ORCID Profile
0000-0002-9722-1509
Current Organisations
Higher Education Academy
,
Organisation
,
Royal Australasian College of Physicians
,
University of Hamburg
,
University of Queensland School of Medicine
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Publisher: Elsevier BV
Date: 09-2020
Publisher: Springer Science and Business Media LLC
Date: 14-07-2017
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.CLINPH.2008.11.008
Abstract: Changes in cerebral impedance in the newborn piglet are able to discriminate, within 1-2 h of acute hypoxia, between animals which will have a good neurological outcome, and those who have suffered more severe hypoxia resulting in poor outcome. The aim of this study was to determine if cerebral impedance could be used to identify those human infants with an encephalopathy following acute hypoxia who subsequently have a poor neurological outcome. It is these infants who may benefit most from neural rescue treatment. Twenty-four newborn term infants with evidence of severe acute intrapartum hypoxia and encephalopathy were studied. Bioimpedance spectroscopy was commenced as soon as possible after birth and repeated every 30 min until the infant was 12 h old. Neurodevelopmental outcome was assessed at 12 months of age. Although cerebral impedance was different to control values, there was no significant difference in cerebral impedance between hypoxic babies with normal and those with abnormal development. Cerebral impedance was increased in hypoxic babies, as predicted from animal data, but the method was not suitable for discrimination of outcome. Cerebral impedance is not useful for early identification of infants who subsequently have a poor outcome after acute intrapartum hypoxia and who may benefit from neural rescue treatment.
Publisher: Springer Science and Business Media LLC
Date: 10-2007
DOI: 10.1007/S00467-007-0561-8
Abstract: Neonatal hypertension occurs in up to 2% of neonatal intensive care survivors and in up to 3% of all neonates. Normal blood pressure (BP) measurements are required to diagnose and manage appropriately both hypotension and hypertension in the neonate and infant. The aim of this study was to provide normative BP measurements during the first year of life of healthy infants born at term, using an oscillometric method. Neonates were enrolled from August 2003 to August 2005. Exclusion criteria included: infants of mothers with hypertension or diabetes of any type, use of illicit substances, congenital or chromosomal anomaly, admission to the neonatal intensive care unit or possible sepsis. There were 406 infants enrolled, with 150 children followed at 6 months of age and 118 children at 12 months of age. There were no differences in BP measurements at 6 months or 12 months of age by gender, weight or height. A BP measurement above the 90th percentile on day 2 or at 6 months was not predictive of a BP above the 90th percentile at 12 months of age. Higher systolic and diastolic measurements at 6 months and 12 months were found, in comparison to those in previous studies using ultrasonic devices. The findings of this study provide normative BP values for infants during their first year of life, using the oscillometric method, the most frequently used method in paediatric, neonatal intensive care and emergency departments.
Publisher: Wiley
Date: 02-2002
Publisher: Wiley
Date: 09-11-2006
DOI: 10.1111/J.1440-1754.2006.00986.X
Abstract: Neonatal herpes encephalitis is usually caused by herpes simplex virus type 2 and results in significant morbidity and mortality. Imaging diagnosis with ultrasound, computed tomography scan and conventional magnetic resonance imaging may be normal in the early course of the disease. In this case diffusion-weighted magnetic resonance imaging detected the disease process earlier and better than the conventional T2-weighted or fluid-attenuated inversion recovery imaging sequences. The use of diffusion-weighted magnetic resonance imaging in neonatal herpes encephalitis proved to be a useful tool in the early stage of the disease.
Publisher: Springer Science and Business Media LLC
Date: 09-2007
DOI: 10.1007/S00467-007-0480-8
Abstract: There has been a temporal trend towards increased birth weight over the past three decades. This increase in birth weight may have resulted in an increase in neonatal blood pressure. Neonatal hypertension is becoming more common, especially in neonatal intensive care unit survivors. Current normative values are required to assist in diagnosis and appropriate management of neonatal hypotension and hypertension. The objective of this study was to determine normative blood pressure readings in healthy term neonates. Term neonates from the postnatal ward were enrolled from August 2003 to August 2005. Exclusion criteria included infants of mothers with preecl sia, hypertension of any cause, gestational diabetes, type 1 diabetes mellitus and illicit substance use, infant congenital or chromosomal anomaly, admission to the neonatal intensive care unit or possible sepsis. Of the 406 infants enrolled, 218 were male. The median systolic, diastolic and mean blood pressures on day 1 of life were 65 mmHg, 45 mmHg, and 48 mmHg, respectively. On day 4, these values had increased to 70 mmHg, 46 mmHg and 54 mmHg. There was a significant elevation in blood pressure from day 1 to day 2 of life. There was no significant difference in blood pressure readings with respect to birth weight or length. The only significant difference between the sexes was a lower mean and diastolic pressure on day 2 in boys. This study has provided current normative blood pressure readings of healthy term neonates that can be used to assess both hypotension and hypertension in the term neonate. No increase in blood pressure was noted from previous studies.
Publisher: Wiley
Date: 27-03-2017
DOI: 10.1111/JOCN.13509
Abstract: To facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. In 2012, an Australian regional neonatal intensive care unit transitioned from an open-plan to a two-cot neonatal intensive care unit design. Research has reported single- and small-room neonatal intensive care unit design may negatively impact on the distances nurses walk, reducing the time they spend providing direct neonatal care. Studies have also reported nurses feel isolated and need additional support and education in such neonatal intensive care units. Staff highlighted their concerns regarding the impact of the new design on workflow and clinical practice. A participatory action research approach. A participatory action group titled the Change and Networking Group collaborated with staff over a four-year period (2009-2013) to facilitate the transition. The Change and Networking Group used a collaborative, cyclical process of planning, gathering data, taking action and reviewing the results to plan the next action. Data sources included meeting and workshop minutes, newsletters, feedback boards, subgroup reports and a staff satisfaction survey. The study findings include a description of (1) how the participatory action research cycles were used by the Change and Networking Group: providing ex les of projects and strategies undertaken and (2) evaluations of participatory action research methodology and Group by neonatal intensive care unit staff and Change and Networking members. This study has described the benefits of using participatory action research to facilitate staff transition from an open-plan to a two-cot neonatal intensive care unit design. Participatory action research methodology enabled the inclusion of staff to find solutions to design and clinical practice questions. Future research is required to assess the long-term effect of neonatal intensive care unit design on staff workload, maintaining and supporting a skilled workforce as well as the impact of a new neonatal intensive care unit design on the neonatal intensive care unit culture. A supportive work environment for staff is critical in providing high-quality health care.
Publisher: Springer Berlin Heidelberg
Date: 2007
Publisher: BMJ
Date: 07-2002
DOI: 10.1136/FN.87.1.F31
Abstract: To evaluate incidence and mortality of congenital heart disease in very low birthweight babies. Retrospective analysis of a 12 year period. Forty seven babies were diagnosed with severe congenital heart disease. The most common lesions were ventricular septal defect and coarctation of the aorta. Mortality attributed to congenital heart disease was 32%. Coarctation of the aorta, the second most common lesion, was fatal in 62% of cases. Closure of a patent ductus arteriosus with indomethacin proved to be detrimental in babies with undiagnosed coarctation, causing rapid deterioration in some. Very low birthweight neonates with severe congenital heart disease have a higher mortality than babies with higher birth weight. A contributing factor is closure of a patent ductus arteriosus if an underlying lesion has not been recognised. This could be of significance if the use of prophylactic treatment with indomethacin becomes more common.
Publisher: Massachusetts Medical Society
Date: 25-02-2016
Publisher: Wiley
Date: 09-2012
DOI: 10.1111/J.1440-1754.2012.02530.X
Abstract: To find out the knowledge and attitudes of health-care professionals (HCPs) in Australian neonatal intensive care units (NICUs) towards breast milk banking (BMBg) and pasteurised donated breast milk (PDBM). Cross-sectional structured survey of HCPs in all 25 NICUs in Australia. Response rate was 43.4% (n= 358 of 825). Participants included nurses and midwives (291, 81.3%) and the remainder were neonatologists and neonatal trainees (67, 18.7%). A variable number of HCPs agreed that PDBM would decrease the risk of necrotising enterocolitis (81%) and allergies (48.9%), 8.4% thought PDBM will carry risk of infections and 78.8% agreed that PDBM is preferable over formula, but only 67.5% thought that establishing breast milk banks (BMBs) are justifiable. Significant differences were found between doctors and nurses/midwives, with 19.4% of doctors compared with 5.8% of nurses/midwives agreed that PDBM carried an increased risk of infection. Although, over 90% of nurses/midwives and 70% of doctors agreed that the donation of breast milk is important, only 71% of nurses/midwives and 52.2% of doctors thought that setting up a BMB was justifiable. The opinions about BMBg differ widely between HCPs however, the majority support the practice. HCPs had different knowledge gaps in regard to BMBg. Nurses/midwives positively view the practice of BMBg more strongly compared with neonatologists.
Publisher: Springer Science and Business Media LLC
Date: 08-2005
Publisher: Wiley
Date: 21-01-2002
Publisher: Springer Science and Business Media LLC
Date: 11-2005
Publisher: Springer Science and Business Media LLC
Date: 08-2005
Publisher: AMPCo
Date: 2017
DOI: 10.5694/MJA16.01212
Publisher: Elsevier BV
Date: 10-2013
Publisher: Wiley
Date: 17-12-2012
DOI: 10.1111/JPC.12028
Abstract: The aim of the study was to compare neurodevelopmental outcomes of extremely preterm infants admitted during (OH) and after (AH) office hours. A retrospective review of the New South Wales and Australian Capital Territory Neonatal Intensive Care Units' (NICUs) Data Collection of all infants 2 standard deviations below the mean), cerebral palsy (unable to walk without aids), deafness (requiring bilateral hearing aids) or blindness (visual acuity <6/60 in the better eye). Mortality and age at follow-up were comparable between the AH and OH groups. Developmental outcome was evaluated in 972 (74.9%) infants admitted during AH and 501 (74.6%) admitted during OH. FD was not significantly different between the AH and OH groups (17.1% vs. 14.8%, adjusted odds ratio 1.131, 95% confidence interval 1.131 (0.839-1.523), P = 0.420). There were no significant differences between AH and OH infants with cerebral palsy (9.6% vs. 7.6%), developmental delay (5.4% vs. 5.0%) or any other component of FD. There is little circadian variation in mortality and adverse neurodevelopmental outcomes in an NICU network with the current model of after hours staffing and support, and sharing of NICU workload within a network.
Publisher: Springer Science and Business Media LLC
Date: 31-10-2007
DOI: 10.1007/S00383-007-2021-8
Abstract: We hypothesise that constipated children would be more likely to come from a socially deprived background. We also hypothesise that a percentage of children with resistant constipation would have a congenital gut motility problem that might be recognised at birth, and that some of these would have slow transit constipation that could be recognised on nuclear transit study. One hundred and forty children with a constipation related diagnosis were seen in the last 4 years, and were reviewed as a retrospective audit. Twenty-six children who were felt likely to have a congenital cause for their constipation were offered nuclear colon transit study to search for slow transit constipation. One hundred and forty children from the constipation clinic were reviewed. There were 67 females (47.9%) and 73 males (52.1%), a sex ratio near equality. The mean age at presentation was 5.38 years. Forty-one percent were formally discharged, 36% were lost to follow up, and 23% are still being seen. There was a highly significant tendency for these children to have delayed passage of meconium, as compared normal newborns (P << 0.001). Twenty-six children were considered for possible transit study, and 14 were performed. Four of these were normal, seven showed hold up in the recto-sigmoid, and three showed more proximal slow transit. Two of these probably have non ISTC diagnoses. Social class seems similar to the general population on the criterion employed. Delayed passage of meconium in this group was significantly more frequent than in the general population, but only one of the group seems likely to have truly idiopathic slow transit constipation, and he did not have delayed passage of meconium. There is no evidence for an effect of social class in this population. Idiopathic slow transit constipation itself is rare.
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/14767050600736713
Abstract: Persistent pulmonary hypertension of the newborn (PPHN) remains an important cause of mortality and morbidity in the term neonate. Preliminary but limited data suggest that there may be a role for sildenafil in the treatment of PPHN. We report the successful treatment of PPHN caused by pulmonary hypoplasia in a patient with spondyloepiphyseal dysplasia congenita.
Publisher: S. Karger AG
Date: 2002
DOI: 10.1159/000065892
Abstract: There are limited data on the volumes used to ventilate infants with respiratory distress syndrome (RDS). There are no data on the volumes to aim for to avoid hypocapnia or unacceptable levels of hypercapnia. In this pilot study we measured minute volumes (MV) in ventilated infants to determine whether MV can predict arterial carbon dioxide (PaCO sub /sub ) within acceptable parameters. Low birth weight infants (n = 14) mechanically ventilated for RDS had lung function recorded (n = 53) as an arterial blood gas was taken. MVs were plotted against PaCO sub /sub giving the regression equation for prediction of PaCO sub /sub (mm Hg) with MV (ml/kg/min): PaCO sub /sub = 58.3 – 0.075 × MV, r = 0.62, r sup /sup = 0.38, p 0.001, residual variance (s sup /sup ) of 52.7 (s = 7.26). 95% CI give a predicted PaCO sub /sub ± 15 mm Hg for a given MV. A MV of 200 ml/kg/min predicts a PaCO sub /sub of 43 mm Hg (95% Cl 29–58). PaCO sub /sub correlates reasonably well with MV. Setting appropriate MVs may allow closer targeting of PaCO sub /sub , and prevent over- or under-ventilation.
Publisher: Informa UK Limited
Date: 2003
Abstract: To evaluate the incidence and outcome of all neonates with demonstrated fetomaternal hemorrhages > or = 20 ml and to assess possible predictors of large fetomaternal hemorrhage and outcome. Retrospective data analysis 1987-2000. Clinical data included antenatal events, method of delivery, condition at birth, hematology results, treatment and outcome. Sixteen infants were identified and treated for fetomaternal hemorrhage. Adverse outcome occurred in five infants (31%). Outcome was predicted by postnatal presentation and initial hemoglobin. Adverse outcome amongst neonates with large fetomaternal hemorrhage is high. Outcome is better predicted by initial hemoglobin than volume of hemorrhage as per the Kleihauer test.
Publisher: AMPCo
Date: 03-2017
DOI: 10.5694/MJA16.00736
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
DOI: 10.1097/ANC.0000000000000443
Abstract: Family-integrated care (FICare) is an innovative model of care developed at Mount Sinai Hospital, Canada, to better integrate parents into the team caring for their infant in the neonatal intensive care unit (NICU). The effects of FICare on neonatal outcomes and parental anxiety were assessed in an international multicenter randomized trial. As an Australian regional level 3 NICU that was randomized to the intervention group, we aimed to explore parent and staff perceptions of the FICare program in our dual occupancy NICU. This qualitative study took place in a level 3 NICU with 5 parent participants and 8 staff participants, using a post implementation review design. Parents and staff perceptions of FICare were explored through focus group methodology. Thematic content analysis was done on focus group transcripts. Parents and staff perceived the FICare program to have had a positive impact on parental confidence and role attainment and thought that FICare improved parent-to-parent and parent-to-staff communication. Staff reported that nurses working with families in the program performed less hands-on care and spent more time educating and supporting parents. FICare may change current NICU practice through integrating and accepting parents as active members of the infant's care team. In addition, nurse's roles may transition from bedside carer to care coordinator, educating and supporting parents during their journey through the NICU. Further research is needed to assess the long-term impact of FICare on neonates, parents, and staff.
Publisher: Wiley
Date: 29-07-2013
DOI: 10.1111/J.1440-1754.2012.02502.X
Abstract: Urinary ascites in a newborn infant is unusual and most commonly results from bladder perforation following umbilical arterial catheterisation or obstructive uropathy. The following report describes a case of fetal bladder rupture with urinary ascites in a mother ventilated and sedated with narcotics and benzodiazepines for H1N1 influenza. This was associated with a unique biochemical profile of hyponatraemia and elevated serum urea and creatinine characteristic of urinary autodialysis in the neonate.
Publisher: Wiley
Date: 20-07-2005
Publisher: Wiley
Date: 26-03-2008
Publisher: BMJ
Date: 09-08-2013
Abstract: To characterise the actuarial day-by-day survival of premature infants in a geographically defined population. 10 Neonatal Intensive Care Units (NICUs) in New South Wales (NSW) and Australian Capital Territory (ACT), Australia. Retrospective analysis of prospectively collected data as part of NICUs' data collection in NSW and ACT. Premature infants born at 22(+0) to 31(+6) weeks' gestation between January 1997 and December 2006 and admitted to one of the 10 NICUs in NSW and ACT. Actuarial day-by-day survival to discharge from NICU. Survival to discharge after initiation of neonatal intensive care ranges from 30.0% at 23 weeks' gestation to 98.8% at 31 weeks. Actuarial day-by-day survival increased across all gestations. This improvement was most notable among the babies who were born <26 weeks gestation. Preterm infants who survive the first few postnatal days have considerable chances of long-term survival. It is important to revise the information stored regarding chances of survival so it covers chances at regular intervals, especially after the first few days of life.
Publisher: Wiley
Date: 18-12-2018
DOI: 10.1111/AJO.12931
Abstract: The number of vaginal breech and twin deliveries may be insufficient for adequate training. To determine whether advanced trainees and new Fellows in obstetrics are gaining adequate experience and confidence in vaginal breech and twin deliveries. An online survey was emailed to registered Royal Australia and New Zealand College of Obstetrics and Gynaecology (RANZCOG) advanced trainees and new Fellows (Years 1-5). This survey asked about their experience, confidence and whether they intend to perform vaginal breech and twin deliveries as specialists. The survey was sent to 703 advanced trainees (162) and Fellows (541) and answered by 217 (31.7%). Experience and confidence in vaginal breech and twin deliveries increased with the number of procedures performed (P < 0.001) in both groups and were significantly higher among Fellows. Despite the level of experience, 100% of respondents felt confident in managing vaginal twin deliveries with or without supervision, whereas 14.9% of respondents did not feel confident in managing vaginal breech deliveries. Intention to offer these procedures in their practice depended on confidence levels, and there was a significant difference between twins and breech. Overall, 87.3% of respondents intended to offer vaginal twin deliveries in their practice, while only 32.7% intended to offer vaginal breech deliveries. Confidence in complex vaginal deliveries increases with increasing number of procedures performed and a significant proportion of trainees and Fellows consider they do not have sufficient experience. The association between confidence and intention to offer these procedures is stronger in twins than in breech deliveries.
Publisher: Springer Science and Business Media LLC
Date: 09-2004
Publisher: Elsevier BV
Date: 08-2020
Publisher: BMJ
Date: 30-10-2014
DOI: 10.1136/ARCHDISCHILD-2013-305677
Abstract: To study the neurodevelopmental outcomes of multiple (twins, triplets, quads) compared with singleton extremely preterm infants <29 weeks gestation. Population-based retrospective cohort study. A network of 10 neonatal intensive care units in a geographically defined area of New South Wales and the Australian Capital territory. 1473 infants 2 SDs below the mean), moderate cerebral palsy (unable to walk without aids), sensorineural or conductive deafness (requiring lification) or bilateral blindness (visual acuity <6/60 in the better eye). Of the 1081 singletons and 392 multiples followed-up, singletons demonstrated higher rates of systemic infections, steroid treatment for chronic lung disease and birth weight <10th percentile. Moderate-severe functional disability did not differ significantly between singletons and multiples (15.8% vs 17.6%, OR 1.14 95% CI 0.84 to 1.54 p=0.464). Further subgroup analysis of twins, higher-order gestations, 1st-born multiples, 2nd or higher-born multiples, same and unlike gender multiples, did not demonstrate statistically higher rates of functional disability compared with singletons. Premature infants from multiple gestation pregnancies appear to have comparable neurodevelopmental outcomes to singletons.
Publisher: Springer Science and Business Media LLC
Date: 09-2004
Publisher: Elsevier BV
Date: 10-2015
Publisher: SAGE Publications
Date: 20-06-2018
Abstract: In 2012, a tertiary neonatal intensive care unit (NICU) transitioned from an open plan (OP) to a dual occupancy (DO) NICU. The DO design aimed to provide a developmental appropriate, family-centered environment for neonates and their families. During planning, staff questioned the impact DO would have on staff workflow and activity. To explore the impact of changing from an OP to a DO NICU, a prospective longitudinal study was undertaken from 2011 to 2014, using observational, time and motion, and surveys methods. Main outcome measures included distance walked by staff, minutes of staff activity, and staff perceptions of the DO design. Results highlighted no significant difference in the distances clinical nurses walked nor time spent providing direct clinical care, whereas technical support staff walked further than other staff in both designs. Staff perceived the DO design created a developmentally appropriate, family-centered environment that facilitated communication and collaboration between staff and families. Staff described the main challenges of the DO design such as effective staff communication, gaining educational opportunities, and the isolation of staff and families compared to the OP design. Our study provides new evidence that DO provides an improved developmentally environment and has similar positive benefits to single-family room for neonates and families. Such design may reduce the larger floor plan’s impact on staff walking distance and work practices. Challenges of staff transition can be minimized by planning and leadership throughout the development and move to a new design.
Publisher: Wiley
Date: 17-02-2021
Publisher: Wiley
Date: 29-01-2023
DOI: 10.1111/JPC.16352
Abstract: This study aims to characterise current pain management practices in extremely preterm infants (gestational age less than or equal to 28 weeks) admitted to neonatal intensive care unit (NICU). Retrospective audit pertaining to patient characteristics, as well as minor painful procedures (MPP), pain mitigation and pain scoring in 25 extremely preterm infants admitted to a tertiary NICU in 2016 over the first 14 days of NICU admission. Opportunities to bundle MPP were identified according to pre‐specified criteria. Bayley Scales of Infant Development, Third Edition (BSID‐III) cognitive, language and motor composite scores were available from the neurodevelopmental follow‐up clinic at 12‐ and 24‐months of corrected age. Linear mixed methods regression was used to examine for correlation between increased exposure to MPP and BSID‐III scores at follow‐up. Extremely preterm infants underwent an average of 11.24 ± 4.12 MPP per day for the first 14 days of NICU admission. Opportunities to bundle MPP were missed 75.98% (408/537) of the time most of these were invasive blood collections. A total of 12.2% (481/3933) of MPP occurred within 4 h of pharmacological or non‐pharmacological pain mitigation. BSID‐III motor composite score was associated with an 11.75 (95% confidence interval 1.99, 21.27) decrease in patients experiencing more than or equal to the third quartile of MPP in the 14 days post‐NICU admission ( P = 0.0329, n = 42). Association was not found for BSID‐III cognitive and language composite scores. There is readily scope for quality improvement initiatives to reduce harm in extremely preterm infants admitted to NICU.
Publisher: Elsevier BV
Date: 04-2018
Publisher: SAGE Publications
Date: 2007
DOI: 10.2350/06-03-0066.1
Abstract: Placental mesenchymal dysplasia is an uncommon disorder in which the placenta is enlarged with abnormal, large, and often cystic villi with dilated and/or thick-walled vessels. These placental changes can mimic a partial hydatidiform mole but in contrast to a partial mole can coexist with a fully viable fetus. Fetal anatomical and vascular anomalies frequently coexist with placental mesenchymal dysplasia. In this case, placental mesenchymal dysplasia was associated with preterm labor at 33 weeks' gestation, fetal compromise, and a large abdominal mass with a large hepatic cyst that was de-roofed at exploratory laparotomy. The neonate remained critically ill with hypoxic ischaemic encephalopathy and coagulopathy and died despite intensive care. Biopsy and autopsy findings showed a large cystic mesenchymal hamartoma affecting the left lobe of the liver. This appears to be the 3rd histologically confirmed association of placental mesenchymal dysplasia with mesenchymal hamartoma of the liver in the English language literature.
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Zsuzsoka Kecskes.