ORCID Profile
0000-0003-2697-1422
Current Organisation
The University of Auckland
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Publisher: Massachusetts Medical Society
Date: 20-09-2007
DOI: 10.1056/NEJMOA071152
Publisher: Springer Science and Business Media LLC
Date: 2012
Publisher: S. Karger AG
Date: 2017
DOI: 10.1159/000456705
Abstract: b i Background: /i /b Many newborn babies experience low blood glucose concentrations, a condition referred to as neonatal hypoglycaemia (NH). The effect of NH on visual development in infancy and childhood is of interest because the occipital lobes, which include the primary visual cortex and a number of extrastriate visual areas, may be particularly susceptible to NH-induced injury. In addition, a number of case series have suggested that NH can affect eye and optic nerve development. b i Objective: /i /b To review the existing literature concerning the effect of NH on the visual system. b i Methods: /i /b A PubMed, Embase, Medline, and Google Scholar literature search was conducted using prespecified MeSH terms. b i Results: /i /b The literature reviewed revealed no clear evidence for an effect of NH on the development of the eye and optic nerve. Furthermore, occipital and occipital-parietal lobe injuries following NH often occurred in conjunction with comorbid conditions and were not clearly linked to subsequent visual dysfunction, possibly due to difficulties in measuring vision in young children and a lack of studies at older ages. A recent, large-scale, prospective study of NH outcomes at 2 years of age found no effect of mild-to-moderate NH on visual development. b i Conclusion: /i /b The effect of NH on visual development is unclear. It is currently unknown whether NH affects visual function in mid-to-late childhood when many visual functions reach adult levels.
Publisher: Public Library of Science (PLoS)
Date: 28-01-2021
DOI: 10.1371/JOURNAL.PMED.1003411
Abstract: Neonatal hypoglycemia is common and can cause brain injury. Buccal dextrose gel is effective for treatment of neonatal hypoglycemia, and when used for prevention may reduce the incidence of hypoglycemia in babies at risk, but its clinical utility remains uncertain. We conducted a multicenter, double-blinded, placebo-controlled randomized trial in 18 New Zealand and Australian maternity hospitals from January 2015 to May 2019. Babies at risk of neonatal hypoglycemia (maternal diabetes, late preterm, or high or low birthweight) without indications for neonatal intensive care unit (NICU) admission were randomized to 0.5 ml/kg buccal 40% dextrose or placebo gel at 1 hour of age. Primary outcome was NICU admission, with power to detect a 4% absolute reduction. Secondary outcomes included hypoglycemia, NICU admission for hypoglycemia, hyperglycemia, breastfeeding at discharge, formula feeding at 6 weeks, and maternal satisfaction. Families and clinical and study staff were unaware of treatment allocation. A total of 2,149 babies were randomized (48.7% girls). NICU admission occurred for 111/1,070 (10.4%) randomized to dextrose gel and 100/1,063 (9.4%) randomized to placebo (adjusted relative risk [aRR] 1.10 95% CI 0.86, 1.42 p = 0.44). Babies randomized to dextrose gel were less likely to become hypoglycemic (blood glucose 2.6 mmol/l) (399/1,070, 37%, versus 448/1,063, 42% aRR 0.88 95% CI 0.80, 0.98 p = 0.02) although NICU admission for hypoglycemia was similar between groups (65/1,070, 6.1%, versus 48/1,063, 4.5% aRR 1.35 95% CI 0.94, 1.94 p = 0.10). There were no differences between groups in breastfeeding at discharge from hospital (aRR 1.00 95% CI 0.99, 1.02 p = 0.67), receipt of formula before discharge (aRR 0.99 95% CI 0.92, 1.08 p = 0.90), and formula feeding at 6 weeks (aRR 1.01 95% CI 0.93, 1.10 p = 0.81), and there was no hyperglycemia. Most mothers (95%) would recommend the study to friends. No adverse effects, including 2 deaths in each group, were attributable to dextrose gel. Limitations of this study included that most participants (81%) were infants of mothers with diabetes, which may limit generalizability, and a less reliable analyzer was used in 16.5% of glucose measurements. In this placebo-controlled randomized trial, prophylactic dextrose gel 200 mg/kg did not reduce NICU admission in babies at risk of hypoglycemia but did reduce hypoglycemia. Long-term follow-up is needed to determine the clinical utility of this strategy. ACTRN 12614001263684 .
Publisher: American Medical Association (AMA)
Date: 17-09-2014
Abstract: Antenatal magnesium sulfate given to pregnant women at imminent risk of very preterm delivery reduces the risk of cerebral palsy in early childhood, although its effects into school age have not been reported from randomized trials. To determine the association between exposure to antenatal magnesium sulfate and neurological, cognitive, academic, and behavioral outcomes at school age. The ACTOMgSO4 was a randomized clinical trial conducted in 16 centers in Australia and New Zealand, comparing magnesium sulfate with placebo given to pregnant women (n = 535 magnesium n = 527 placebo) for whom imminent birth was planned or expected before 30 weeks' gestation. Children who survived from the 14 centers who participated in the school-age follow-up (n = 443 magnesium n = 424 placebo) were invited for an assessment at 6 to 11 years of age between 2005 and 2011. Mortality, cerebral palsy, motor function, IQ, basic academic skills, attention and executive function, behavior, growth, and functional outcomes. Main analyses were imputed for missing data. Of the 1255 fetuses known to be alive at randomization, the mortality rate to school age was 14% (88/629) in the magnesium sulfate group and 18% (110/626) in the placebo group (risk ratio [RR], 0.80 95% CI, 0.62-1.03, P = .08). Of 867 survivors available for follow-up, outcomes at school age (corrected age 6-11 years) were determined for 669 (77%). Comparing the magnesium sulfate and placebo groups revealed no statistically significant difference in proportions with cerebral palsy (23/295 [8%] and 21/314 [7%], respectively odds ratio [OR], 1.26 95% CI, 0.84-1.91 P = .27) or abnormal motor function (80/297 [27%] and 80/300 [27%], respectively OR, 1.16 95% CI, 0.88-1.52 P = .28). There was also little difference between groups on any of the cognitive, behavioral, growth, or functional outcomes. Magnesium sulfate given to pregnant women at imminent risk of birth before 30 weeks' gestation was not associated with neurological, cognitive, behavioral, growth, or functional outcomes in their children at school age, although a mortality advantage cannot be excluded. The lack of long-term benefit requires confirmation in additional studies. anzctr.org.au Identifier: ACTRN12606000252516.
Publisher: BMJ
Date: 20-09-2005
Publisher: Wiley
Date: 03-02-2021
DOI: 10.1111/APA.15763
Abstract: To examine the contributions of specific neurocognitive skills to behaviour problems in children born very preterm. We assessed children born weeks’ gestation or g at age 7 years using subtests of the Wechsler Intelligence Scale for Children Fourth Edition, performance and questionnaire‐based measures of executive function, and Child Behavior Checklist and Teacher Rating Form. We evaluated the contributions of IQ and executive function to behaviour problems and the moderating effect of sex using multiple regression. The 129 children (mean age = 7.2 years) had lower IQ, inferior executive function and increased internalising problems compared with normative s les. Verbal comprehension skills and working memory were associated with total, internalising and externalising problems at school. Performance‐based and questionnaire‐based executive function were associated with total and externalising behaviour problems both at home and school. Sex moderated the relationships between information processing and parent‐reported total problems, and between teacher‐rated executive function and total problems. Both IQ and executive function are related to behaviour problems in children born very preterm, but the relationships are different in boys and girls. Executive function may be a useful target for intervention.
Publisher: American Physiological Society
Date: 2005
DOI: 10.1152/AJPREGU.00357.2004
Abstract: In sheep, parturition is initiated by increased fetal hypothalamic-pituitary-adrenal axis (HPAA) activity leading to PGE 2 and PGF 2α production and a rise in the 17β-estradiol-progesterone (E 2 /P 4 ) ratio. Uteroplacental PG production can also increase fetal HPAA activity. Periconceptional maternal undernutrition accelerates fetal HPAA maturation resulting in preterm labor. We determined whether preterm labor was preceded by an increase in PG concentrations and E 2 /P 4 ratio and whether these increases preceded or followed the corresponding rise in cortisol concentrations. Singleton-bearing ewes were nourished ad libitum (N, n = 9) or undernourished (UN, n = 10) to reduce maternal weight by 15% from −61 days (d) to +30 d after mating with ad libitum intake thereafter. Paired maternal and fetal blood s les were collected from 126 d until delivery. Half the UN group delivered prematurely ( SD below mean gestation for the flock). PG and cortisol concentrations and E 2 /P 4 ratio increased before delivery in the same way in both groups. However, the increases occurred 7–10 d earlier in UN than in N animals. In both UN and N fetuses cortisol concentrations rose before fetal and maternal PG concentrations and maternal E 2 /P 4 ratio. Periconceptional maternal undernutrition induces preterm delivery in sheep by advancing the expected prepartum rise in cortisol and PG concentrations and E 2 /P 4 ratio. The rise in fetal cortisol concentration precedes the rise in fetal and maternal PG concentrations and maternal E 2 /P 4 ratio, suggesting that the underlying mechanism is likely to be acceleration of fetal HPAA maturation, resulting in initiation of the normal process of parturition.
Publisher: Elsevier BV
Date: 04-2003
Publisher: Oxford University Press (OUP)
Date: 27-04-2007
DOI: 10.1093/IJE/DYM067
Abstract: Recent epidemiological evidence has shown increased rates of cardiovascular mortality and associated risk factors in those born small. However, scarce information exists concerning cardiovascular risk factors in adulthood following pre-term birth, or distinguishing the relative contributions of length of gestation and fetal growth to small size at birth. Prospective follow-up of 458 30-year-olds whose mothers took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (147 born at term, 311 born pre-term). Follow-up assessments included anthropometry, blood pressure, blood lipids, early morning cortisol levels and 75 g oral glucose tolerance test. Gestational age at birth, pre-term birth, and birth weight z-score were not associated with serum cholesterol, triglyceride or cortisol at age 30 (P > 0.1 for all). However, pre-term birth was associated with increased systolic blood pressure (3.5 mmHg, 95% CI 0.9-6.1 mmHg, P = 0.009) and insulin resistance at age 30 [Log (Insulin area under the curve) = 0.17, 95% CI 0.05-0.28, P = 0.006]. Low gestational age at birth was also associated with these outcomes, whereas birth weight, adjusted for gestational age, was not. Adults who were born moderately pre-term have increased blood pressure and insulin resistance at 30 years of age. Pre-term birth rather than poor fetal growth is the major determinant of this association. As both the incidence of pre-term birth and survival amongst those born pre-term are increasing, this group may contribute an increasing proportion to overall cardiovascular disease burden.
Publisher: Elsevier BV
Date: 02-2018
DOI: 10.1016/J.JPEDS.2017.09.081
Abstract: To determine whether tight glycemic control of neonatal hyperglycemia changes neurodevelopment, growth, and metabolism at school age. Children born very low birth weight and randomized as hyperglycemic neonates to a trial of tight vs standard glycemic control were assessed at 7 years corrected age, including Wechsler Intelligence Scale for Children Fourth Edition, Movement Assessment Battery for Children 2, visual and neurologic examinations, growth measures, dual X-ray absorptiometry, and frequently s led intravenous glucose tolerance test. The primary outcome was survival without neurodevelopmental impairment at age 7 years. Outcomes were compared using linear regression, adjusted for sex, small for gestational age, birth plurality, and the clustering of twins. Data are reported as number (%) or mean (SD). Of the 88 infants randomized, 11 (13%) had died and 57 (74% of eligible children) were assessed at corrected age 7 years. Survival without neurodevelopmental impairment occurred in 25 of 68 children (37%), with no significant difference between tight (14 of 35 40%) and standard (11 of 33 33%) glycemic control groups (P = .60). Children in the tight group were shorter than those in the standard group (121.3 [6.3] cm vs 125.1 [5.4] cm P < .05), but had similar weight and head circumference. Children in the tight group had greater height-adjusted lean mass (18.7 [0.3] vs 17.6 [0.2] kg P < .01) and lower fasting glucose concentrations (84.6 [6.30] vs 90.0 [5.6] mg⋅dL Tight glycemic control for neonatal hyperglycemia does not change survival without neurodevelopmental impairment, but reduces height, increases height-adjusted lean mass, and reduces fasting blood glucose concentrations at school age. ACTRN: 12606000270516.
Publisher: Wiley
Date: 08-2006
DOI: 10.1359/JBMR.060516
Abstract: Small birth size is associated with reduced adult bone mass. We determined if antenatal betamethasone exposure, birth weight, or prematurity affects peak bone mass in 174 adults. Antenatal betamethasone exposure did not. Lower birth weight and prematurity predicted reduced adult height. Slower fetal growth rather than prematurity predicted lower bone mass, but this lower bone mass was appropriate for reduced adult height. Small size at birth is reported to be associated with lower bone mass in adulthood. However, previous studies have not distinguished the relative contributions of length of gestation and fetal growth to size at birth. Fetal exposure to excess glucocorticoids has been proposed as a core mechanism underlying the associations between birth size and later disease risk. Antenatal glucocorticoids are given to pregnant women at risk for preterm delivery for the prevention of neonatal respiratory distress syndrome in their infants. We determined the relationship of antenatal exposure to betamethasone, birth weight, and prematurity to peak bone mass and femoral geometry in the adult survivors of the first randomized trial of antenatal glucocorticoids. We studied 174 young adults (mean age, 31 years) whose mothers participated in a randomized trial of antenatal betamethasone. Mothers received two doses of intramuscular betamethasone or placebo 24 h apart. Two thirds of participants were born preterm (<37 weeks gestation). We measured indices of bone mass and size and derived estimates of volumetric density and bone geometry from DXA assessments of the lumbar spine, femur, and total body. There were no differences between betamethasone-exposed and placebo-exposed groups in any of the lumbar spine, femur, or total body DXA measures. There was no effect of antenatal betamethasone on adult height, although leg length was increased relative to trunk length (p = 0.002). A lighter birth weight (p <or = 0.001) and lower gestational age (p = 0.013) were associated with shorter stature (height Z scores) at age 31 years. Prematurity had no effect on peak bone mass or femoral geometry. However, lower birth weight, independent of gestational age, was associated with lower later bone mass (p < 0.001 for lumbar spine and total body, p = 0.003 for femoral neck BMC). These effects on bone mass were related to bone size and not to estimates of volumetric density. In the femur, lower birth weight, independent of gestational age, was associated with narrowing of the upper shaft and narrow neck regions. Antenatal betamethasone exposure does not affect peak bone mass or femoral geometry in adulthood. Birth weight and prematurity predict adult height, but it is slower fetal growth, rather than prematurity, that predicts lower peak bone mass. The lower peak bone mass in those born small is appropriate for their adult height.
Publisher: Elsevier BV
Date: 07-2018
Publisher: Wiley
Date: 08-2007
DOI: 10.1111/J.1469-8749.2007.00597.X
Abstract: The aim of this study was to determine if preterm birth is associated with socioeconomic status (SES), psychological functioning, and health-related quality of life (HRQoL) in adulthood. We used prospective follow-up of 192 adult offspring of mothers who took part in a randomized controlled trial of antenatal betamethasone for the prevention of neonatal respiratory distress syndrome (66 born at term [33 males, 33 females] 126 born preterm [66 males, 60 females]). Cognitive functioning was assessed using the Wechsler Abbreviated Scale of Intelligence. Working memory and attention was assessed using the Benton Visual Retention Test, the Paced Auditory Serial Addition Test, and the Brown Attention Deficit Disorder Scale. Psychiatric morbidity was assessed using the Beck Depression Inventory II, the State-Trait Anxiety Inventory, and the Schizotypy Traits Questionnaire. Handedness was assessed using the Edinburgh Handedness Inventory. HRQoL was assessed using the Short Form-36 Health Survey. Moderately preterm birth (median gestation 34wks, mean birthweight 1946g [SD 463g]) was not related to later marital status, educational attainment, SES, cognitive functioning, working memory, attention, or symptoms of anxiety or schizotypy at 31 years of age. Preterm birth was associated with fewer symptoms of depression and higher levels of satisfaction in three of the eight HRQoL domains measured (bodily pain, general health perception, and social functioning). Adults who were born moderately preterm have SES, psychological functioning, and HRQoL consistent with those who were born at term. This good long-term outcome cannot be extrapolated to those with early childhood disability or very low birthweights.
Publisher: The Endocrine Society
Date: 23-07-2015
DOI: 10.1210/EN.2015-1095
Abstract: Adults born preterm are at increased risk of impaired glucose tolerance and diabetes. Late gestation fetuses exposed to high blood glucose concentration also are at increased risk of impaired glucose tolerance as adults. Preterm babies commonly become hyperglycemic and are thus exposed to high blood glucose concentration at an equivalent stage of pancreatic maturation. It is not known whether preterm birth itself, or complications of prematurity, such as hyperglycemia, alter later pancreatic function. To distinguish these, we made singleton preterm lambs hyperglycemic (HYPER) for 12 days after birth with a dextrose infusion and compared them with vehicle-treated preterm and term controls and with HYPER lambs made normoglycemic with an insulin infusion. Preterm birth reduced β-cell mass, apparent by 4 weeks after term and persisting to adulthood (12 mo), and was associated with reduced insulin secretion at 4 months (juvenile) and reduced insulin mRNA expression in adulthood. Hyperglycemia in preterm lambs further down-regulated key pancreatic gene expression in adulthood. These findings indicate that reduced β-cell mass after preterm birth may be an important factor in increased risk of diabetes after preterm birth and may be exacerbated by postnatal hyperglycemia.
Publisher: American Academy of Pediatrics (AAP)
Date: 09-2004
Abstract: Objective. To determine whether prenatal exposure to betamethasone for the prevention of neonatal respiratory distress syndrome (RDS) alters blood pressure in childhood. Design. Prospective follow-up study of a randomized, double-blind, placebo-controlled trial. Setting. National Women's Hospital (Auckland, New Zealand). Participants. Two hundred twenty-three 6-year-old children of mothers who presented with unplanned premature labor and took part in a randomized, controlled trial of prenatal betamethasone therapy for the prevention of neonatal RDS. Intervention. Mothers received 2 doses of betamethasone (12 mg) or placebo, administered through intramuscular injection, 24 hours apart. Main Outcome Measures. Systolic and diastolic blood pressure at 6 years of age. Results. Children exposed prenatally to betamethasone (n = 121) did not differ in systolic or diastolic blood pressure from children exposed to placebo (n = 102) (mean difference: systolic: −1.6 mm Hg 95% confidence interval: −4.1 to 0.8 mm Hg diastolic: −0.3 mm Hg 95% confidence interval: −2.5 to 1.8 mm Hg). Conclusion. Prenatal exposure to betamethasone for prevention of neonatal RDS does not alter blood pressure at 6 years of age.
Publisher: Public Library of Science (PLoS)
Date: 22-05-2012
Publisher: Wiley
Date: 08-2002
DOI: 10.1046/J.1440-1754.2002.00790.X
Abstract: To establish the preterm infant hospitalization risks from respiratory syncytial virus (RSV) in New Zealand and the net cost per hospitalization averted by palivizumab. The 437 infants born < 32 weeks' gestation in 1997 and treated at five major neonatal units were identified. Subsequent admissions during the next 2 years for bronchiolitis, pneumonia and croup were tracked, and information collected on RSV tests performed. Data on the length of stay and hospital costs were used to calculate the potential net cost per hospitalization averted associated with the use of palivizumab and the number needed to treat (NNT) to prevent one hospitalization. Estimated RSV readmission risk before 1 year corrected age in infants < 32 weeks' gestation discharged home on oxygen, and those " 28 weeks' gestation, or between 29 and 31 weeks' gestation with or without chronic lung disease was 42%, 23%, 19%, 10% and 8%, respectively. The NNT with palivizumab to prevent one hospitalization ranged from six to 26 across subgroups. Mean (range) net cost per hospitalization averted was 60,000 New Zealand dollars ($28,000-$166,700). In no subgroup would prophylaxis result in net cost saving. Prophylaxis for all NZ infants " 28 weeks' gestation would cost approximately $1,090,000 net and prevent 29 hospitalizations annually, being equivalent to $37,000 net per hospitalization averted, with eight infants treated to prevent one hospitalization. Alternative assumptions about cost and efficacy failed to alter these findings. If value is placed on preventing morbidity, the priority groups for palivizumab prophylaxis are preterm infants discharged home on oxygen, followed by preterm infants of 28 weeks' gestation or less.
Publisher: Elsevier BV
Date: 05-2005
Publisher: Association for Research in Vision and Ophthalmology (ARVO)
Date: 30-12-2013
Publisher: Elsevier BV
Date: 04-1993
DOI: 10.1016/0140-6736(93)91224-A
Abstract: Babies who are small at birth or during infancy have increased rates of cardiovascular disease and non-insulin-dependent diabetes as adults. Some of these babies have low birthweights, some are small in relation to the size of their placentas, some are thin at birth, and some are short at birth and fail to gain weight in infancy. This paper shows how fetal undernutrition at different stages of gestation can be linked to these patterns of early growth. The fetuses' adaptations to undernutrition are associated with changes in the concentrations of fetal and placental hormones. Persisting changes in the levels of hormone secretion, and in the sensitivity of tissues to them, may link fetal undernutrition with abnormal structure, function, and disease in adult life.
Publisher: BMJ
Date: 05-09-2005
Publisher: BMJ
Date: 08-2006
Publisher: Wiley
Date: 2003
DOI: 10.1046/J.1440-1754.2003.00069.X
Abstract: To determine the current management of bronchiolitis by five major New Zealand hospitals and to identify areas for improvement. Lists of infants under 1 year of age admitted with bronchiolitis during 1998 were obtained from the casemix offices of the five largest New Zealand hospitals with paediatric services. Hospital records from a random s le of these admissions were reviewed. Out of the 409 infants admitted overnight, 8% had been born less than or=32 weeks gestation and 53% were aged younger than 6 months. Overall, 59% received oxygen, 21% had nasogastric fluids, 22% had intravenous fluids, 34% were prescribed antibiotics, 42% received bronchodilators and 60% had a chest radiograph. Respiratory secretions were collected for viral studies from 58% of infants and, in 59%, respiratory syncytial virus was detected. Significant variations in management were detected between hospitals. The overall proportion of infants requiring oxygen, intravenous or nasogastric fluids (65%) was significantly higher than that found in a 1986-1988 Christchurch study where only 25% received one or more of these interventions (P < 0.001). Opportunities exist to rationalize bronchiolitis management in New Zealand with potential cost savings, particularly by reducing the number of chest radiographs and prescribing of unnecessary antibiotics and bronchodilators.
No related grants have been discovered for Jane Harding.