment for withdrawal was required for 202 (23.2%), and 143 (70.8%) infants were discharged home on medication. Infants who completed inpatient pharmacological treatment were hospitalised longer (median 26.0 vs. 12.0 days) and were more likely to be premature (37.3 vs. 14.0%). Child-at-risk notifications affected 40.6% of the infants, and 7.6% were fostered prior to discharge. A total of 333 (38.2%) infants were breastfed at discharge. Our regional study highlights a substantial prevalence of drug use in pregnancy with considerable adverse perinatal and hospital outcomes in infants born to these mothers. Coordinated health care and resources are needed to support these mother-infant pairs because of their social, medical and mental-health issues.
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.EARLHUMDEV.2014.04.017
Abstract: Early respiratory management of very low birth weight infants has changed over recent years to a practice of early use of CPAP with early selective surfactant administration, and decreased use of mechanical ventilation. One strategy is to use the combination of surfactant and prompt extubation to nasal continuous positive airway pressure (INtubate, SURfactant, Extubate, or INSURE). The aim of this study is to describe blood flow and ductal flow in a prospective cohort during the transitional period when this respiratory management strategy is used. Inborn infants <29week gestation underwent INSURE within 30min of birth using 200mg/kg Curosurf. Blood pressure and blood flow parameters (RVO, LVO, SVC flow, ductus arteriosus) were measured at 6, 24 and 72h of age and information on morbidity was collected. Sixty-eight infants with a median (range) weight of 940 (450-1380) g were studied. 13 (19%) patients needed mechanical ventilation within 72h of life (INSURE failure). Blood flows and blood pressure were within reported ranges. Eleven (16%) patients had a blood pressure <gestational age and 9 (13%) patients had low blood flow. These data show a low prevalence of low blood pressure and low blood flow in the first 3days after INSURE as compared to cohorts where mechanical ventilation was preferred during transition. We speculate that altered ventilation strategies have helped decrease the incidence of low blood flow and low blood pressure.
Publisher: Cambridge University Press (CUP)
Date: 12-12-2014
DOI: 10.1017/S2040174414000592
Abstract: Preterm birth is common and the associated short-term morbidity well described. The adult-onset consequences of preterm birth are less clear, but cardiovascular and metabolic health may be adversely affected. Although large animal models of preterm birth addressing important short-term issues exist, long-term studies are h ered by significant logistical constraints. Current small animal models of prematurity require terminal caesarean section of the mother both caesarean birth and early maternal care modify offspring adult cardio-metabolic function. We describe a novel method for inducing preterm labour in guinea pigs. With support comparable to that received by moderately preterm human infants, preterm pups are viable. Growth trajectories between preterm and term-born pups differ significantly between term equivalent age and weaning ex-preterm animals demonstrate increased weight and ponderal index. We believe this novel paradigm will significantly improve our ability to investigate the cardio-metabolic sequelae of preterm birth throughout the life course and into the second generation.
Publisher: American Academy of Pediatrics (AAP)
Date: 2017
Abstract: Lower concentrations of oxygen (O2) (≤30%) are recommended for preterm resuscitation to avoid oxidative injury and cerebral ischemia. Effects on long-term outcomes are uncertain. We aimed to determine the effects of using room air (RA) or 100% O2 on the combined risk of death and disability at 2 years in infants & weeks’ gestation. A randomized, unmasked study designed to determine major disability and death at 2 years in infants & weeks’ gestation after delivery room resuscitation was initiated with either RA or 100% O2 and which were adjusted to target pulse oximetry of 65% to 95% at 5 minutes and 85% to 95% until NICU admission. Of 6291 eligible patients, 292 were recruited and 287 (mean gestation: 28.9 weeks) were included in the analysis (RA: n = 144 100% O2: n = 143). Recruitment ceased in June 2014, per the recommendations of the Data and Safety Monitoring Committee owing to loss of equipoise for the use of 100% O2. In non-prespecified analyses, infants & weeks who received RA resuscitation had higher hospital mortality (RA: 10 of 46 [22%] than those given 100% O2: 3 of 54 [6%] risk ratio: 3.9 [95% confidence interval: 1.1–13.4] P = .01). Respiratory failure was the most common cause of death (n = 13). Using RA to initiate resuscitation was associated with an increased risk of death in infants & weeks’ gestation. This study was not a prespecified analysis, and it was underpowered to address this post hoc hypothesis reliably. Additional data are needed.
Publisher: The Endocrine Society
Date: 11-2003
Abstract: CRH plays a central role as a mediator of the hypothalamic-pituitary-adrenal axis and stress response and is a potent vasodilator. Previously, we have shown that CRH causes a gender-specific vasodilation in human skin, although the mechanism by which CRH operates is unclear. CRH causes mast cell degranulation in rat skin. As such, histamine and other mast cell-derived factors may be indirectly responsible for the vasodilatory effects of CRH, although CRH is also known to act directly on the vasculature. CRH-induced vasodilation in human skin was examined using laser Doppler flowmetry and iontophoresis in adult females. CRH (1 nM) was administered iontophoretically to the forearm, and blood flow was measured simultaneously in the same area by laser Doppler. CRH-induced dilation of the skin microvasculature was significantly reduced in the presence of the mast cell degranulation inhibitor, sodium cromoglycate, the histamine H(1)-antagonist, promethazine, or the H(2)-antagonist, ranitidine. CRH-induced dilation was also significantly reduced in the presence of the nitric oxide synthase inhibitor, N(omega)-nitro-L-arginine methyl ester, or the cyclooxygenase inhibitor, piroxicam. These findings provide novel evidence that CRH-induced vasodilation in human skin occurs via mast cell degranulation and is principally mediated by histamine and, to a lesser extent, by prostacyclin and nitric oxide.
Publisher: Georg Thieme Verlag KG
Date: 17-11-2011
Abstract: With improved health care, the number of premature babies who survive to adulthood is expected to increase. The objective of this review is to determine whether premature infants have an increased risk of chronic kidney disease (CKD). A literature review was performed by searching PubMed (U.S. National Library of Medicine) and the Cochrane Library, using the keywords "prematurity," "kidney," "nephrogenesis," "oligonephropathy," and "kidney impairment." Articles published in English since 1990 were reviewed. Increasing evidence suggests that prematurity causes oligonephropathy independently of, and coexisting with, intrauterine growth restriction. Animal studies show that nephrogenesis continues for up to 3 weeks in extrauterine life, but with up to 18% abnormal glomeruli. Nephrogenesis is further impaired in preterm infants who develop renal impairment in the early postnatal period, which is estimated to be 8 to 24%. Premature infants are at risk for CKD. A larger longitudinal study is needed that follows up premature infants to determine the exact incidence of CKD. Until then, renal assessment in premature infants should be incorporated into follow-up guidelines, in addition to the current assessment of growth and neurodevelopmental outcomes. The cost implications to a comprehensive program, impact of early identification, and strategies to improve outcomes in this population are needed.
Publisher: Springer New York
Date: 25-10-2011
Publisher: American Physiological Society
Date: 08-2009
DOI: 10.1152/AJPREGU.00175.2009
Abstract: Placental 11β-hydroxysteroid dehydrogenase-2 (11βHSD2) limits fetal glucocorticoid exposure and is associated with physiological stability in the premature newborn infant. Antenatal betamethasone alters 11βHSD2 activity and confers sex-specific advantages in neonatal outcome. We investigated the influence of betamethasone and sex on 11βHSD2 activity, neonatal adrenal function and clinical course in 24- to 36-wk gestation neonates from birth to day 5 of life. Univariate analyses demonstrated an interaction between timing of betamethasone exposure and sex for 11βHSD2 activity rate ( P = 0.02) and umbilical arterial cortisol ( P = 0.01). For infants born 72 h following antenatal betamethasone, females had higher 11βHSD2 activity ( P 0.01) and umbilical arterial cortisol ( P = 0.01) than males. Females born 72 h of betamethasone exposure had higher day 1 urinary cortisol, if exposed to perinatal stress, than males ( P 0.01). For infants born 72 h after betamethasone exposure, 11βHSD2 activity was negatively correlated with Clinical Illness Severity Score score ( r = −0.79 P = 0.01) and positively correlated with mean arterial blood pressure ( r = 0.8 P = 0.01) only in females. Sex-specific placental 11BHSD2 autoregulation following antenatal betamethasone exposure may limit adrenal suppression in females influencing physiological stability following preterm birth. A lack of adjustment in 11βHSD2 and adrenal response may contribute to the increased incidence of poor outcome observed in preterm males.
Publisher: BMJ
Date: 1995
DOI: 10.1136/FN.72.1.F79
Publisher: Elsevier BV
Date: 06-1994
Publisher: Elsevier BV
Date: 1995
DOI: 10.1016/0195-6701(95)90294-5
Abstract: The level of contamination of stethoscopes used in a neonatal intensive care unit was studied, along with the practices used for cleaning these items. A policy of alcohol cleaning was introduced and the effect of this change on the level of bacterial growth was observed after a six-week period. It was found that 71% of stethoscopes had a significant bacterial growth and that this was reduced to 30% after the cleaning procedure change (P < 0.05). Stethoscopes and other equipment are a potential source of nosocomial infection on the neonatal intensive care unit.
Publisher: BMJ
Date: 27-02-1993
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2008
Publisher: Cambridge University Press (CUP)
Date: 08-11-2013
DOI: 10.1017/S2040174413000494
Abstract: Rates of chronic kidney disease (CKD) among Indigenous groups in Australia exceed non-Indigenous rates eight-fold. Using kidney volume as a surrogate for nephron number, we carried out a study to determine if Indigenous neonates have a smaller kidney volume (and thus a reduced nephron number) from birth compared with non-Indigenous neonates. We recruited term and preterm neonates ( weeks) at a tertiary care neonatal unit over a 12 months period. Preterm neonates were assessed (renal sonography and renal function measurement) at 32 weeks corrected age (CA) and again at 38 weeks CA when blood pressure was also measured. All term neonates were assessed in the first post-natal week, including renal sonography, renal function and blood pressure measurement. The primary outcome measured was total kidney volume (TKV) and estimated glomerular filtration rate (eGFR) was a secondary outcome. Data was available for 44 preterm (11 Indigenous) and 39 term (13 Indigenous) neonates. TKV of Indigenous neonates was significantly lower at 32 weeks [12.0 (2.0) v. 15.4 (5.1) ml P =0.03] and 38 weeks CA [18.6 (4.0) v. 22.6 (5.9) ml P =0.04] respectively. Term Indigenous neonates also had smaller kidney volumes compared with non-Indigenous neonates. Despite a smaller kidney volume (and reduced nephron number), Indigenous neonates did not have a significantly lower eGFR. Indigenous neonates achieve similar eGFRs to Non-Indigenous neonates, presumably through a higher single nephron filtration rate. This places Indigenous neonates at a greater risk of long-term kidney damage later in life.
Publisher: Wiley
Date: 24-06-2016
DOI: 10.1111/APA.13485
Abstract: This study determined current international clinical practice and opinions regarding initial fractional inspired oxygen (FiO2 ) and pulse oximetry (SpO2 ) targets for delivery room resuscitation of preterm infants of less than 29 weeks of gestation. An online survey was disseminated to neonatal clinicians via established professional clinical networks using a web-based survey programme between March 9 and June 30, 2015. Of the 630 responses from 25 countries, 60% were from neonatologists. The majority (77%) would target SpO2 between the 10th to 50th percentiles values for full-term infants. The median starting FiO2 was 0.3, with Japan using the highest (0.4) and the UK using the lowest (0.21). New Zealand targeted the highest SpO2 percentiles (median 50%). Most respondents agreed or did not disagree that a trial was required that compared the higher FiO2 of 0.6 (83%), targeting the 50th SpO2 percentile (60%), and the lower FiO2 of 0.21 (80%), targeting the 10th SpO2 percentile (78%). Most (65%) would join this trial. Many considered that evidence was lacking and further research was needed. Clinicians currently favour lower SpO2 targets for preterm resuscitation, despite acknowledging the lack of evidence for benefit or harm, and 65% would join a clinical trial.
Publisher: Springer Science and Business Media LLC
Date: 12-2006
DOI: 10.1016/J.JSGI.2006.06.006
Abstract: Peripheral microvascular function is altered in preecl sia (PE). Recent studies suggest that maternal physiology varies with fetal sex. We wanted to examine if there were sex-specific differences in maternal peripheral microvascular function in normal pregnancy and pregnancy complicated by PE. Peripheral microvascular responses were examined using the noninvasive technique of laser Doppler flowmetry in normotensive healthy pregnant women and in women diagnosed with PE. We measured baseline perfusion, response to thermal hyperemia, post-occlusive reperfusion, and vasodilatation in response to corticotropin-releasing hormone (CRH), a potent vasodilator in human skin. At 31 to 40 weeks' gestation those women with a male fetus exhibited increased vasodilatation in response to CRH (P <.05) and greater baseline perfusion (P <.05) than those pregnant with a female fetus. PE women pregnant with a male fetus demonstrated a significantly reduced vasodilatation in response to CRH (P <.05), reduced baseline perfusion (P <.05), and reduced response to thermal hyperemia (P <.05) compared to normotensive women pregnant with a male fetus. Microvascular function was not significantly different between preecl tic and normotensive women with a female fetus. These data show that there are differences in maternal peripheral microvascular function in relation to fetal sex.
Publisher: American Academy of Pediatrics (AAP)
Date: 06-2017
Publisher: American Academy of Pediatrics (AAP)
Date: 02-2017
Abstract: Little is known of the long-term, including school, outcomes of children diagnosed with Neonatal abstinence syndrome (NAS) (International Statistical Classification of Disease and Related Problems [10th Edition], Australian Modification, P96.1). Linked analysis of health and curriculum-based test data for all children born in the state of New South Wales (NSW), Australia, between 2000 and 2006. Children with NAS (n = 2234) were compared with a control group matched for gestation, socioeconomic status, and gender (n = 4330, control) and with other NSW children (n = 598 265, population) for results on the National Assessment Program: Literacy and Numeracy, in grades 3, 5, and 7. Mean test scores (range 0–1000) for children with NAS were significantly lower in grade 3 (359 vs control: 410 vs population: 421). The deficit was progressive. By grade 7, children with NAS scored lower than other children in grade 5. The risk of not meeting minimum standards was independently associated with NAS (adjusted odds ratio [aOR], 2.5 95% confidence interval [CI], 2.2–2.7), indigenous status (aOR, 2.2 95% CI, 2.2–2.3), male gender (aOR, 1.3 95% CI, 1.3–1.4), and low parental education (aOR, 1.5 95% CI, 1.1–1.6), with all Ps & .001. A neonatal diagnostic code of NAS is strongly associated with poor and deteriorating school performance. Parental education may decrease the risk of failure. Children with NAS and their families must be identified early and provided with support to minimize the consequences of poor educational outcomes.
Publisher: BMJ
Date: 20-09-2006
Publisher: The Endocrine Society
Date: 2002
Abstract: Males and females have a significantly different life expectancy because of the cardioprotective effects of estrogen. The mechanisms that result in this difference between the sexes are not fully understood. However, stress is a contributing factor to the development of cardiovascular disease, and stress-related factors derived from central or peripheral sources may have differential effects in the modulation of cardiovascular function in males and females. CRH is a central modulator of the stress response and is known to have vasodilator effects in a number of vascular beds. We have examined whether CRH has vasodilator effects in human skin and whether this effect is different between males and females using laser Doppler and iontophoresis. CRH (1 nm) had vasodilatory effects in the skin circulation of both premenopausal females (n = 6) and age-matched males (n = 5), but CRH-induced dilation was significantly more potent in females than males. Acetylcholine-(1 nm) and sodium nitroprusside- (0.74 nm) induced dilation was not significantly different between males (n = 6) and females (n = 6). This is the first study to demonstrate that CRH acts locally as a vasodilator in human skin circulation and that this response is augmented in premenopausal females. The mechanism by which CRH causes dilation in human skin is presently unknown. However, these data suggest that CRH-induced dilation may be one mechanism by which cardiovascular risk is reduced in premenopausal women.
Publisher: Springer Science and Business Media LLC
Date: 06-2016
Publisher: Elsevier BV
Date: 03-1999
DOI: 10.1016/S0022-3476(99)70454-3
Abstract: To determine whether children with homozygous sickle cell (SS) disease and splenectomy are at greater risk of death, overwhelming septicemia, or other complications. A total of 130 patients with SS treated by splenectomy (46 recurrent acute splenic sequestration, 84 chronic hypersplenism) over a 22.5-year period at the Sickle Cell Clinic of the University Hospital of the West Indies, Kingston, Jamaica, were compared with a control group matched for sex, age, and duration of follow-up in a retrospective review. Deaths and bacteremias were examined over the whole study period. Painful crises, acute chest syndromes, and febrile episodes were compared in the 90 patients completing 5 years of postsplenectomy follow-up. Mortality and bacteremic episodes did not differ between the splenectomy and control groups. Painful crises were more common in the splenectomy group than in the control group (P =.01) but did not differ between splenectomy indications. Acute chest syndrome was more common in the splenectomy group than in the control group (P <.01) and was more common in the acute splenic sequestration group than in the hypersplenism group (P =.01). Febrile events did not differ between the groups or between the indications for splenectomy. Splenectomy does not increase the risk of death or bacteremic illness in patients with SS disease and, if otherwise indicated, should not be deferred for these reasons.
Publisher: Springer Science and Business Media LLC
Date: 04-2008
Publisher: Public Library of Science (PLoS)
Date: 25-03-2015
Publisher: AMPCo
Date: 04-2016
DOI: 10.5694/MJA15.01179
Location: Australia
No related grants have been discovered for Ian Wright.