ORCID Profile
0000-0002-9699-8201
Current Organisation
University of Queensland School of Public Health
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Publisher: Springer Science and Business Media LLC
Date: 04-01-2016
Publisher: Elsevier BV
Date: 11-2021
DOI: 10.1016/J.IJID.2021.07.037
Abstract: To compare neurological functioning of neonates born to mothers with and without malaria in pregnancy. Pregnant women presenting at Korle Bu Teaching Hospital, Ghana were recruited into this prospective observational study. Malaria exposure was determined by clinically documented antenatal malaria infection parasitemia in maternal, placental, or umbilical cord blood or placental histology. Neurological functioning was assessed using the Hammersmith Neonatal Neurological Examination within 48 hours of birth. Performance was classified as "optimal" or "suboptimal" by subdomain and overall. Between November 21, 2018 and February 10, 2019, a total of 211 term-born neonates, of whom 27 (13%) were exposed to malaria in pregnancy, were included. In the reflexes subdomain, exposed neonates tended to score lower (adjusted mean difference -0.34, 95% confidence interval -0.70 to 0.03), with an increased risk (adjusted risk ratio 1.63, 95% confidence interval 1.09 to 2.44) of suboptimal performance compared with unexposed neonates. There were no significant between-group differences in scores or optimality classification for the remaining subdomains and overall. Malaria-exposed neonates had similar neurological functioning relative to unexposed neonates, with differences confined to the reflexes subdomain, suggesting potential underlying neurological immaturity or injury. Further studies are needed to confirm these findings and determine the significance of malaria in pregnancy on long-term neurological outcomes.
Publisher: Elsevier BV
Date: 07-2019
Publisher: Elsevier BV
Date: 04-2022
DOI: 10.1016/J.PEDIATRNEUROL.2021.10.017
Abstract: Atypical cries have been identified in infants with neurological dysfunction. The aim of this study was to conduct a systematic review and meta-analysis to appraise existing evidence for associations between acoustic cry characteristics and neurological dysfunction in infants aged 18 months or less. PubMed/MEDLINE, PsycINFO, CINAHL, and Embase were searched for original, peer-reviewed studies published in English reporting cry variables in infants aged 18 months or less with or at risk of neurological dysfunction. Studies without a nonneurologically impaired control s le were excluded. Pooled effect sizes were estimated using standardized mean difference (SMD) and odds ratio (OR). I From March 2018 to February 2019, 28,294 studies were retrieved. Eight were meta-analyzed. Infants with or at risk of neurological dysfunction exhibited higher mean (SMD = 0.11 [95% confidence interval, 0.00 to 0.23]) and minimum (SMD = 0.93 [0.64 to 1.23]) fundamental frequency higher odds of hyperphonation (OR = 13.17 [1.05 to 165.87]), biphonation (OR = 10.62 [1.53 to 73.59]), rise-fall-rise melodies (OR = 4.66 [1.16 to 18.66]), and flat melodies (OR = 4.47 [1.27 to 15.68]) and lower odds of fall-rise-fall melodies (OR = 0.21 [0.05 to 0.83]). Infants with underlying neuropathology have unique cries characterized by higher fundamental frequency, dysphonation, and atypical melodies, although study heterogeneity and imprecision of effect size estimates limited our interpretation. Assessment of acoustic cry characteristics offers the potential for noninvasive, rapid, point-of-care screening for neurologically high-risk infants.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2016
Publisher: American Society of Tropical Medicine and Hygiene
Date: 03-06-2015
Publisher: American Academy of Pediatrics (AAP)
Date: 08-2022
DOI: 10.1542/PEDS.2022-057092O
Abstract: Preterm and low birth weight (LBW) infants are often separated from parents during hospitalization. Our objective was to assess effects of interventions to increase family involvement in the routine newborn care of preterm or LBW infants compared with standard NICU care on infant and parental outcomes. Data sources include Medline, Embase, CINAHL, and World Health Organization Global Index Medicus to August 2021. The study selection included randomized controlled trials (RCTs) of family involvement intervention packages. Data were extracted and pooled with random-effects models. We included 15 RCTs with 5240 participants. All interventions included direct parental bedside care packages varied with respect to additional components. Family involvement interventions decreased retinopathy of prematurity (odds ratio 0.52, 95% confidence interval [CI]: 0.34, 0.80 8 RCTs), length of hospital stay (mean difference [MD] −2.91 days 95% CI: −5.15,−0.82 11 RCTs), and parental stress and anxiety (Parental Stress Scale: MD −0.29 points, 95% CI: −0.56,−0.01, 2 RCTs Anxiety State-Trait scale: MD −1.79, 95% CI: −3.11,−0.48 2 RCTs). Family involvement increased weight gain velocity (MD 2.09 g/day 95% CI: 1.27, 2.91 3 RCTs), neurobehavioral exam scores (MD: 1.11 95% CI: 0.21, 2.01 2 RCTs) and predominant or exclusive breastmilk intake (odds ratio 1.34 95% CI: 1.01, 1.65 3 RCTs). It may decrease rates of bronchopulmonary dysplasia, infection, and intraventricular hemorrhage. There were no effects on mortality or necrotizing enterocolitis. Certainty of evidence ranged from low to moderate. Family involvement has a beneficial role on several infant and parental outcomes.
Publisher: Springer Science and Business Media LLC
Date: 23-09-2011
Abstract: Following the development of resistance to anti-malarial mono-therapies, malaria endemic countries in Africa now use artemisinin-based combination therapy (ACT) as recommended first-line treatment for uncomplicated malaria. Patients' adherence to ACT is an important factor to ensure treatment efficacy, as well as to reduce the likelihood of parasite resistance to these drugs. This study reports adherence to a specific ACT, artemether-lumefantrine (AL), under conditions of routine clinical practice in Kenya. The study was undertaken in Garissa and Bunyala districts among outpatients of five government health facilities. Patients treated with AL were visited at home four days after having been prescribed the drug. Respondents (patients ≥ 15 years and caregivers of patients 15 years) were interviewed using a standardized questionnaire, AL blister packs were physically inspected and the adherence status of patients was then recorded. Multivariate logistic regression modelling was used to determine predictors of adherence. Of the 918 patients included in the study, 588 (64.1%) were 'probably adherent', 291 (31.7%) were 'definitely non-adherent' and 39 (4.2%) were 'probably non-adherent'. Six factors were found to be significant predictors of adherence: patient knowledge of the ACT dosing regimen (odds ratio (OR) = 1.76 95% CI = 1.32-2.35), patient age (OR = 1.65 95% CI = 1.02-1.85), respondent age (OR = 1.37 95% CI = 1.10-2.48), whether a respondent had seen AL before (OR = 1.46 95% CI = 1.08-1.98), whether a patient had reported dislikes to AL (OR = 0.62 95% CI = 0.47-0.82) and whether a respondent had waited more than 24 hours to seek treatment (OR = 0.73 95% CI = 0.54-0.99). Overall, adherence to AL was found to be low in both Garissa and Bunyala districts, with patient knowledge of the AL dosing regimen found to be the strongest predictor of adherence. Interventions aimed at increasing community awareness of the AL dosing regimen, use of child friendly formulations and improving health workers' prescribing practices are likely to ensure higher adherence to AL and eventual treatment success.
Publisher: Wiley
Date: 04-2021
DOI: 10.1111/AJO.13325
Abstract: Stillbirth rates have shown little improvement for two decades in Australia. Perinatal mortality audit is key to prevention, but the literature suggests that implementation is suboptimal. To determine the proportion of perinatal deaths which are associated with contributing factors relating to care in Queensland, Australia. Retrospective audit of perinatal deaths ≥ 34 weeks gestation by the Health Department in Queensland was undertaken. Cases and demographic information were obtained from the Queensland Perinatal Data Collection. A multidisciplinary panel used the Perinatal Society of Australia and New Zealand (PSANZ) perinatal mortality audit guidelines to classify the cause of death and to identify contributing factors. Contributing factors were classified as ‘insignificant’, ‘possible’, or ‘significant’. From 1 January to 31 December 2018, 65 deaths (56 stillbirths and nine neonatal deaths) were eligible and audited. Most deaths were classified as unexplained (51.8% of stillbirths). Contributing factors were identified in 46 (71%) deaths: six insignificant (all stillbirths), 20 possibly related to outcome (17 stillbirths), and 20 significantly (16 stillbirths). Areas for practice improvements mainly related to the care for women with risk factors for stillbirth, especially antenatal care. The PSANZ guidelines were applied and enabled a systematic approach. A high proportion of late gestation perinatal deaths are associated with contributing factors relating to care. Improving antenatal care for women with risk factors for stillbirth is a priority. Perinatal mortality audit is a valuable step in stillbirth prevention and the PSANZ guidelines allow a systematic approach to aid implementation and reporting.
Publisher: Wiley
Date: 30-01-2023
DOI: 10.1111/AJO.13647
Abstract: Delayed reporting of decreased fetal movements (DFM) could represent a missed opportunity to prevent stillbirth. Mobile phone applications (apps) have the potential to improve maternal awareness and reporting of DFM and contribute to stillbirth prevention. To evaluate the effectiveness of the My Baby's Movements (MBM) app on late‐gestation stillbirth rates. The MBM trial evaluated a multifaceted fetal movements awareness package across 26 maternity services in Australia and New Zealand between 2016 and 2019. In this secondary analysis, generalised linear mixed models were used to compare rates of late‐gestation stillbirth, obstetric interventions, and neonatal outcomes between app users and non‐app users including calendar time, cluster, primiparity and other potential confounders as fixed effects, and hospital as a random effect. Of 140 052 women included, app users comprised 9.8% ( n = 13 780). The stillbirth rate was not significantly lower among app users (1.67/1000 vs 2.29/1000) (adjusted odds ratio (aOR) 0.79 95% CI 0.51–1.23). App users were less likely to have a preterm birth (aOR 0.81 0.75–0.88) or a composite adverse neonatal outcome (aOR 0.87 0.81–0.93) however, they had higher rates of induction of labour (IOL) (aOR 1.27 1.22–1.32) and early term birth (aOR 1.08 1.04–1.12). The MBM app had low uptake and its use was not associated with stillbirth rates but was associated with some neonatal benefit, and higher rates of IOL and early term birth. Use and acceptability of tools designed to promote fetal movement awareness is an important knowledge gap. The implications of increased IOL and early term births warrant consideration in future studies.
Publisher: Elsevier BV
Date: 05-2023
Publisher: Elsevier BV
Date: 11-2020
Publisher: Wiley
Date: 08-05-2023
Abstract: To examine the prevalence of novel newborn types among 165 million live births in 23 countries from 2000 to 2021. Population‐based, multi‐country analysis. National data systems in 23 middle‐ and high‐income countries. Liveborn infants. Country teams with high‐quality data were invited to be part of the Vulnerable Newborn Measurement Collaboration. We classified live births by six newborn types based on gestational age information (preterm weeks versus term ≥37 weeks) and size for gestational age defined as small (SGA, th centile), appropriate (10th–90th centiles), or large (LGA, th centile) for gestational age, according to INTERGROWTH‐21st standards. We considered small newborn types of any combination of preterm or SGA, and term + LGA was considered large. Time trends were analysed using 3‐year moving averages for small and large types. Prevalence of six newborn types. We analysed 165 017 419 live births and the median prevalence of small types was 11.7% – highest in Malaysia (26%) and Qatar (15.7%). Overall, 18.1% of newborns were large (term + LGA) and was highest in Estonia 28.8% and Denmark 25.9%. Time trends of small and large infants were relatively stable in most countries. The distribution of newborn types varies across the 23 middle‐ and high‐income countries. Small newborn types were highest in west Asian countries and large types were highest in Europe. To better understand the global patterns of these novel newborn types, more information is needed, especially from low‐ and middle‐income countries.
Publisher: Wiley
Date: 24-10-2022
Abstract: The My Baby’s Movements (MBM) trial aimed to evaluate the impact on stillbirth rates of a multifaceted awareness package (the MBM intervention). Stepped‐wedge cluster‐randomised controlled trial. Twenty‐seven maternity hospitals in Australia and New Zealand. Women with a singleton pregnancy without major fetal anomaly at ≥28 weeks of gestation from August 2016 to May 2019. The MBM intervention was implemented at randomly assigned time points, with the sequential introduction of eight groups of between three and five hospitals at 4‐monthly intervals. Using generalised linear mixed models, the stillbirth rate was compared in the control and the intervention periods, adjusting for calendar time, study population characteristics and hospital effects. Stillbirth at ≥28 weeks of gestation. There were 304 850 births with 290 105 births meeting the inclusion criteria: 150 053 in the control and 140 052 in the intervention periods. The stillbirth rate was lower (although not statistically significantly so) during the intervention compared with the control period (2.2/1000 versus 2.4/1000 births aOR 1.18, 95% CI 0.93–1.50 P = 0.18). The decrease in stillbirth rate was greater across calendar time: 2.7/1000 in the first versus 2.0/1000 in the last 18 months. No increase in secondary outcomes, including obstetric intervention or adverse neonatal outcome, was evident. The MBM intervention did not reduce stillbirths beyond the downward trend over time. As a result of low uptake, the role of the intervention remains unclear, although the downward trend across time suggests some benefit in lowering the stillbirth rate. In this study setting, an awareness of the importance of fetal movements may have reached pregnant women and clinicians prior to the implementation of the intervention. The My Baby’s Movements intervention to raise awareness of decreased fetal movement did not significantly reduce stillbirth rates.
Publisher: Wiley
Date: 08-05-2023
Abstract: To compare neonatal mortality associated with six novel vulnerable newborn types in 125.5 million live births across 15 countries, 2000–2020. Population‐based, multi‐country study. National data systems in 15 middle‐ and high‐income countries. We used in idual‐level data sets identified for the Vulnerable Newborn Measurement Collaboration. We examined the contribution to neonatal mortality of six newborn types combining gestational age (preterm [PT] versus term [T]) and size‐for‐gestational age (small [SGA], th centile, appropriate [AGA], 10th–90th centile or large [LGA], th centile) according to INTERGROWTH‐21st newborn standards. Newborn babies with PT or SGA were defined as small and T + LGA was considered as large. We calculated risk ratios (RRs) and population attributable risks (PAR%) for the six newborn types. Mortality of six newborn types. Of 125.5 million live births analysed, risk ratios were highest among PT + SGA (median 67.2, interquartile range [IQR] 45.6–73.9), PT + AGA (median 34.3, IQR 23.9–37.5) and PT + LGA (median 28.3, IQR 18.4–32.3). At the population level, PT + AGA was the greatest contributor to newborn mortality (median PAR% 53.7, IQR 44.5–54.9). Mortality risk was highest among newborns born before 28 weeks (median RR 279.5, IQR 234.2–388.5) compared with babies born between 37 and 42 completed weeks or with a birthweight less than 1000 g (median RR 282.8, IQR 194.7–342.8) compared with those between 2500 g and 4000 g as a reference group. Preterm newborn types were the most vulnerable, and associated with the highest mortality, particularly with co‐existence of preterm and SGA. As PT + AGA is more prevalent, it is responsible for the greatest burden of neonatal deaths at population level.
Publisher: Springer Science and Business Media LLC
Date: 19-08-2016
Publisher: University of Queensland Library
Date: 2021
DOI: 10.14264/BBD718A
Publisher: Springer Science and Business Media LLC
Date: 25-02-2016
Publisher: Springer Science and Business Media LLC
Date: 13-10-2017
Publisher: Elsevier BV
Date: 2021
DOI: 10.1016/J.EARLHUMDEV.2020.105133
Abstract: To describe gestational age-specific distribution of scores for the Hammersmith Neonatal Neurological Examination (HNNE) up to 48 h after birth in a low-risk, term-born, single-center s le in Ghana. This is a nested substudy of a larger prospective study (IMPRINT: Impact of Malaria in Pregnancy on Infant Neurodevelopment) comprising 140 low-risk, term-born neonates at Korle Bu Teaching Hospital in Accra, Ghana, between November 2018 and February 2019. The s le was stratified into three gestational age groups: early-term (37 + 0-38 + 6, weeks + days n = 61), full-term (39 + 0-40 + 6, weeks + days n = 52), and late ost-term (41 + 0-42 + 6, weeks + days n = 27). Neonates were administered the 34-item HNNE by trained physicians. As per the original British scoring system, raw scores for the Ghanaian s le were plotted and scores > 10th centile were assigned a score of 1, 5th-10th centile 0.5, and < 5th centile 0. The range of raw scores for 16/34 HNNE items varied with gestational age. Specifically, 100% (7/7), 50% (5/10), 33% (1/3), 33% (1/3), 20% (1/5), and 14% (1/7) of items within the orientation and behavior, tone, abnormal signs atterns, movements, tone patterns, and reflexes subdomain, respectively showed a different distribution of scores above the 10th centile across the three gestational age groups. Differences in gestational age-specific results within our s le in comparison to the original British s le could be, albeit unlikely, due to misclassification of gestational age, unmeasured maternal or fetal morbidity, or perhaps more likely, variation in testing or test conditions, or some combination of these. Genetic variation in neurological development is also a possibility. Further research is warranted to determine the reasons for differences. Our findings highlight the need to determine the accuracy and reliability of standardized neurologic assessments in predicting neurodevelopmental risk for infants in low- and middle-income countries.
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Harriet Lawford.