ORCID Profile
0000-0002-9015-5668
Current Organisations
University of Wollongong
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Publisher: Informa UK Limited
Date: 03-07-2015
Publisher: Wiley
Date: 18-06-2014
DOI: 10.1111/JPC.12636
Publisher: Edward Elgar Publishing
Date: 11-02-2022
Publisher: Springer Science and Business Media LLC
Date: 02-2017
Publisher: S. Karger AG
Date: 2014
DOI: 10.1159/000363126
Abstract: b i Background: /i /b Gases for respiratory support at birth are typically ‘cold and dry', which may increase the risk of hypothermia and lung injury. b i Objectives: /i /b To determine the feasibility of using heated humidification from birth. b i Method: /i /b A humidifier targeting 37°C, a manual-fill chamber and a Neopuff Infant T-piece resuscitator and circuit were attached to a face mask and a manikin. Recordings using 20 ml H sub /sub O for humidification and a flow of 10 l/min were undertaken. Temperature and relative humidity (RH) were recorded. Additional recordings were made, each with one alteration to baseline (50 ml H sub /sub O for humidification, auto-fill chamber, a flow of 8 l/min, addition of circuit extension piece, warmed humidification H sub /sub O, increased ambient temperature and targeting 31°C). The duration of heated humidification and the response to disconnecting the power were investigated. b i Results: /i /b The baseline circuit achieved 95% RH and 31°C in 3 min, % RH in 7 min and ≥35°C in 9 min. No circuit alterations resulted in faster gas conditioning. The extended length circuit and targeting 31°C reduced the maximum temperature achieved. A flow of 8 l/min resulted in slower heating and humidification. The baseline circuit delivered heated humidification for 39 min. Without power, the temperature and humidity fell below international standards in 3 min. b i Conclusion: /i /b Rapid gas conditioning for newborn stabilisation is feasible using the experimental set-up, ≥20 ml H sub /sub O and a flow of 10 l/min. The circuit could be used immediately once switched on. Without power, conditioning is quickly lost. Investigation of the clinical effects of gas conditioning is warranted.
Publisher: Elsevier BV
Date: 04-2014
DOI: 10.1016/J.JPEDS.2013.11.072
Abstract: The precision of oxygen saturation (SpO2) targeting in preterm infants on continuous positive airway pressure (CPAP) is incompletely characterized. We therefore evaluated SpO2 targeting in infants solely receiving CPAP, aiming to describe their SpO2 profile, to document the frequency of prolonged hyperoxia and hypoxia episodes and of fraction of inspired oxygen (FiO2) adjustments, and to explore the relationships with neonatal intensive care unit operational factors. Preterm infants <37 weeks' gestation in 2 neonatal intensive care units were studied if they were receiving CPAP and in supplemental oxygen at the beginning of each 24-hour recording. SpO2, heart rate, and FiO2 were recorded (s ling interval 1-2 seconds). We measured the proportion of time spent in predefined SpO2 ranges, the frequency of prolonged episodes (≥30 seconds) of SpO2 deviation, and the effect of operational factors including nurse-patient ratio. A total of 4034 usable hours of data were recorded from 45 infants of gestation 30 (27-32) weeks (median [IQR]). When requiring supplemental oxygen, infants were in the target SpO2 range (88%-92%) for only 31% (19%-39%) of total recording time, with 48 (6.9-90) episodes per 24 hours of severe hyperoxia (SpO2 ≥98%), and 9.0 (1.6-21) episodes per 24 hours of hypoxia (SpO2 <80%). An increased frequency of prolonged hyperoxia in supplemental oxygen was noted when nurses were each caring for more patients. Adjustments to FiO2 were made 25 (16-41) times per day. SpO2 targeting is challenging in preterm infants receiving CPAP support, with a high proportion of time spent outside the target range and frequent prolonged hypoxic and hyperoxic episodes.
Publisher: Springer Science and Business Media LLC
Date: 09-11-2023
DOI: 10.1007/S10691-022-09499-1
Abstract: Australia is witnessing a political, social and cultural renaissance of public debate regarding violence against women, particularly in relation to domestic and family violence (DFV), sexual assault and sexual harassment. Women's voices calling for law reform are central to that renaissance, as they have been to feminist law reform dating back to nineteenth-century c aigns for property and suffrage rights. Although feminist research has explored women’s voices, speaking out and storytelling to highlight the exclusions and limitations of the legal and criminal justice systems in responding to women’s experience, less attention has been paid to how women's voices are elicited, received and listened to, and the forms of response they have received. We argue that three recent public inquiries in Australia reveal an urgent need for a victim-survivor-centred theory of listening to women’s voices in law reform seeking to address violence against women. We offer a nascent theory of a victim-survivor-centred approach grounded in openness, receptivity, attentiveness and responsiveness, and argue that in each of our case studies, law reform actors failed to adequately listen to women by silencing and refusing to listen to them by hearing them but failing to be open, receptive and attentive and by selectively hearing and resisting transformation. We argue that these inquiries signal an acute need for attention to the dynamics of listening in law reform processes, and conclude that a victim-survivor-centred theory of listening is a critical foundation for meaningful change to address violence against women.
Publisher: Routledge
Date: 04-2020
Publisher: Informa UK Limited
Date: 03-07-2015
Publisher: Public Library of Science (PLoS)
Date: 17-02-2015
Publisher: Informa UK Limited
Date: 03-07-2015
Publisher: Routledge
Date: 27-04-2011
Publisher: BMJ
Date: 31-03-2014
DOI: 10.1136/ARCHDISCHILD-2013-305484
Abstract: To assess whether defined reference ranges of oxygen saturation (SpO₂) and heart rate (HR) of term infants after birth also apply for infants born after midwifery supervised uncomplicated vaginal birth, where delayed cord cl ing (DCC) and immediate skin to skin contact (ISSC) is routine management. Prospective observational study. Infants born vaginally after uncomplicated birth, that is, no augmentation, maternal pain relief or instrumental delivery. Midwives supervising uncomplicated birth at home or in hospital in the Leiden region (The Netherlands) used an oximeter and recorded SpO₂ and HR in the first 10 min after birth. SpO₂ and HR values were compared to the international defined reference ranges. In Leiden, values of 109 infants were obtained and are comparable with previously defined reference ranges, except for a higher SpO₂ (p<0.05) combined with a slower increase in the first 3 min. The Leiden cohort also had a lower HR (p 180 bpm) occurred less often, and a bradycardia (<80 bpm) more often (p<0.05). Defined reference ranges can be used in infants born after uncomplicated vaginal birth with DCC and ISSC, but higher SpO₂ and lower HR were observed in the first minutes.
Publisher: Routledge
Date: 06-2023
Publisher: Informa UK Limited
Date: 2004
Publisher: Informa UK Limited
Date: 11-2005
Publisher: BMJ
Date: 07-11-2012
DOI: 10.1136/ARCHDISCHILD-2012-301628
Abstract: The aim of this study was to determine if the National Institute of Child Health and Human Development (NICHD) calculator, designed to predict mortality or neurosensory disability in infants 22-25 weeks' gestation, was valid for contemporary Australian infants. Outcome data at 2 years of age for 114 infants who were liveborn in Victoria, Australia, in 2005, between 22 and 25 completed weeks' gestation, weighing 401-1000 g at birth, and free of lethal anomalies, were entered into the NICHD online calculator. Predicted outcomes were then compared with the actual outcomes. Of the 114 infants, 99 (87%) were inborn and 15 (13%) were outborn. The overall prediction of death for inborn infants was 47.1% compared with the actual death rate to 2 years of age of 49.5%. The area under the curve (AUC) was 0.803 (95% CI 0.718 to 0.888 p<0.001) for mortality, comparable with the AUC for the NICHD study (AUC: 0.753 95% CI 0.737 to 0.769 p<0.001). The accuracy for predicting death was not as precise for outborn infants (AUC: 0.643 95% CI 0.337 to 0.949 p=0.36). The calculator overestimated the combined outcome of death or survival with major disability at 72.0%, compared with an actual rate of 60.5%. The NICHD outcome estimator was helpful in predicting mortality for inborn infants, 22-25 weeks' gestation, but was less precise for outborn infants. It overestimated the combined outcome of death or major disability in infants born in Victoria, Australia, in 2005.
Publisher: Wiley
Date: 07-08-2015
DOI: 10.1111/APA.13123
Publisher: Informa UK Limited
Date: 2002
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.JPEDS.2014.04.020
Abstract: To test whether 4 commonly used self-inflating bags with a reservoir in situ can reliably deliver different oxygen concentrations (21%-100%) using a portable oxygen cylinder with flows of ≤5 L/min. Four self-inflating bags (from Laerdal, Ambu, Parker Healthcare, and Mayo Healthcare) were tested to provide positive pressure ventilation to a manikin at 60 inflations/min by 4 operators. Oxygen delivery was measured for 2 minutes, combining oxygen flows (0.25, 0.5, 1, 5 L/min) and peak inspiratory pressures (PIPs 20-25, 35-40 cmH2O). Combinations (n=128) were performed twice. Oxygen delivery depended upon device, oxygen flow, and PIP. All self-inflating bags delivered mean oxygen concentrations of 40% at PIP 20-25 cmH2O. With 1 L/min, 3 self-inflating bags delivered 40%-60% at PIP 35-40 cmH2O and all delivered >60% at PIP 20-25 cmH2O. With 5 L/min, all self-inflating bags delivered close to or 100%, regardless of PIP. Differences in oxygen delivery between self-inflating bags were statistically significant (P<.001) even when differences were not clinically important. Self-inflating bags with a reservoir in situ can deliver a variety of oxygen concentrations without a blender, from <40% with 0.25 L/min oxygen flow to 100% with 5 L/min. The adjustment of oxygen flow may be a useful method of titrating oxygen in settings where air-oxygen blenders are unavailable.
Publisher: Wiley
Date: 20-03-2015
DOI: 10.1111/APA.12932
Abstract: We assessed the influence of system messages (SyMs) on oxygen saturation (SpO2 ) and heart rate measurements after birth to see whether clinical decision-making changed if clinicians included SyM data. The heart rate and SpO2 of term infants were recorded using Masimo pulse oximeters. Differences in means and standard deviations (SD) were calculated. Permutation corrected the nonrandom distribution and intersubject variation. SpO2 and heart rate centile charts were computed with, and without, SyMs. Pulse oximetry measurements from 117 neonates provided 28 477 data points. SyMs occurred in 46% of measurements. Low signal quality accounted for 99.9% of SyMs. The mean SpO2 was lower with SyMs (p < 0.001), while the SpO2 SD was similar to data without SyMs. The SpO2 centile charts were approximately 2% lower with SyMs included, but they were not more dispersed. Mean heart rate was lower (p < 0.001) and more dispersed (p < 0.001) when a SyM occurred. The heart rate centile charts were lower, with increased variability, when SyMs were included. A SyM occurred frequently during pulse oximetry in term infants after birth. SpO2 measurements with low signal quality proved reliable for monitoring an infant's clinical condition. However, heart rate could be underestimated by low signal quality measurements.
Publisher: Elsevier BV
Date: 07-2015
DOI: 10.1016/J.JPEDS.2015.04.003
Abstract: To compare the nasal tube with face mask as interfaces for stabilization of very preterm infants at birth by using physiological measurements of leak, obstruction, and expired tidal volumes during positive pressure ventilation (PPV). In the delivery room, 43 infants <30 weeks gestation were allocated to receive respiratory support by nasal tube or face mask. Respiratory function, heart rate, and oxygen saturation were measured. Occurrence of obstruction, amount of leak, and tidal volumes were compared using a Mann-Whitney U test or a Fisher exact test. The first 5 minutes after initiation of PPV were analyzed (1566 inflations in the nasal tube group and 1896 inflations in the face mask group). Spontaneous breathing coincided with PPV in 32% of nasal tube and 34% of face mask inflations. During inflations, higher leak was observed using nasal tube compared with face mask (98% [33%-100%] vs 14 [0%-39%] P < .0001). Obstruction occurred more often (8.2% vs 1.1% P < .0001). Expired tidal volumes were significantly lower during inflations when using nasal tube compared with face mask (0.0 [0.0-3.1] vs 9.9 [5.5-12.8] mL/kg P < .0001) and when spontaneous breathing coincided with PPV (4.4 [2.1-8.4] vs 9.6 [5.4-15.2] mL/kg P 0.05). Heart rate was not significantly different between groups, but oxygen saturation was significantly lower in the nasal tube group the first 2 minutes after start of respiratory support. The use of a nasal tube led to large leak, more obstruction, and inadequate tidal volumes compared with face mask. Trial registration Registered with the Dutch Trial Registry (NTR 2061) and the Australia and New Zealand Clinical Trials Register (ACTRN 12610000230055).
Publisher: Wiley
Date: 04-2015
DOI: 10.1111/AJO.12313
Abstract: Very preterm infants born in non-tertiary hospitals ('outborn') are known to have higher mortality rates compared with infants 'inborn' in tertiary centres. The aim of this study was to report changes over time in the incidence of outborn livebirths, 22-31 weeks and infant mortality rates for outborn compared with inborn births. We conducted a population-based cohort study of consecutive livebirths, 22-31 weeks' gestation in Victoria from 1990 to 2009. The relationship between birthplace, gestational age, birthweight, sex and infant mortality were analysed by logistic regression. There were 13,760 livebirths, 22-31 weeks: 14% were outborn. The proportion of outborn livebirths fell from 19% in 1991 to a nadir of 9% in 1997, but climbed to 17% by 2009. At all times, outborns had higher mortality rates compared with inborns. The overall infant mortality rate was 250.6 per 1000 outborn compared with 113.3 per 1000 inborn livebirths (adjusted odds ratio (aOR) 2.76 (95% CI 2.32, 3.27, P < 0.001). There were no differences between outborn and inborn mortality risks for 22-week livebirths (OR 7.04, 95% CI 0.87, 56.8, P = 0.067), but there were at 23-27 weeks (aOR 3.16, 95% CI 2.52, 3.96, P < 0.001) and at 28-31 weeks (aOR 1.66, 95% CI 1.19, 2.31, P = 0.003). Over time, mortality rates fell for inborn 23-27 week infants. Mortality rates fell for outborn 23-27 week infants in 1990-2005, but rose in 2006-2009. Outborn livebirths at 22-31 weeks' gestation occur too frequently and are associated with a significantly increased risk of mortality. Strategies to reduce outborn livebirths are required.
Publisher: BMJ
Date: 10-07-2013
DOI: 10.1136/ARCHDISCHILD-2012-301787
Abstract: The 2010 ILCOR neonatal resuscitation guidelines do not specify appropriate inflation times for the initial lung inflations in apnoeic newborn infants. The authors compared three ventilation strategies immediately after delivery in asphyxiated newborn lambs. Experimental animal study. Facility for animal research. Eighteen near-term lambs (weight 3.5-3.9 kg) delivered by caesarean section. Asphyxia was induced by occluding the umbilical cord and delaying ventilation onset (10-11 min) until mean carotid blood pressure (CBP) was ≤22 mm Hg. Animals were ided into three groups (n=6) and ventilation started with: (1) inflation times of 0.5 s at a ventilation rate 60/min, (2) five 3 s inflations or (3) a single 30 s inflation. Subsequent ventilation used inflations at 0.5 s at 60/min for all groups. Times to reach a heart rate (HR) of 120 bpm and a mean CBP of 40 mm Hg. Secondary outcome was change in lung compliance. Median time to reach HR 120 bpm and mean CBP 40 mm Hg was significantly shorter in the single 30 s inflation group (8 s and 74 s) versus the 5×3 s inflation group (38 s and 466 s) and the conventional ventilation group (64 s and 264 s). Lung compliance was significantly better in the single 30 s inflation group. A single sustained inflation of 30 s immediately after birth improved speed of circulatory recovery and lung compliance in near-term asphyxiated lambs. This approach for neonatal resuscitation merits further investigation.
Publisher: Wiley
Date: 19-01-2015
DOI: 10.1111/APA.12914
Abstract: It takes several minutes for infants to become pink after birth. Preductal oxygen saturation (SpO2) measurements are used to guide the delivery of supplemental oxygen to newly born infants, but pulse oximetry is not available in many parts of the world. We explored whether the pinkness of an infant's tongue provided a useful indication that supplemental oxygen was required. This was a prospective observational study of infants delivered by Caesarean section. Simultaneous recording of SpO2 and visual assessment of whether the tongue was pink or not was made at 1-7 and 10 min after birth. The 38 midwives and seven paediatric trainees carried out 271 paired assessments on 68 infants with a mean (SD) birthweight of 3214 (545) grams and gestational age of 38 (2) weeks. When the infant did not have a pink tongue, this predicted SpO2 of <70% with a sensitivity of 26% and a specificity of 96%. Tongue colour was a specific but insensitive sign that indicated when SpO2 was <70%. When the tongue is pink, it is likely that an infant has an SpO2 of more than 70% and does not require supplemental oxygen.
Publisher: S. Karger AG
Date: 11-11-2015
DOI: 10.1159/000440642
Abstract: b i Background: /i /b Oxygen saturation (SpO sub /sub ) targeting in the preterm infant may be improved with a better understanding of the SpO sub /sub responses to changes in inspired oxygen (FiO sub /sub ). b i Objective: /i /b We investigated the first-order FiO sub /sub -SpO sub /sub relationship, aiming to quantify the parameters governing that relationship, the influences on these parameters and their variability. b i Methods: /i /b In recordings of FiO sub /sub and SpO sub /sub from preterm infants on continuous positive airway pressure and supplemental oxygen, we identified unique FiO sub /sub adjustments and mapped the subsequent SpO sub /sub responses. For responses identified as first-order, the delay, time constant and gain parameters were determined. Clinical and physiological predictors of these parameters were sought in regression analysis, and intra- and inter-subject variability was evaluated. b i Results: /i /b In 3,788 h of available data from 47 infants at 31 (28-33) post-menstrual weeks [median (interquartile range)], we identified 993 unique FiO sub /sub adjustments followed by a first-order SpO sub /sub response. All response parameters differed between FiO sub /sub increments and decrements, with increments having a shorter delay, longer time constant and higher gain [2.9 (1.7-4.8) vs. 1.3 (0.58-2.6), p 0.05]. Gain was also higher in less mature infants and in the setting of recent SpO sub /sub instability, and was diminished with increasing severity of lung dysfunction. Intra-subject variability in all parameters was prominent. b i Conclusions: /i /b First-order SpO sub /sub responses show variable gain, influenced by the direction of FiO sub /sub adjustment and the severity of lung disease, as well as substantial intra-subject parameter variability. These findings should be taken into account in adjustment of FiO sub /sub for SpO sub /sub targeting in preterm infants.
Publisher: BMJ
Date: 10-07-2015
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.MIDW.2013.06.005
Abstract: to evaluate the feasibility of using pulse oximetry (PO) for evaluating infants born in community-based midwifery care. a prospective, observational study of infants born after midwifery supervised (home) births. 27 midwives from seven practices providing primary care in (home) births used PO at birth or the early puerperal period over a ten-month period. Data were obtained on the effect of PO on outcome, interventions and decision-making. Midwives were surveyed about applicability and usefulness of PO. 153 infants born in primary midwifery care. all births were uncomplicated except for one infant receiving supplemental oxygen and another was mask ventilated. In 138/153 (90%) infants PO was successfully used and 88% of midwives found PO easy to use. In 148/153 (97%) infants PO did not influence midwives' clinical judgment and referral policy. In 5/153 (3%) infants, midwives were uncertain of the infant's condition, but PO measurements were reassuring. In case of suboptimal neonatal condition or resuscitation, 100% of midwives declared they would use PO again. it is feasible to use PO in community based midwifery care, but not considered an important contribution to routine evaluation of infants. Midwives would like to have PO available during suboptimal neonatal condition or when resuscitation is required. PO can be applied in community based midwifery care it does not lead to insecurity or extra referral. Further research on a larger group of infants must show the effect of PO on neonatal outcomes.
Publisher: BMJ
Date: 13-03-2014
Publisher: BMJ
Date: 16-10-2013
DOI: 10.1136/ARCHDISCHILD-2013-304582
Abstract: Ventilation during neonatal resuscitation is typically initiated with a face mask, but may be ineffective due to leak or obstruction. To compare leak using three methods of mask hold. Medical and nursing staff regularly involved in neonatal resuscitation used the three holds (two-point, two-handed, spider) on a manikin in a random order to apply positive pressure ventilation (PPV) at standard settings each for 1 min while mask leak was recorded. Participants (n=53) varied in experience (1-23 years) and hand size. Combined median (IQR) leak was 14 (2-46)% and was not different among the holds. There was no difference in the leak measured using the three different mask holds.
Publisher: Routledge
Date: 24-07-2015
Publisher: Informa UK Limited
Date: 08-11-2018
Publisher: Wiley
Date: 06-10-2014
DOI: 10.1111/JPC.12393
No related grants have been discovered for Cassandra Sharp.