ORCID Profile
0000-0001-6944-381X
Current Organisation
The University of Auckland
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Publisher: MDPI AG
Date: 04-06-2020
DOI: 10.3390/NU12061677
Abstract: Small-for-gestational-age (SGA) is associated with significant perinatal morbidity and mortality. Our aim was to investigate gene-nutrient interactions between maternal one-carbon single nucleotide polymorphisms (SNPs) and folic acid supplement (FAS) use, and their association with SGA. Nulliparous New Zealand women with singleton pregnancy were recruited as part of the Screening for Pregnancy Endpoints prospective cohort study. Data on FAS use was collected via face-to-face interview at 15 weeks’ gestation participants were followed prospectively and birth outcome data collected within 72 h of delivery. Participants were genotyped for MTHFR 677, MTHFR 1298, MTHFD1 1958, MTR 2756, MTRR 66 and TCN2 776 SNPs. Genotype data for at least one SNP was available for 1873 (93%) of eligible participants. Analysis showed a significant SNP-FAS interaction for MTHFR 1298 (p = 0.020), MTHFR 677 (p = 0.019) and TCN2 776 (p = 0.017) in relation to SGA: MTHFR 1298 CC variant non-FAS users had an increased likelihood [Odds Ratio (OR) = 2.91 (95% Confidence Interval (CI) = 1.52, 5.60] compared with wild-type (MTHFR 1298 AA) FAS users. MTHFR 677 variant allele carrier (MTHFR 677 CT + MTHFR 677 TT) non-FAS users had an increased likelihood [OR = 1.87 (95% CI = 1.21, 2.88)] compared to wild-type (MTHFR 677 CC) FAS users. TCN2 776 variant (TCN2 776 GG) non-FAS users had an increased likelihood [OR = 2.16 (95% CI = 1.26, 3.71)] compared with wild type homozygote + heterozygote (TCN2 776 CC + TCN2 776 CG) FAS users. No significant interactions were observed for MTHFD1 1958, MTR 2756 or MTRR 66 (p 0.05). We observed an overall pattern of FAS attenuating differences in the likelihood of SGA seen between genotype groups in FAS non-users. Future research should focus on how intake of other one-carbon nutrients might mediate these gene-nutrient interactions.
Publisher: Springer Science and Business Media LLC
Date: 23-08-2019
DOI: 10.1007/S12024-019-00157-8
Abstract: Problems often arise in cases of lethal inflicted injury in infants and children in determining the chronology of events. However, on occasion it may be assumed that a parent's statement that the child appeared normal at a particular time is correct. It is then inferred that the lethal injury occurred after this time. In a study of infants from Queensland, Australia a significant number of cases occurred where a parent/carer did not actually recognise that an infant was deceased or in extremis despite handling of the infants, some of whom had established rigor mortis. Assessment of their infant's health status was quite flawed, presumably due to inattention, fatigue, or confirmatory bias (seeing what is expected). This could also apply to infants with head injuries who may manifest quite non-specific signs such as lethargy, somnolence or alteration in conscious state, manifestations that could easily be confused with normal drowsiness or sleep. Thus, the evaluation of parent/carer statements must be tempered by the knowledge that their opinions may not always (for completely understandable reasons) be reliable, and should not be uncritically accepted as a basis for deciding the time course for a lethal process.
Publisher: Wiley
Date: 05-03-2018
DOI: 10.1111/AJO.12790
Abstract: For parents who experience stillbirth, knowing the cause of their baby's death is important. A post mortem examination is the gold standard investigation, but little is known about what may influence parents' decisions to accept or decline. We aimed to identify factors influencing maternal decision-making about post mortem examination after late stillbirth. In the New Zealand Multicentre Stillbirth Study, 169 women with singleton pregnancies, no known abnormality at recruitment, and late stillbirth (≥28weeks gestation), from seven health regions were interviewed within six weeks of birth. The purpose of this paper was to explore factors related to post mortem examination decision-making and the reasons for declining. We asked women if they would make the same decision again. Maternal decision to decline a post mortem (70/169, 41.4%) was more common among women of Māori (adjusted odds ratio (aOR) 4.99 95% confidence interval (CI) 1.70-14.64) and Pacific (aOR 3.94 95% CI 1.47-10.54) ethnicity compared to European, and parity two or more (aOR 2.95 95% CI 1.14-7.62) compared to primiparous. The main reason for declining was that women 'did not want baby to be cut'. Ten percent (7/70) who declined said they would not make this decision again. No woman who consented regretted her decision. Ethnic differences observed in women's post mortem decision-making should be further explored in future studies. Providing information of the effect of post mortem on the baby's body and the possible emotional benefits of a post mortem may assist women faced with this decision in the future.
Publisher: MDPI AG
Date: 21-09-2023
Publisher: Wiley
Date: 08-06-2018
DOI: 10.1111/PPE.12476
Abstract: Preecl sia is a significant contributor to maternal and neonatal morbidity and mortality. Folic acid supplementation is recommended periconceptionally for the prevention of neural tube defects. Epidemiological evidence suggests that maternal folic acid supplementation may play a role in preventing other adverse birth outcomes. This systematic review aimed to investigate the effect of maternal folic acid supplementation during pregnancy on risk of preecl sia and gestational hypertension. Multiple scientific databases and grey literature were searched for relevant studies. Studies were reviewed according to pre-specified inclusion and exclusion criteria. Study characteristics were summarised and study quality was assessed. A meta-analysis of observational studies was conducted to examine the effect of maternal folic acid supplementation on preecl sia risk. Meta-analysis of eight observational studies showed significantly lower odds of preecl sia with folic acid supplementation in comparison to no folic acid supplementation: OR = 0.78 (95% CI 0.63, 0.98), with moderately high heterogeneity between studies. Subgroup analysis showed no significant subgroup difference between folic acid supplementation taken by itself, in comparison to folic acid taken in or alongside a multivitamin. Low level evidence is available for a modest association between maternal folic acid supplementation and reduction in preecl sia risk. Future studies should differentiate between early and late onset and mild vs severe preecl sia, and should control for relevant confounders including the presence of multivitamin supplements. The protocol for this systematic review was prospectively registered with PROSPERO (CRD42015029310).
Publisher: SAGE Publications
Date: 30-09-2020
Abstract: To determine the level of quality of life (QoL) in children with cleft lip and/or palate (CL/P) and whether this differs by cleft phenotype. A cohort of children with CL/P born in New Zealand. A nationwide study of children born with CL/P and having primary surgery in New Zealand. Children with CL/P and their families (n = 397) who attended a cleft clinic between October 1, 2014, and September 30, 2017, and agreed to complete questionnaires on QoL. Primary outcomes were QoL from the PedsQL 4.0 core generic questionnaires and the PedsQL 2.0 Family impact scale. Children with CL/P in New Zealand generally have a high QoL as assessed by the PedsQL. The impact of cleft phenotype had limited effects on the child, however there were significant impacts on parents and families. We found that the family impact scale differed by cleft phenotype with those with CL having the highest QoL and those with cleft palate the lowest, and this was consistent across QoL subscales. Quality of life improved as a whole by age, particularly in physical and cognitive functioning, as well as in the ability to undertake family activities. Children with CL/P have generally good levels of QoL in New Zealand, however cleft phenotype impacts on the level, with the lowest levels in those with cleft palate. Psychological support of children with cleft and their families should be an integral part of cleft care.
Publisher: Wiley
Date: 09-10-2019
DOI: 10.1111/CDOE.12499
Abstract: To investigate the dental caries experience of New Zealand children born with orofacial cleft (OFC), to compare this to age-specific national population-based data and to investigate any differences by demographic characteristics, cleft type and exposure to community water fluoridation. Nationwide retrospective study of 554 dental records from 478 children born after 1 January 2000 with OFC were assessed at aged 5 (n = 333) and 12 years (n = 221), with 76 children (15.9%) having records at both ages. Community Oral Health Service records were analysed to determine dental caries experience (dmft/DMFT). Logistic regression was used to assess the likelihood of having experienced dental caries (d A higher (49.6%) caries prevalence (dmft ≥ 1) and mean dmft at 5 years old (2.3 SD 3.6) were found in children with OFC than 5-year-olds in the general population (prevalence 40.4% and mean dmft 1.8). The 12-year-old (37.6%) caries prevalence (DMFT ≥ 1) and mean DMFT 0.8 (SD 1.4) were similar to population-based data (caries prevalence 37.3% and mean DMFT 0.9). Children with caries (dmf/DMF ≥ 1) had means of 4.8 (SD 3.8) at age 5 and 2.1 (SD 1.4) at age 12 years. Greater caries experience was associated Pacific and Māori ethnicity, and not receiving community water fluoridation. No differences were detected by sex or cleft type. The dental caries experience for 5-year-old children with OFC was poor in relation to population-based data and similar for 12-year-olds. Preventive guidelines for children with OFC from an early age should be a priority, along with the extension of community water fluoridation coverage.
Publisher: Elsevier BV
Date: 08-2017
DOI: 10.1016/J.JPEDS.2017.04.058
Abstract: To estimate associations between factors recorded in pregnancy and the first week of life and subsequent abusive head trauma. Multicenter, retrospective case-control study of perinatal records from 142 cases of abusive head trauma and 550 controls, matched by date and hospital of birth from 1991 to 2010. Multiple logistic regression assessed the relationship between perinatal exposures and abusive head trauma. The risk of abusive head trauma decreased with increasing maternal age (OR, 0.91 per year 95% CI 0.85-0.97) and increasing gestational age at birth (OR 0.79 per week 95% CI 0.69-0.91). Mothers of cases were more likely to be Māori (OR 4.61 95% CI 1.98-10.78), to be single (OR 5.10 95% CI 1.83-14.23), have recorded social concerns (OR 4.29 95% CI 1.32-13.91), and have missing data for antenatal care, partner status, social concerns, and substance abuse (OR 13.53 95% CI 2.39-76.47). Case mothers were more likely not to take supplements in pregnancy (OR 3.53 95% CI 1.30-9.54), to have membrane rupture longer than 48 hours before delivery (OR 13.01 95% CI 2.84-59.68), and to formula feed (OR for mixed breast and formula feeding 6.06 95% CI 2.39-15.36) before postnatal discharge (median 3 days). Factors associated with subsequent abusive head trauma can be identified from routine perinatal records. Targeted interventions initiated perinatally could possibly prevent some cases of abusive head trauma. However, any plans for targeted prevention strategies should consider not only those with identified risk factors but also those for which data are missing.
Publisher: SAGE Publications
Date: 21-10-2021
DOI: 10.1177/10556656211044939
Abstract: To assess speech outcomes at five and ten years of age in a nationwide study of children with orofacial cleft. Prospective study. Children born with orofacial cleft and having primary surgery in New Zealand. Speech s les were available for 151 five-year-old, and 163 ten-year-old children. Intelligibility, Acceptability, Velopharyngeal function, Hypernasality, Hyponasality, severity of airflow evaluated by perceptual speech assessment (using the standardised Rhinocleft assessment), and overall assessment of requirement for clinical intervention. A large proportion of five-year-old children had speech that was considered to be not completely intelligible, was not acceptable, and had inadequate velopharyngeal function. The noted deficiencies led to a clinical judgement that further speech and/or surgical intervention was required in 85% with cleft lip and palate, 65% with cleft palate and 26% with cleft lip. The proportion of children with poor speech outcomes in the ten-year-old children was lower, though of clinical importance, further intervention required for 25% with CLP, 15% with CP and 3% with CL. The number of sound production errors in both age groups followed the same pattern with fewest in those with CL and most in those with CLP. A significant proportion of children with orofacial cleft were found to have poor speech outcomes requiring further treatment. The outcomes are poor compared to centres reported in the UK and Scandinavia. New Zealand requires a review of the current services for in iduals born with cleft to improve speech outcomes and interdisciplinary care.
Publisher: Wiley
Date: 29-03-2019
DOI: 10.1111/OCR.12310
Abstract: To (a) assess nasolabial outcomes across four main cleft subgroups, (b) assess agreement using a categorical and a continuous scoring measure and (c) compare outcomes to international studies. Analysis of 470 images of which 218 was unilateral cleft lip and palate (UCLP), 128 unilateral cleft lip (UCL), 90 bilateral cleft lip and palate (BCLP) and 34 bilateral cleft lip (BCL). Images were taken around five (n = 279) and eight-ten (n = 191) years of age. Cropped images were assessed using the Asher-McDade (AM) and a 100 mm visual analogue scale (VAS) by a panel of six raters. Scoring was undertaken for vermillion border and nasal form, symmetry and profile. Analysis was undertaken for each subscore, a total score with sensitivity analysis using a total score based on the subscores for each patient. AM intra- and inter-rater reliability was assessed using weighted kappa and for the VAS components reliability was assessed using Pearson correlation. The AM intra-rater reliability was moderate/substantial, whilst inter-rater reliability was fair. The VAS intra-rater correlations were high, and inter-rater correlations were moderate. Better outcomes were found with cleft lip (CL) vs cleft lip and palate (CLP). No differences were found for sex, ethnicity, age and cleft laterality (unilateral). The AM found no difference between unilateral or bilateral. The VAS found bilateral scored worse than unilateral for both CL and CLP. The nasolabial outcomes differ by cleft type. The correlation was relatively high for the VAS whilst the AM had relatively poor reliability.
Publisher: Wiley
Date: 28-10-2020
Abstract: To investigate behavioural and social characteristics of women who experienced a late stillbirth compared with women with ongoing live pregnancies at similar gestation. Case-control study. 41 maternity units in the UK. Women who had a stillbirth ≥28 weeks' gestation (n = 287) and women with an ongoing pregnancy at the time of interview (n = 714). Data were collected using an interviewer-administered questionnaire which included questions regarding women's behaviours (e.g. alcohol intake and household smoke exposure) and social characteristics (e.g. ethnicity, employment, housing). Stress was measured by the 10-item Perceived Stress Scale. Late stillbirth. Multivariable analysis adjusting for co-existing social and behavioural factors showed women living in the most deprived quintile had an increased risk of stillbirth compared with the least deprived quintile (adjusted odds ratio [aOR] 3.16 95% CI 1.47-6.77). There was an increased risk of late stillbirth associated with unemployment (aOR 2.32 95% CI 1.00-5.38) and women who declined to answer the question about domestic abuse (aOR 4.12 95% CI 2.49-6.81). A greater number of antenatal visits than recommended was associated with a reduction in stillbirth (aOR 0.26 95% CI 0.16-0.42). This study demonstrates associations between late stillbirth and socio-economic deprivation, perceived stress and domestic abuse, highlighting the need for strategies to prevent stillbirth to extend beyond maternity care. Enhanced antenatal care may be able to mitigate some of the increased risk of stillbirth. Deprivation, unemployment, social stress & declining to answer about domestic abuse increase risk of #stillbirth after 28 weeks' gestation.
Publisher: SAGE Publications
Date: 16-12-2020
Abstract: To describe (1) oral health related quality of life (OHRQoL) for children with orofacial cleft (OFC) in New Zealand and (2) assess any differences in OHRQoL by sex, ethnicity, and cleft phenotype using the 16 item (and 8 item subset) of the Child Perception Questionnaire (CPQ) and Parent version (P-CPQ). Prospective cross-sectional nationwide study. Children with OFC and their parents completed the 16-item CPQ or the Parent CPQ, respectively, when attending cleft clinic appointments between January 2015 and December 2017. Overall, 174 children (mean age 10.4 ± 1.2 years) and their parents (n = 181) completed the CPQ or P-CPQ. In multivariable analysis, neither the CPQ nor P-CPQ 16-item or 8-item subset showed significant differences in OHRQoL total score with cleft phenotype. Children with cleft lip and palate (CLP) had higher (worse) well-being scores than those with cleft palate alone (CP) on the P-CPQ. Pacific Island children had consistently higher scores across both CPQ and P-CPQ, total and subscales. Significant differences in OHRQoL among children with OFC were found for the well-being domain for children with CLP as reported by P-CPQ, but the symptom domain and total score showed no differences. Poorer scores were reported for children of Pacific Island descent using both questionnaires. The study findings indicate that children with OFC in New Zealand are a group who experience worse OHRQoL when referenced to normative non-OFC data. Further investigations are required to establish greater insight into specific factors influencing OHRQoL.
Publisher: BMJ
Date: 05-2021
DOI: 10.1136/BMJOPEN-2020-047681
Abstract: A ‘Sleep-On-Side When Baby’s Inside’ public health c aign was initiated in New Zealand in 2018. This was in response to evidence that maternal supine going-to-sleep position was an independent risk factor for stillbirth from 28 weeks’ gestation. We evaluated the success of the c aign on awareness and modification of late pregnancy going-to-sleep position through nationwide surveys. Two web-based cross-sectional surveys were conducted over 12 weeks in 2019–2020 in a s le of (1) pregnant women ≥28 weeks, primary outcome of going-to-sleep position and (2) health professionals providing pregnancy care, primary outcome of knowledge of going-to-sleep position and late stillbirth risk. Univariable logistic regression was performed to identify factors associated with supine going-to-sleep position. The survey of pregnant women comprised 1633 eligible participants. Going-to-sleep position last night was supine (30, 1.8%), non-supine (1597, 97.2%) and no recall (16, 1.0%). Supine position had decreased from 3.9% in our previous New Zealand-wide study (2012–2015). Most women (1412, 86.5%) had received sleep-on-side advice with no major resultant worry (1276, 90.4%). Two-thirds (918, 65.0%) had changed their going-to-sleep position based on advice, with most (611 of 918, 66.5%) reporting little difficulty. Supine position was associated with Māori (OR 5.05, 95% CI 2.10 to 12.1) and Asian-non-Indian (OR 4.20, 95% CI 1.27 to 13.90) ethnicity single (OR 10.98, 95% CI 4.25 to 28.42) and cohabitating relationship status (OR 2.69, 95% CI 1.09 to 6.61) hospital-based maternity provider (OR 2.55, 95% CI 1.07 to 6.10) education overseas (OR 3.92, 95% CI 1.09 to 14.09) and primary-secondary level (OR 2.80, 95% CI 1.32 to 6.08) and not receiving sleep-on-side advice (OR 6.70, 95% CI 3.23 to 13.92). The majority of health professionals (709 eligible participants) reported awareness of supine going-to-sleep position and late stillbirth risk (543, 76.6%). Most pregnant women had received and implemented sleep-on-side advice without major difficulty or concern. Some groups of women may need a tailored approach to acquisition of going-to-sleep position information.
Publisher: Wiley
Date: 20-03-2019
DOI: 10.1111/OCR.12305
Abstract: To investigate the amount of bone fill post-secondary alveolar bone grafting for children with cleft in New Zealand. Retrospective analysis of post-operative intra-oral periapical and upper anterior occlusal radiographs of 45 grafted sites where all grafting was undertaken within the New Zealand public hospital service. A modified Kindelan Index and a 100 mm visual analogue scale (VAS) were used to assess the amount of bone fill using intra-oral radiographs by 4 orthodontists experienced in cleft care and who were blind to the patient's identity. Fourteen duplicated radiographs were randomly selected and added to the s le for reliability assessment. The Kindelan Index rated 37.8% Grade 1 (Good), 31.1% rated Grade 2 (Satisfactory), 22.2% rated Grade 3 (Unsatisfactory) and 8.9% Grade 4 (Failure), a combined unsatisfactory/failure rate of 31.1%. The average VAS score was 50 mm ± 24 mm, and there was a strong relationship between Kindelan and VAS assessments. Those patients aged 10-11 years had significantly better outcomes using both assessments compared to those aged 11. The VAS assessment found that higher caseload surgeons had better outcomes, although the difference was of borderline statistical significance (mean VAS 56 mm vs 44 mm P = 0.07). Contemporary secondary alveolar bone grafting bone fill outcomes in New Zealand are poor when compared to contemporary international studies. These findings indicate a review of secondary bone grafting is required to improve outcomes for New Zealand children with cleft.
Publisher: BMJ
Date: 02-2021
DOI: 10.1136/BMJPO-2020-000972
Abstract: To investigate primary infant caregiver awareness of the current national public health safe sleep messages and the associations of awareness with care practices. A cross-sectional survey in Queensland, Australia. All families with live babies birthed during April–May 2017 were eligible. Questionnaires were distributed when infants were approximately 3 months old. Of the 10 200 eligible families, 3341 (33%) primary caregivers participated. Participants were asked: to recall key safe sleeping messages they were aware of (unprompted) questions about their infant care practices and to select the current, national six safe sleeping messages (prompted multi-choice). Overall, the majority of families are aware of sleep-related infant mortality and sudden infant death (3178/3317, 96%) however, approximately one in four caregivers (867/3292, 26%) could not identify the current six messages to promote safer infant sleep in a multi-choice question. Despite being aware of the six key messages, some caregiver practices did not always align with advice (336/2423, 14% were not smoke-free 349/2423, 14% were not usually supine for sleep 649/2339, 28% employed practices which may increase risk of head or face covering 426/2423, 18% were not receiving breastmilk). There is considerable scope for improvement in parent awareness and ability to recall key safe sleep messages. Awareness of advice does not always translate into safe infant care. Health promotion messaging to encourage safer infant sleep, ultimately aimed at reducing sudden unexpected infant deaths, needs more effective supportive strategies and dissemination if future c aigns are to be successful.
Publisher: Wiley
Date: 03-03-2019
DOI: 10.1111/OCR.12294
Abstract: (a) To establish baseline lateral craniofacial morphology and soft tissue profile outcomes for New Zealand children with complete unilateral and complete bilateral cleft lip and palate (CUCLP/CBCLP) and determine differences in relation to demographic characteristics including cleft type, sex and ethnicity and (b) To compare these outcomes to similar international studies. Nation-wide prospective and retrospective cephalometric analysis of 76 patients with CUCLP and 23 patients with CBCLP pre-secondary alveolar bone graft. Assessment was undertaken by three experienced orthodontists blinded to patient identity. A total of 13 hard tissue and 8 soft tissue landmarks were identified allowing for an assessment of 16 angular, three linear and one ratio variables. Inter-assessor reliability was determined by pre-defined measurement error thresholds. Inter-assessor reliability of cephalometric landmarks restricted reporting to 10 hard tissue, four soft tissue and one ratio variables. CUCLP had greater midface and mandibular retrusion than CBCLP. Females had greater midface and mandibular prominence and smaller nasal projections. The Pacific and Māori groups had more retrusive midfacial profiles, and the Pacific group had more prominent mandibles. A sub-analysis of New Zealand European CUCLP results found they were closely aligned to Eurocleft and Americleft study centres with less favourable outcomes. The reliability of a number of cephalometric measurements was poor. Lateral craniofacial morphology and soft tissue profile outcomes varied between CUCLP/CBCLP, sex and ethnicity. The New Zealand European outcomes are similar to or less favourable to other studies.
Publisher: Springer Science and Business Media LLC
Date: 15-11-2021
DOI: 10.1186/S12916-021-02140-Z
Abstract: Late stillbirth continues to affect 3–4/1000 pregnancies in high-resource settings, with even higher rates in low-resource settings. Reduced foetal movements are frequently reported by women prior to foetal death, but there remains a poor understanding of the reasons and how to deal with this symptom clinically, particularly during the preterm phase of gestation. We aimed to determine which women are at the greatest odds of stillbirth in relation to the maternal report of foetal movements in late pregnancy (≥ 28 weeks’ gestation). This is an in idual participant data meta-analysis of all identified case-control studies of late stillbirth. Studies included in the IPD were two from New Zealand, one from Australia, one from the UK and an internet-based study based out of the USA. There were a total of 851 late stillbirths, and 2257 controls with ongoing pregnancies. Increasing strength of foetal movements was the most commonly reported ( 60%) pattern by women in late pregnancy, which were associated with a decreased odds of late stillbirth (adjusted odds ratio (aOR) = 0.20, 95% CI 0.15 to 0.27). Compared to no change in strength or frequency women reporting decreased frequency of movements in the last 2 weeks had increased odds of late stillbirth (aOR = 2.33, 95% CI 1.73 to 3.14). Interaction analysis showed increased strength of movements had a greater protective effect and decreased frequency of movements greater odds of late stillbirth at preterm gestations (28–36 weeks’ gestation). Foetal hiccups (aOR = 0.45, 95% CI 0.36 to 0.58) and regular episodes of vigorous movement (aOR = 0.67, 95% CI 0.52 to 0.87) were associated with decreased odds of late stillbirth. A single episode of unusually vigorous movement was associated with increased odds (aOR = 2.86, 95% CI 2.01 to 4.07), which was higher in women at term. Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.
Publisher: Wiley
Date: 30-07-2021
DOI: 10.1111/APA.16040
Abstract: To understand which safe sleep recommendations parents find most challenging to implement, identifying common barriers encountered and investigate whether challenges are associated with practices employed. A cross‐sectional survey of 3341 Australian families with young infants who birthed a live baby during April–May 2017. Caregivers were asked about infant care practices and family characteristics. Qualitative free‐text items explored challenges faced with current safe sleep recommendations. Nearly one‐third (n = 1033, 31%) of caregivers reported difficulty with at least one safe sleep recommendation. Infant sleep position and avoiding bed‐sharing were identified as the most challenging recommendations. Caregivers described barriers which influenced consistency in uptake of advice. Families who described difficulty with a recommendation were significantly less likely to consistently employ that advice compared to those who did not report difficulty (sleep position: 198/473,42% vs 2548/2837,90% [p 0.0001] own sleep space: (269/344,78% vs 1331/2884,46% [p 0.0001]). When families encountered challenges, they often proposed alternate strategies with an inference their substitute action compensated potential increased risk. Many families encounter difficulties implementing safe sleep advice these challenges negatively impact care practices. Effective interventions meeting in idual family needs, to provide safe sleep environments consistently, are necessary to improve sleep‐related infant care and further reduce infant mortality.
Publisher: Springer Science and Business Media LLC
Date: 17-07-2019
DOI: 10.1007/S00414-019-02126-W
Abstract: Despite being widely used, few studies have assessed the utility of the San Diego definition of sudden infant death syndrome (SIDS). The purpose of this study was to evaluate pathologists' application of the San Diego definition in all cases of sudden unexpected death in infancy (SUDI) that occurred in Queensland, Australia, between 2010 and 2014. Key coronial documents of 228 cases of SUDI were reviewed independently by three reviewers and classified according to the San Diego definition. Clear guidance regarding the evidentiary threshold for classification and interpretation of the San Diego definition was provided. All reviewers classified cases identically in 202 cases (88.6%). Consensus was achieved on the classification of the remaining 26 deaths following case discussion. After review, 79 cases were classified as SIDS, a one third reduction compared with the original classification, mainly due to a high probability of accidental asphyxia. The number of cases classified as undetermined (USID) almost doubled (75/228, 32.9%), and there was more than a fivefold increase in cases classified as asphyxia (43/228, 18.9%). Natural conditions decreased by approximately one third (21/228, 9.2%). This study demonstrates that with clear guidelines for interpretation, the San Diego definition can be applied reliably, with discrepancies resolved through a process of peer review.
Publisher: Wiley
Date: 08-08-2023
DOI: 10.1111/AOGS.14652
Abstract: Maternal perception of fetal movements during pregnancy are reassuring however, the perception of a reduction in movements are concerning to women and known to be associated with increased odds of late stillbirth. Prior to full term, little evidence exists to provide guidelines on how to proceed unless there is an immediate risk to the fetus. Increased strength of movement is the most commonly reported perception of women through to full term, but perception of movement is also hypothesized to be influenced by fetal size. The study aimed to assess the pattern of maternal perception of strength and frequency of fetal movement by gestation and customized birthweight quartile in ongoing pregnancies. A further aim was to assess the association of stillbirth to perception of fetal movements stratified by customized birthweight quartile. This analysis was an in idual participant data meta‐analyses of five case–control studies investigating factors associated with stillbirth. The dataset included 851 cases of women with late stillbirth ( weeks' gestation) and 2257 women with ongoing pregnancies who then had a liveborn infant. The frequency of prioritized fetal movement from 28 weeks' gestation showed a similar pattern for each quartile of birthweight with increased strength being the predominant perception of fetal movement through to full term. The odds of stillbirth associated with reduced fetal movements was increased in all quartiles of customized birthweight centiles but was notably greater in babies in the lowest two quartiles (Q1: adjusted OR: 9.34, 95% CI: 5.43, 16.06 and Q2: adjusted OR: 6.11, 95% CI: 3.11, 11.99). The decreased odds associated with increased strength of movement was present for all customized birthweight quartiles (adjusted OR range: 0.25–0.56). Increased strength of fetal movements in late pregnancy is a positive finding irrespective of fetal size. However, reduced fetal movements are associated with stillbirth, and more so when the fetus is small.
Publisher: Wiley
Date: 12-09-2021
DOI: 10.1111/JPC.15178
Publisher: MDPI AG
Date: 23-06-2022
Abstract: Modifiable infant sleep and care practices are recognised as the most important factors parents and health practitioners can influence to reduce the risk of sleep-related infant mortality. Understanding caregiver awareness of, and perceptions relating to, public health messages and identifying trends in contemporary infant care practices are essential to appropriately inform and refine future infant safe sleep advice. This scoping review sought to examine the extent and nature of empirical literature concerning infant caregiver engagement with, and implementation of, safe sleep risk-reduction advice relating to Sudden Unexpected Deaths in Infancy (SUDI). Databases including PubMed, CINAHL, Scopus, Medline, EMBASE and Ovid were searched for relevant peer reviewed publications with publication dates set between January 2000–May 2021. A total of 137 articles met eligibility criteria. Review results map current infant sleeping and care practices that families adopt, primary infant caregivers’ awareness of safe infant sleep advice and the challenges that families encounter implementing safe sleep recommendations when caring for their infant. Findings demonstrate a need for ongoing monitoring of infant sleep practices and family engagement with safe sleep advice so that potential disparities and population groups at greater risk can be identified, with focused support strategies applied.
Publisher: Wiley
Date: 14-04-2020
DOI: 10.1111/APA.15274
Publisher: SAGE Publications
Date: 25-11-2020
Abstract: To determine whether children with an orofacial cleft have higher levels of behavioral problems than the general population and whether this differs by cleft phenotype. A cohort of children with cleft lip and/or palate (CL/P) born in New Zealand from January 1, 2000. Cleft clinics in New Zealand participating in a larger outcomes study between 2014 and 2017. Children (N = 378) aged 5 to 12 years of age and their parents. The Strengths and Difficulties Questionnaire (SDQ) and Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales 4.0 and Family Impact Module 2.0. Compared to standardized norms, children with a cleft had higher than expected (defined as 20%) levels of abnormal/borderline SDQ scores for conduct problems (27.4%, P = .0003) and peer relationship problems (31.6%, P .0001) but lower than expected levels of problems with pro-social skills (6.3%, P .0001). There were no significant differences by age-group and or cleft phenotype other than an increased risk of hyperactivity in children with CP compared to children with CL. Total difficulties SDQ scores had moderate correlations with the PedsQL. While over 90% of children with CL/P had normal prosocial skills, they may not be easily accepted by their peers which may result in behavioral problems. These concerns were moderately related to lower quality of life. Support for establishment and maintenance of peer relationships is important to address externalizing and peer difficulties in children with CL/P. Community knowledge and understanding of CL/P needs to continue to be promoted.
No related grants have been discovered for John Thompson.